|
HC PARAFFIN BATH PT
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97018
|
| Hospital Charge Code |
905103109
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC PARAFFIN BATH PT COMM MCARE
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97018
|
| Hospital Charge Code |
900419066
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC PARAFFIN BATH PT COMM MCARE
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97018
|
| Hospital Charge Code |
900419066
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Senior |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC PARANASAL SINUS LTD
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
909001142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.62 |
| Max. Negotiated Rate |
$433.50 |
| Rate for Payer: Adventist Health Commercial |
$115.60
|
| Rate for Payer: Cash Price |
$317.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$391.31
|
| Rate for Payer: Heritage Provider Network Senior |
$391.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.50
|
| Rate for Payer: Multiplan Commercial |
$433.50
|
|
|
HC PARANASAL SINUS LTD
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
909001142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$433.50 |
| Rate for Payer: Adventist Health Commercial |
$115.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$308.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$397.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.65
|
| Rate for Payer: Blue Shield of California Commercial |
$131.04
|
| Rate for Payer: Blue Shield of California EPN |
$105.38
|
| Rate for Payer: Cash Price |
$317.90
|
| Rate for Payer: Cash Price |
$317.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$375.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.78
|
| Rate for Payer: Heritage Provider Network Senior |
$357.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$275.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$433.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC PARASITE SCREEN
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 87272
|
| Hospital Charge Code |
900911729
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.65 |
| Max. Negotiated Rate |
$234.75 |
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Cash Price |
$172.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.90
|
| Rate for Payer: Heritage Provider Network Senior |
$211.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.25
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
|
|
HC PARASITE SCREEN
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 87272
|
| Hospital Charge Code |
900911729
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$234.75 |
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$167.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$215.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.05
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$172.15
|
| Rate for Payer: Cash Price |
$172.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$203.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.75
|
| Rate for Payer: Heritage Provider Network Senior |
$193.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$149.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC PARATHYROID WITH PLANAR
|
Facility
|
IP
|
$1,303.00
|
|
|
Service Code
|
CPT 78072
|
| Hospital Charge Code |
900078072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$235.84 |
| Max. Negotiated Rate |
$977.25 |
| Rate for Payer: Adventist Health Commercial |
$260.60
|
| Rate for Payer: Cash Price |
$716.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$882.13
|
| Rate for Payer: Heritage Provider Network Senior |
$882.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.75
|
| Rate for Payer: Multiplan Commercial |
$977.25
|
|
|
HC PARATHYROID WITH PLANAR
|
Facility
|
OP
|
$1,303.00
|
|
|
Service Code
|
CPT 78072
|
| Hospital Charge Code |
900078072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$235.84 |
| Max. Negotiated Rate |
$1,025.89 |
| Rate for Payer: Adventist Health Commercial |
$260.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$696.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$895.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Blue Shield of California Commercial |
$794.83
|
| Rate for Payer: Blue Shield of California EPN |
$635.86
|
| Rate for Payer: Cash Price |
$716.65
|
| Rate for Payer: Cash Price |
$716.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$846.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Senior |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$846.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$683.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$806.56
|
| Rate for Payer: Heritage Provider Network Senior |
$806.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$591.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$621.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$786.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$861.75
|
| Rate for Payer: Multiplan Commercial |
$977.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$752.32
|
| Rate for Payer: TriValley Medical Group Senior |
$683.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$651.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$651.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC PARAVALVULAR LEAK TRICUSPID
|
Facility
|
IP
|
$21,755.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820329
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,937.66 |
| Max. Negotiated Rate |
$16,316.25 |
| Rate for Payer: Adventist Health Commercial |
$4,351.00
|
| Rate for Payer: Cash Price |
$11,965.25
|
| Rate for Payer: Cash Price |
$11,965.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,937.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,438.75
|
| Rate for Payer: Multiplan Commercial |
$16,316.25
|
|
|
HC PARAVALVULAR LEAK TRICUSPID
|
Facility
|
OP
|
$21,755.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820329
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$16,316.25 |
| Rate for Payer: Adventist Health Commercial |
$4,351.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,628.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,945.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| 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 |
$11,965.25
|
| Rate for Payer: Cash Price |
$11,965.25
|
| Rate for Payer: Cash Price |
$11,965.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,140.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,466.34
|
| Rate for Payer: Heritage Provider Network Senior |
$244.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$377.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,937.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,438.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$16,316.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$218.68
|
| Rate for Payer: TriValley Medical Group Senior |
$198.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC PARTIAL AMPUTATION OF TOE
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$923.10 |
| Max. Negotiated Rate |
$3,825.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,452.70
|
| Rate for Payer: Heritage Provider Network Senior |
$3,452.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.00
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
|
|
HC PARTIAL AMPUTATION OF TOE
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,503.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,315.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Senior |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,122.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,452.70
|
| Rate for Payer: Heritage Provider Network Senior |
$3,452.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,432.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,740.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,194.48
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,834.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,688.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC PARTIAL RMVL DIST PHALANX FNGR
|
Facility
|
OP
|
$3,990.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
900501314
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,741.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,593.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Senior |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,033.48
|
| 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) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,903.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,338.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,562.18
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,435.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,321.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC PARTIAL RMVL DIST PHALANX FNGR
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
900501314
|
|
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: Cash Price |
$2,194.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
|
|
HC PARTIAL RMVL OF EYE FLUID
|
Facility
|
IP
|
$7,526.00
|
|
|
Service Code
|
CPT 67005
|
| Hospital Charge Code |
900501540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,362.21 |
| Max. Negotiated Rate |
$5,644.50 |
| Rate for Payer: Adventist Health Commercial |
$1,505.20
|
| Rate for Payer: Cash Price |
$4,139.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,095.10
|
| Rate for Payer: Heritage Provider Network Senior |
$5,095.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,362.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.50
|
| Rate for Payer: Multiplan Commercial |
$5,644.50
|
|
|
HC PARTIAL RMVL OF EYE FLUID
|
Facility
|
OP
|
$7,526.00
|
|
|
Service Code
|
CPT 67005
|
| Hospital Charge Code |
900501540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,111.00 |
| Rate for Payer: Adventist Health Commercial |
$1,505.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,170.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Cash Price |
$4,139.30
|
| Rate for Payer: Cash Price |
$4,139.30
|
| Rate for Payer: Cash Price |
$4,139.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,891.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Senior |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,891.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,897.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,095.10
|
| Rate for Payer: Heritage Provider Network Senior |
$5,095.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,589.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,362.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,332.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,651.35
|
| Rate for Payer: Multiplan Commercial |
$5,644.50
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,707.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,491.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC PASSY MUIR VALVE FOR VENTS
|
Facility
|
IP
|
$288.00
|
|
| Hospital Charge Code |
900800705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.98
|
| Rate for Payer: Heritage Provider Network Senior |
$194.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
|
|
HC PASSY MUIR VALVE FOR VENTS
|
Facility
|
OP
|
$288.00
|
|
| Hospital Charge Code |
900800705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$153.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.00
|
| Rate for Payer: Blue Shield of California Commercial |
$175.68
|
| Rate for Payer: Blue Shield of California EPN |
$140.54
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Dignity Health Senior |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.27
|
| Rate for Payer: Heritage Provider Network Senior |
$178.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$137.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$144.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$144.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
|
HC PASSY MUIR VALVE SPEAKING
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
900800700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$153.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.00
|
| Rate for Payer: Blue Shield of California Commercial |
$175.68
|
| Rate for Payer: Blue Shield of California EPN |
$140.54
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Dignity Health Senior |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.27
|
| Rate for Payer: Heritage Provider Network Senior |
$178.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$137.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$144.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$144.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
|
HC PASSY MUIR VALVE SPEAKING
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
900800700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.98
|
| Rate for Payer: Heritage Provider Network Senior |
$194.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
|
|
HC PCI BYPASS GRAFT
|
Facility
|
IP
|
$14,879.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
906820243
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,693.10 |
| Max. Negotiated Rate |
$11,159.25 |
| Rate for Payer: Adventist Health Commercial |
$2,975.80
|
| Rate for Payer: Cash Price |
$8,183.45
|
| Rate for Payer: Cash Price |
$8,183.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,693.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,719.75
|
| Rate for Payer: Multiplan Commercial |
$11,159.25
|
|
|
HC PCI BYPASS GRAFT
|
Facility
|
OP
|
$14,879.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
906820243
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$2,975.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,221.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| 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 |
$8,183.45
|
| Rate for Payer: Cash Price |
$8,183.45
|
| Rate for Payer: Cash Price |
$8,183.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,210.10
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$781.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,693.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,719.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$11,159.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$14,409.33
|
| 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 |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PCI BYPASS GRAFT
|
Facility
|
IP
|
$12,647.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
906811440
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,289.11 |
| Max. Negotiated Rate |
$9,485.25 |
| Rate for Payer: Adventist Health Commercial |
$2,529.40
|
| Rate for Payer: Cash Price |
$6,955.85
|
| Rate for Payer: Cash Price |
$6,955.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,289.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,161.75
|
| Rate for Payer: Multiplan Commercial |
$9,485.25
|
|
|
HC PCI BYPASS GRAFT
|
Facility
|
OP
|
$12,647.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
906811440
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$2,529.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,688.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| 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 |
$6,955.85
|
| Rate for Payer: Cash Price |
$6,955.85
|
| Rate for Payer: Cash Price |
$6,955.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,828.49
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$781.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,289.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,161.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$9,485.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$14,409.33
|
| 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 |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
