|
HC I & D OF SCROTUM
|
Facility
|
IP
|
$5,887.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,065.55 |
| Max. Negotiated Rate |
$4,415.25 |
| Rate for Payer: Adventist Health Commercial |
$1,177.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,791.23
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,985.50
|
| Rate for Payer: Heritage Provider Network Senior |
$3,985.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,065.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,471.75
|
| Rate for Payer: Multiplan Commercial |
$4,415.25
|
|
|
HC I & D OF SCROTUM
|
Facility
|
OP
|
$5,887.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,065.55 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,177.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,638.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,796.32
|
| Rate for Payer: Blue Shield of California EPN |
$2,225.29
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,826.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,688.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,985.50
|
| Rate for Payer: Heritage Provider Network Senior |
$3,985.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,808.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,065.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,091.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,471.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$4,415.25
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,532.20
|
| Rate for Payer: TriValley Medical Group Senior |
$3,532.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.84 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$532.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$408.98
|
| Rate for Payer: Blue Shield of California EPN |
$325.46
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$559.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$391.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$582.90
|
| Rate for Payer: Heritage Provider Network Senior |
$582.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$410.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$645.75
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$516.60
|
| Rate for Payer: TriValley Medical Group Senior |
$516.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.84 |
| Max. Negotiated Rate |
$645.75 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$554.48
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$582.90
|
| Rate for Payer: Heritage Provider Network Senior |
$582.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.25
|
| Rate for Payer: Multiplan Commercial |
$645.75
|
|
|
HC I.D. PENTAGASTRIN CONCENTRATIO
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
909301533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.89
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.90
|
| Rate for Payer: Heritage Provider Network Senior |
$102.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
|
|
HC I.D. PENTAGASTRIN CONCENTRATIO
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
909301533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$93.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.03
|
| Rate for Payer: Blue Shield of California Commercial |
$92.72
|
| Rate for Payer: Blue Shield of California EPN |
$74.18
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$98.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.09
|
| Rate for Payer: Heritage Provider Network Senior |
$94.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$72.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$60.80
|
| Rate for Payer: TriValley Medical Group Senior |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$76.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$76.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC I&D PERIANAL ABSCESS SUPERFICIAL
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
900501156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.36 |
| Max. Negotiated Rate |
$1,091.25 |
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$937.02
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$985.03
|
| Rate for Payer: Heritage Provider Network Senior |
$985.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$263.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.75
|
| Rate for Payer: Multiplan Commercial |
$1,091.25
|
|
|
HC I&D PERIANAL ABSCESS SUPERFICIAL
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
900501156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.36 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$899.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$691.12
|
| Rate for Payer: Blue Shield of California EPN |
$549.99
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$945.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,196.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$985.03
|
| Rate for Payer: Heritage Provider Network Senior |
$985.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$694.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$263.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,375.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$1,091.25
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$873.00
|
| Rate for Payer: TriValley Medical Group Senior |
$873.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
HC I&D PERITONSILAR ABSCESS
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
900501151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$528.08
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
|
|
HC I&D PERITONSILAR ABSCESS
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
900501151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$389.50
|
| Rate for Payer: Blue Shield of California EPN |
$309.96
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$533.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$391.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$492.00
|
| Rate for Payer: TriValley Medical Group Senior |
$492.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC I & D PILONIDAL CYST COMPLICAT
|
Facility
|
OP
|
$3,218.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
900501530
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$582.46 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$643.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,988.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,528.55
|
| Rate for Payer: Blue Shield of California EPN |
$1,216.40
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,091.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,178.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2,178.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,534.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$582.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$2,413.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,930.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,930.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC I & D PILONIDAL CYST COMPLICAT
|
Facility
|
IP
|
$3,218.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
900501530
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$582.46 |
| Max. Negotiated Rate |
$2,413.50 |
| Rate for Payer: Adventist Health Commercial |
$643.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,072.39
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,178.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2,178.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$582.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.50
|
| Rate for Payer: Multiplan Commercial |
$2,413.50
|
|
|
HC I & D PILONIDAL CYST SIMPLE
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
900501002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$528.08
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
|
|
HC I & D PILONIDAL CYST SIMPLE
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
900501002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$389.50
|
| Rate for Payer: Blue Shield of California EPN |
$309.96
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$533.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$391.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$492.00
|
| Rate for Payer: TriValley Medical Group Senior |
$492.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC IDR CORDIS VISTA BRITE TIPN
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
CPT 0220T
|
| Hospital Charge Code |
909010220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,267.00 |
| Max. Negotiated Rate |
$31,374.11 |
| Rate for Payer: Adventist Health Commercial |
$1,400.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,326.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,512.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,150.00
|
| Rate for Payer: Cash Price |
$3,150.00
|
| Rate for Payer: Cash Price |
$3,150.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,550.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,163.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,512.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,200.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16,512.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,333.00
|
| Rate for Payer: Heritage Provider Network Senior |
$20,310.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31,374.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,267.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,989.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,127.00
|
| Rate for Payer: Multiplan Commercial |
$5,250.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$18,163.96
|
| Rate for Payer: TriValley Medical Group Senior |
$18,163.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Vantage Medical Group Senior |
$16,512.69
|
|
|
HC IDR CORDIS VISTA BRITE TIPN
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
CPT 0220T
|
| Hospital Charge Code |
909010220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,267.00 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Adventist Health Commercial |
$1,400.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,508.00
|
| Rate for Payer: Cash Price |
$3,150.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,739.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,739.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,267.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,750.00
|
| Rate for Payer: Multiplan Commercial |
$5,250.00
|
|
|
HC I&D RECTAL ABSCESS
|
Facility
|
OP
|
$5,622.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
900501335
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,017.58 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,124.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,474.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,670.45
|
| Rate for Payer: Blue Shield of California EPN |
$2,125.12
|
| Rate for Payer: Cash Price |
$2,529.90
|
| Rate for Payer: Cash Price |
$2,529.90
|
| Rate for Payer: Cash Price |
$2,529.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,654.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,539.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,806.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,806.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,681.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,017.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,769.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,405.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$4,216.50
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,373.20
|
| Rate for Payer: TriValley Medical Group Senior |
$3,373.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
HC I&D RECTAL ABSCESS
|
Facility
|
IP
|
$5,622.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
900501335
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,017.58 |
| Max. Negotiated Rate |
$4,216.50 |
| Rate for Payer: Adventist Health Commercial |
$1,124.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,620.57
|
| Rate for Payer: Cash Price |
$2,529.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,806.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,806.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,017.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,405.50
|
| Rate for Payer: Multiplan Commercial |
$4,216.50
|
|
|
HC I & D THYROGLOSSAL DUCT CYST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
CPT 60000
|
| Hospital Charge Code |
900501674
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$409.06 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$452.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,396.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,073.50
|
| Rate for Payer: Blue Shield of California EPN |
$854.28
|
| Rate for Payer: Cash Price |
$1,017.00
|
| Rate for Payer: Cash Price |
$1,017.00
|
| Rate for Payer: Cash Price |
$1,017.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,469.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,469.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,995.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,530.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,530.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,078.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$409.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,294.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$1,695.00
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,356.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,356.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC I & D THYROGLOSSAL DUCT CYST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
CPT 60000
|
| Hospital Charge Code |
900501674
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$409.06 |
| Max. Negotiated Rate |
$1,695.00 |
| Rate for Payer: Adventist Health Commercial |
$452.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,455.44
|
| Rate for Payer: Cash Price |
$1,017.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,530.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,530.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$409.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.00
|
| Rate for Payer: Multiplan Commercial |
$1,695.00
|
|
|
HC I & D VAGINAL HEMATOMA
|
Facility
|
IP
|
$2,885.00
|
|
|
Service Code
|
CPT 57022
|
| Hospital Charge Code |
902400747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$522.18 |
| Max. Negotiated Rate |
$2,163.75 |
| Rate for Payer: Adventist Health Commercial |
$577.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,857.94
|
| Rate for Payer: Cash Price |
$1,298.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,953.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$522.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.25
|
| Rate for Payer: Multiplan Commercial |
$2,163.75
|
|
|
HC I & D VAGINAL HEMATOMA
|
Facility
|
OP
|
$2,885.00
|
|
|
Service Code
|
CPT 57022
|
| Hospital Charge Code |
902400747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$522.18 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$577.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,782.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,370.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,090.53
|
| Rate for Payer: Cash Price |
$1,298.25
|
| Rate for Payer: Cash Price |
$1,298.25
|
| Rate for Payer: Cash Price |
$1,298.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,875.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,735.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,953.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,376.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$522.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,296.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,006.17
|
| Rate for Payer: Multiplan Commercial |
$2,163.75
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,731.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,731.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
HC IHC EACH ADDL SINGLE MULTI PER SPEC MEDI
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
903800243
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$119.46 |
| Max. Negotiated Rate |
$709.47 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$407.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$709.47
|
| Rate for Payer: Blue Shield of California Commercial |
$433.73
|
| Rate for Payer: Blue Shield of California EPN |
$348.79
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$429.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$461.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.54
|
| Rate for Payer: Heritage Provider Network Senior |
$408.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$314.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$530.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.77
|
| Rate for Payer: Multiplan Commercial |
$495.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$461.02
|
| Rate for Payer: TriValley Medical Group Senior |
$461.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
HC IHC EACH ADDL SINGLE MULTI PER SPEC MEDI
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
903800243
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$119.46 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.04
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$446.82
|
| Rate for Payer: Heritage Provider Network Senior |
$446.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.00
|
| Rate for Payer: Multiplan Commercial |
$495.00
|
|
|
HC IHC FIRST SINGLE MULTI PER SPEC MEDI
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
903800242
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$96.65 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$106.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$343.90
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$361.52
|
| Rate for Payer: Heritage Provider Network Senior |
$361.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.50
|
| Rate for Payer: Multiplan Commercial |
$400.50
|
|
