|
HC INCISION/DRAIN FOREARM/WRIST
|
Facility
|
IP
|
$5,215.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
900501423
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$943.91 |
| Max. Negotiated Rate |
$3,911.25 |
| Rate for Payer: Adventist Health Commercial |
$1,043.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,358.46
|
| Rate for Payer: Cash Price |
$2,346.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,530.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,530.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$943.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,303.75
|
| Rate for Payer: Multiplan Commercial |
$3,911.25
|
|
|
HC INCISION/DRAIN PERIRECTAL ABSC
|
Facility
|
OP
|
$4,080.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
900501237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$738.48 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$816.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,521.44
|
| 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 |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,938.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,542.24
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,652.00
|
| 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 |
$2,762.16
|
| Rate for Payer: Heritage Provider Network Senior |
$2,762.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,946.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$738.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,769.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$3,060.00
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,448.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,448.00
|
| 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 INCISION/DRAIN PERIRECTAL ABSC
|
Facility
|
IP
|
$4,080.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
900501237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$738.48 |
| Max. Negotiated Rate |
$3,060.00 |
| Rate for Payer: Adventist Health Commercial |
$816.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,627.52
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,762.16
|
| Rate for Payer: Heritage Provider Network Senior |
$2,762.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$738.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Multiplan Commercial |
$3,060.00
|
|
|
HC INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$906.27 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,001.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,094.33
|
| 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 |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,378.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,892.65
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,254.55
|
| 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 |
$3,389.74
|
| Rate for Payer: Heritage Provider Network Senior |
$3,389.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,388.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$906.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,296.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,251.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,006.17
|
| Rate for Payer: Multiplan Commercial |
$3,755.25
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,004.20
|
| Rate for Payer: TriValley Medical Group Senior |
$3,004.20
|
| 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 INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$906.27 |
| Max. Negotiated Rate |
$3,755.25 |
| Rate for Payer: Adventist Health Commercial |
$1,001.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,224.51
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,389.74
|
| Rate for Payer: Heritage Provider Network Senior |
$3,389.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$906.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,251.75
|
| Rate for Payer: Multiplan Commercial |
$3,755.25
|
|
|
HC INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$906.27 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,001.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,094.33
|
| 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 |
$6,245.00
|
| 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 |
$2,253.15
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,254.55
|
| 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 |
$3,099.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4,595.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,098.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$906.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,296.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,251.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,006.17
|
| Rate for Payer: Multiplan Commercial |
$3,755.25
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,109.55
|
| Rate for Payer: TriValley Medical Group Senior |
$4,109.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| 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 INCISION/DRAIN THIGH/KNEE LESI
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
909000271
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$906.27 |
| Max. Negotiated Rate |
$3,755.25 |
| Rate for Payer: Adventist Health Commercial |
$1,001.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,224.51
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,389.74
|
| Rate for Payer: Heritage Provider Network Senior |
$3,389.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$906.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,251.75
|
| Rate for Payer: Multiplan Commercial |
$3,755.25
|
|
|
HC INCISION/DRAIN,UPPER ARM/ELBOW
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
CPT 23930
|
| Hospital Charge Code |
900501316
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$906.27 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,001.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,094.33
|
| 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 |
$2,378.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,892.65
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,254.55
|
| 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 |
$3,389.74
|
| Rate for Payer: Heritage Provider Network Senior |
$3,389.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,388.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$906.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,296.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,251.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,006.17
|
| Rate for Payer: Multiplan Commercial |
$3,755.25
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,004.20
|
| Rate for Payer: TriValley Medical Group Senior |
$3,004.20
|
| 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 INCISION/DRAIN,UPPER ARM/ELBOW
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
CPT 23930
|
| Hospital Charge Code |
900501316
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$906.27 |
| Max. Negotiated Rate |
$3,755.25 |
| Rate for Payer: Adventist Health Commercial |
$1,001.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,224.51
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,389.74
|
| Rate for Payer: Heritage Provider Network Senior |
$3,389.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$906.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,251.75
|
| Rate for Payer: Multiplan Commercial |
$3,755.25
|
|
|
HC INCISION FINGER TENDON EACH
|
Facility
|
OP
|
$3,990.00
|
|
|
Service Code
|
CPT 26455
|
| Hospital Charge Code |
900501536
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,465.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,895.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,508.22
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,593.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,068.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,903.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,394.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,394.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC INCISION FINGER TENDON EACH
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
CPT 26455
|
| Hospital Charge Code |
900501536
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,569.56
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
|
|
HC INCISION LINGUAL FRENUM
|
Facility
|
IP
|
$3,673.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
900501558
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$664.81 |
| Max. Negotiated Rate |
$2,754.75 |
| Rate for Payer: Adventist Health Commercial |
$734.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,365.41
|
| Rate for Payer: Cash Price |
$1,652.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,486.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2,486.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$918.25
|
| Rate for Payer: Multiplan Commercial |
$2,754.75
|
|
|
HC INCISION LINGUAL FRENUM
|
Facility
|
OP
|
$3,673.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
900501558
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$664.81 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$734.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,269.91
|
| 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 |
$1,744.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,388.39
|
| Rate for Payer: Cash Price |
$1,652.85
|
| Rate for Payer: Cash Price |
$1,652.85
|
| Rate for Payer: Cash Price |
$1,652.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,387.45
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,995.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,486.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2,486.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,752.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,294.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$918.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$2,754.75
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,203.80
|
| Rate for Payer: TriValley Medical Group Senior |
$2,203.80
|
| 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 INCISION OF EYE
|
Facility
|
IP
|
$6,458.00
|
|
|
Service Code
|
CPT 66172
|
| Hospital Charge Code |
900501631
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,168.90 |
| Max. Negotiated Rate |
$4,843.50 |
| Rate for Payer: Adventist Health Commercial |
$1,291.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,158.95
|
| Rate for Payer: Cash Price |
$2,906.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,372.07
|
| Rate for Payer: Heritage Provider Network Senior |
$4,372.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,168.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.50
|
| Rate for Payer: Multiplan Commercial |
$4,843.50
|
|
|
HC INCISION OF EYE
|
Facility
|
OP
|
$6,458.00
|
|
|
Service Code
|
CPT 66172
|
| Hospital Charge Code |
900501631
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,168.90 |
| Max. Negotiated Rate |
$8,435.00 |
| Rate for Payer: Adventist Health Commercial |
$1,291.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,991.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,067.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,441.12
|
| Rate for Payer: Cash Price |
$2,906.10
|
| Rate for Payer: Cash Price |
$2,906.10
|
| Rate for Payer: Cash Price |
$2,906.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,197.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,197.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,968.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,372.07
|
| Rate for Payer: Heritage Provider Network Senior |
$4,372.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,080.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,168.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,413.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$4,843.50
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,874.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,874.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC INCISION OF LABIAL FRENUM
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
900501559
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$556.50 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$477.85
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
|
|
HC INCISION OF LABIAL FRENUM
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
900501559
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$458.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$352.45
|
| Rate for Payer: Blue Shield of California EPN |
$280.48
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$482.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$693.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$353.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$797.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$445.20
|
| Rate for Payer: TriValley Medical Group Senior |
$445.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
IP
|
$1,201.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.38 |
| Max. Negotiated Rate |
$900.75 |
| Rate for Payer: Adventist Health Commercial |
$240.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$773.44
|
| Rate for Payer: Cash Price |
$540.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$813.08
|
| Rate for Payer: Heritage Provider Network Senior |
$813.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.25
|
| Rate for Payer: Multiplan Commercial |
$900.75
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
IP
|
$1,201.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$217.38 |
| Max. Negotiated Rate |
$900.75 |
| Rate for Payer: Adventist Health Commercial |
$240.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$773.44
|
| Rate for Payer: Cash Price |
$540.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$813.08
|
| Rate for Payer: Heritage Provider Network Senior |
$813.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.25
|
| Rate for Payer: Multiplan Commercial |
$900.75
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$1,201.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$240.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$742.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$570.48
|
| Rate for Payer: Blue Shield of California EPN |
$453.98
|
| Rate for Payer: Cash Price |
$540.45
|
| Rate for Payer: Cash Price |
$540.45
|
| Rate for Payer: Cash Price |
$540.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$780.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$321.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$813.08
|
| Rate for Payer: Heritage Provider Network Senior |
$813.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$572.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$900.75
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$720.60
|
| Rate for Payer: TriValley Medical Group Senior |
$720.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC INCISION THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$1,201.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
900501157
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$217.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$240.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$742.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$732.61
|
| Rate for Payer: Blue Shield of California EPN |
$586.09
|
| Rate for Payer: Cash Price |
$540.45
|
| Rate for Payer: Cash Price |
$540.45
|
| Rate for Payer: Cash Price |
$540.45
|
| Rate for Payer: Cash Price |
$540.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$780.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$321.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$743.42
|
| Rate for Payer: Heritage Provider Network Senior |
$743.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$572.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$900.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$353.49
|
| Rate for Payer: TriValley Medical Group Senior |
$321.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC INC & REM F/B SUBQ TIS COMPL
|
Facility
|
OP
|
$4,402.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
900501004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$796.76 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$880.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,720.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,090.95
|
| Rate for Payer: Blue Shield of California EPN |
$1,663.96
|
| Rate for Payer: Cash Price |
$1,980.90
|
| Rate for Payer: Cash Price |
$1,980.90
|
| Rate for Payer: Cash Price |
$1,980.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,861.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,980.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,980.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,099.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$796.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,100.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$3,301.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,641.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,641.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC INC & REM F/B SUBQ TIS COMPL
|
Facility
|
IP
|
$4,402.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
900501004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$796.76 |
| Max. Negotiated Rate |
$3,301.50 |
| Rate for Payer: Adventist Health Commercial |
$880.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,834.89
|
| Rate for Payer: Cash Price |
$1,980.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,980.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,980.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$796.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,100.50
|
| Rate for Payer: Multiplan Commercial |
$3,301.50
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
|
OP
|
$1,201.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$240.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$742.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$570.48
|
| Rate for Payer: Blue Shield of California EPN |
$453.98
|
| Rate for Payer: Cash Price |
$540.45
|
| Rate for Payer: Cash Price |
$540.45
|
| Rate for Payer: Cash Price |
$540.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$780.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$813.08
|
| Rate for Payer: Heritage Provider Network Senior |
$813.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$572.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$900.75
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$720.60
|
| Rate for Payer: TriValley Medical Group Senior |
$720.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
|
IP
|
$1,201.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.38 |
| Max. Negotiated Rate |
$900.75 |
| Rate for Payer: Adventist Health Commercial |
$240.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$773.44
|
| Rate for Payer: Cash Price |
$540.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$813.08
|
| Rate for Payer: Heritage Provider Network Senior |
$813.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.25
|
| Rate for Payer: Multiplan Commercial |
$900.75
|
|
