|
HC SURGICAL PROCEDURE
|
Facility
|
IP
|
$13,155.00
|
|
| Hospital Charge Code |
900501689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,381.06 |
| Max. Negotiated Rate |
$9,866.25 |
| Rate for Payer: Adventist Health Commercial |
$2,631.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,037.48
|
| Rate for Payer: Cash Price |
$5,919.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,905.94
|
| Rate for Payer: Heritage Provider Network Senior |
$8,905.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,381.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,288.75
|
| Rate for Payer: Multiplan Commercial |
$9,866.25
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.59 |
| Max. Negotiated Rate |
$1,309.63 |
| Rate for Payer: Adventist Health Commercial |
$261.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$899.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.83
|
| Rate for Payer: Blue Shield of California Commercial |
$83.23
|
| Rate for Payer: Blue Shield of California EPN |
$47.33
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$850.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: Dignity Health Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$689.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$810.27
|
| Rate for Payer: Heritage Provider Network Senior |
$810.27
|
| Rate for Payer: Humana Medicare |
$689.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,309.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$868.49
|
| Rate for Payer: Multiplan Commercial |
$981.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$689.28
|
| Rate for Payer: TriValley Medical Group Senior |
$689.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$680.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$680.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
OP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
906601168
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$22.59 |
| Max. Negotiated Rate |
$1,309.63 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,130.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Blue Shield of California Commercial |
$83.23
|
| Rate for Payer: Blue Shield of California EPN |
$47.33
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,069.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: Dignity Health Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,069.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$689.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,018.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,018.87
|
| Rate for Payer: Humana Medicare |
$689.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,309.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$868.49
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$689.28
|
| Rate for Payer: TriValley Medical Group Senior |
$689.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$680.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$680.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$236.93 |
| Max. Negotiated Rate |
$981.75 |
| Rate for Payer: Adventist Health Commercial |
$261.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$899.28
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$886.19
|
| Rate for Payer: Heritage Provider Network Senior |
$886.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.25
|
| Rate for Payer: Multiplan Commercial |
$981.75
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
IP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
906601168
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$297.93 |
| Max. Negotiated Rate |
$1,234.50 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,130.80
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,114.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,114.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.50
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
|
|
HC SURGPREP FC/HD/HND/FT/G 1ST 100 SQ CM
|
Facility
|
IP
|
$3,332.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
900101497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$603.09 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Adventist Health Commercial |
$666.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,289.08
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,255.76
|
| Rate for Payer: Heritage Provider Network Senior |
$2,255.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.00
|
| Rate for Payer: Multiplan Commercial |
$2,499.00
|
|
|
HC SURGPREP FC/HD/HND/FT/G 1ST 100 SQ CM
|
Facility
|
OP
|
$3,332.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
900101497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.45 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$666.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,289.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,069.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,955.88
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,165.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: Dignity Health Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,062.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2,062.51
|
| Rate for Payer: Humana Medicare |
$784.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$101.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,490.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.73
|
| Rate for Payer: Multiplan Commercial |
$2,499.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.18
|
| Rate for Payer: TriValley Medical Group Senior |
$863.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC SURGPREP FC/HD/HND/FT/G EACH ADDL 100 SQ CM
|
Facility
|
IP
|
$1,822.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
900101498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.78 |
| Max. Negotiated Rate |
$1,366.50 |
| Rate for Payer: Adventist Health Commercial |
$364.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,251.71
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,233.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,233.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.50
|
| Rate for Payer: Multiplan Commercial |
$1,366.50
|
|
|
HC SURGPREP FC/HD/HND/FT/G EACH ADDL 100 SQ CM
|
Facility
|
OP
|
$1,822.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
900101498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.23 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$364.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,251.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,548.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,002.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,366.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,131.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,069.51
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,184.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,548.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,548.70
|
| Rate for Payer: Dignity Health Senior |
$1,548.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,127.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$156.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$878.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.50
|
| Rate for Payer: Multiplan Commercial |
$1,366.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$911.00
|
| Rate for Payer: TriValley Medical Group Senior |
$911.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,548.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,548.70
|
|
|
HC SURGPREP TRUNK/ARM/LEG 1ST 100 SQ CM
|
Facility
|
OP
|
$3,332.00
|
|
|
Service Code
|
CPT 15002
|
| Hospital Charge Code |
900101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$666.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,289.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,069.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,955.88
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,165.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,062.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2,062.51
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,329.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: Multiplan Commercial |
$2,499.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,506.34
|
| Rate for Payer: TriValley Medical Group Senior |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC SURGPREP TRUNK/ARM/LEG 1ST 100 SQ CM
|
Facility
|
IP
|
$3,332.00
|
|
|
Service Code
|
CPT 15002
|
| Hospital Charge Code |
900101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$603.09 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Adventist Health Commercial |
$666.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,289.08
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,255.76
|
| Rate for Payer: Heritage Provider Network Senior |
$2,255.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.00
|
| Rate for Payer: Multiplan Commercial |
$2,499.00
|
|
|
HC SURGPREP TRUNK/ARM/LEG EACH ADDL 100 SQ CM
|
Facility
|
OP
|
$3,332.00
|
|
|
Service Code
|
CPT 15003
|
| Hospital Charge Code |
900101496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.51 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$666.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,289.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,832.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,832.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,499.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,069.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,955.88
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,165.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,832.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,832.20
|
| Rate for Payer: Dignity Health Senior |
$2,832.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,062.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2,062.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$93.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,606.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.00
|
| Rate for Payer: Multiplan Commercial |
$2,499.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,666.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,666.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,832.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,832.20
|
|
|
HC SURGPREP TRUNK/ARM/LEG EACH ADDL 100 SQ CM
|
Facility
|
IP
|
$3,332.00
|
|
|
Service Code
|
CPT 15003
|
| Hospital Charge Code |
900101496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$603.09 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Adventist Health Commercial |
$666.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,289.08
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,255.76
|
| Rate for Payer: Heritage Provider Network Senior |
$2,255.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.00
|
| Rate for Payer: Multiplan Commercial |
$2,499.00
|
|
|
HC SUSCEPTIBILITY PANEL YEAST
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900914672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$81.75 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.88
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.79
|
| Rate for Payer: Heritage Provider Network Senior |
$73.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.25
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
|
|
HC SUSCEPTIBILITY PANEL YEAST
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900914672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$72.35 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.35
|
| Rate for Payer: Blue Shield of California Commercial |
$67.53
|
| Rate for Payer: Blue Shield of California EPN |
$52.79
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Senior |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.28
|
| Rate for Payer: Heritage Provider Network Senior |
$48.28
|
| Rate for Payer: Humana Medicare |
$8.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.90
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.65
|
| Rate for Payer: TriValley Medical Group Senior |
$8.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC SUTURE EYELID, FULL THICKNESS
|
Facility
|
OP
|
$4,818.00
|
|
|
Service Code
|
CPT 67935
|
| Hospital Charge Code |
900501309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$872.06 |
| Max. Negotiated Rate |
$4,547.00 |
| Rate for Payer: Adventist Health Commercial |
$963.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,309.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,168.10
|
| Rate for Payer: Cash Price |
$2,168.10
|
| Rate for Payer: Cash Price |
$2,168.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,131.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: Dignity Health Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,131.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,261.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3,261.79
|
| Rate for Payer: Humana Medicare |
$2,919.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,322.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$872.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,445.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,678.78
|
| Rate for Payer: Multiplan Commercial |
$3,613.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,749.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,609.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC SUTURE EYELID, FULL THICKNESS
|
Facility
|
IP
|
$4,818.00
|
|
|
Service Code
|
CPT 67935
|
| Hospital Charge Code |
900501309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$872.06 |
| Max. Negotiated Rate |
$3,613.50 |
| Rate for Payer: Adventist Health Commercial |
$963.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,309.97
|
| Rate for Payer: Cash Price |
$2,168.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,261.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3,261.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$872.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.50
|
| Rate for Payer: Multiplan Commercial |
$3,613.50
|
|
|
HC SUTURE EYELID,PARTIAL THICKNES
|
Facility
|
OP
|
$4,818.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
900501413
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$872.06 |
| Max. Negotiated Rate |
$4,379.50 |
| Rate for Payer: Adventist Health Commercial |
$963.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,309.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,168.10
|
| Rate for Payer: Cash Price |
$2,168.10
|
| Rate for Payer: Cash Price |
$2,168.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,131.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: Dignity Health Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,131.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,261.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3,261.79
|
| Rate for Payer: Humana Medicare |
$2,919.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,322.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$872.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,445.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,678.78
|
| Rate for Payer: Multiplan Commercial |
$3,613.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,749.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,609.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC SUTURE EYELID,PARTIAL THICKNES
|
Facility
|
IP
|
$4,818.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
900501413
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$872.06 |
| Max. Negotiated Rate |
$3,613.50 |
| Rate for Payer: Adventist Health Commercial |
$963.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,309.97
|
| Rate for Payer: Cash Price |
$2,168.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,261.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3,261.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$872.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.50
|
| Rate for Payer: Multiplan Commercial |
$3,613.50
|
|
|
HC SUTURE HAND/FOOT 1 DIGIT NERVE
|
Facility
|
IP
|
$8,362.00
|
|
|
Service Code
|
CPT 64831
|
| Hospital Charge Code |
900501398
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,513.52 |
| Max. Negotiated Rate |
$6,271.50 |
| Rate for Payer: Adventist Health Commercial |
$1,672.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,744.69
|
| Rate for Payer: Cash Price |
$3,762.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,661.07
|
| Rate for Payer: Heritage Provider Network Senior |
$5,661.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,513.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,090.50
|
| Rate for Payer: Multiplan Commercial |
$6,271.50
|
|
|
HC SUTURE HAND/FOOT 1 DIGIT NERVE
|
Facility
|
OP
|
$8,362.00
|
|
|
Service Code
|
CPT 64831
|
| Hospital Charge Code |
900501398
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$6,271.50 |
| Rate for Payer: Adventist Health Commercial |
$1,672.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,744.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$3,762.90
|
| Rate for Payer: Cash Price |
$3,762.90
|
| Rate for Payer: Cash Price |
$3,762.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,435.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: Dignity Health Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,435.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,412.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,661.07
|
| Rate for Payer: Heritage Provider Network Senior |
$5,661.07
|
| Rate for Payer: Humana Medicare |
$2,412.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,030.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,513.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,090.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,039.60
|
| Rate for Payer: Multiplan Commercial |
$6,271.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,036.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,793.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC SUTURE HAND/FOOT NERVE EA ADDL
|
Facility
|
OP
|
$7,575.00
|
|
|
Service Code
|
CPT 64832
|
| Hospital Charge Code |
900501552
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$6,438.75 |
| Rate for Payer: Adventist Health Commercial |
$1,515.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,204.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,438.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,166.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,681.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$3,408.75
|
| Rate for Payer: Cash Price |
$3,408.75
|
| Rate for Payer: Cash Price |
$3,408.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,923.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,438.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,438.75
|
| Rate for Payer: Dignity Health Senior |
$6,438.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,923.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,128.28
|
| Rate for Payer: Heritage Provider Network Senior |
$5,128.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,651.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,371.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,893.75
|
| Rate for Payer: Multiplan Commercial |
$5,681.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,750.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,530.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,438.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6,438.75
|
|
|
HC SUTURE HAND/FOOT NERVE EA ADDL
|
Facility
|
IP
|
$7,575.00
|
|
|
Service Code
|
CPT 64832
|
| Hospital Charge Code |
900501552
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,371.08 |
| Max. Negotiated Rate |
$5,681.25 |
| Rate for Payer: Adventist Health Commercial |
$1,515.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,204.02
|
| Rate for Payer: Cash Price |
$3,408.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,128.28
|
| Rate for Payer: Heritage Provider Network Senior |
$5,128.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,371.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,893.75
|
| Rate for Payer: Multiplan Commercial |
$5,681.25
|
|
|
HC SWALLOWING STUDY W VIDEO
|
Facility
|
IP
|
$1,207.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
909001803
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.47 |
| Max. Negotiated Rate |
$905.25 |
| Rate for Payer: Adventist Health Commercial |
$241.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$829.21
|
| Rate for Payer: Cash Price |
$543.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.14
|
| Rate for Payer: Heritage Provider Network Senior |
$817.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.75
|
| Rate for Payer: Multiplan Commercial |
$905.25
|
|
|
HC SWALLOWING STUDY W VIDEO
|
Facility
|
OP
|
$1,207.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
909001803
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$905.25 |
| Rate for Payer: Adventist Health Commercial |
$241.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$145.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$829.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$312.75
|
| Rate for Payer: Blue Shield of California Commercial |
$266.69
|
| Rate for Payer: Blue Shield of California EPN |
$151.66
|
| Rate for Payer: Cash Price |
$543.15
|
| Rate for Payer: Cash Price |
$543.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$784.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$747.13
|
| Rate for Payer: Heritage Provider Network Senior |
$747.13
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$905.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
