|
HC SURGPREP FC/HD/HND/FT/G EACH ADDL 100 SQ CM
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
900101498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.19 |
| Max. Negotiated Rate |
$821.25 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$705.18
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$741.32
|
| Rate for Payer: Heritage Provider Network Senior |
$741.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$198.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.75
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
|
|
HC SURGPREP FC/HD/HND/FT/G EACH ADDL 100 SQ CM
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
900101498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$676.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$821.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$667.95
|
| Rate for Payer: Blue Shield of California EPN |
$534.36
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$711.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$930.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$677.80
|
| Rate for Payer: Heritage Provider Network Senior |
$677.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$522.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$198.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$547.50
|
| Rate for Payer: TriValley Medical Group Senior |
$547.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$547.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC SURGPREP TRUNK/ARM/LEG 1ST 100 SQ CM
|
Facility
|
IP
|
$4,407.00
|
|
|
Service Code
|
CPT 15002
|
| Hospital Charge Code |
900101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$797.67 |
| Max. Negotiated Rate |
$3,305.25 |
| Rate for Payer: Adventist Health Commercial |
$881.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,838.11
|
| Rate for Payer: Cash Price |
$1,983.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,983.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,983.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$797.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.75
|
| Rate for Payer: Multiplan Commercial |
$3,305.25
|
|
|
HC SURGPREP TRUNK/ARM/LEG 1ST 100 SQ CM
|
Facility
|
OP
|
$4,407.00
|
|
|
Service Code
|
CPT 15002
|
| Hospital Charge Code |
900101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$797.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$881.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,723.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,688.27
|
| Rate for Payer: Blue Shield of California EPN |
$2,150.62
|
| Rate for Payer: Cash Price |
$1,983.15
|
| Rate for Payer: Cash Price |
$1,983.15
|
| Rate for Payer: Cash Price |
$1,983.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,864.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$950.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,727.93
|
| Rate for Payer: Heritage Provider Network Senior |
$2,727.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,102.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$797.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$3,305.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,045.63
|
| Rate for Payer: TriValley Medical Group Senior |
$1,045.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,203.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,203.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC SURGPREP TRUNK/ARM/LEG EACH ADDL 100 SQ CM
|
Facility
|
IP
|
$3,578.00
|
|
|
Service Code
|
CPT 15003
|
| Hospital Charge Code |
900101496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$647.62 |
| Max. Negotiated Rate |
$2,683.50 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,304.23
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,422.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,422.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$647.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.50
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
|
|
HC SURGPREP TRUNK/ARM/LEG EACH ADDL 100 SQ CM
|
Facility
|
OP
|
$3,578.00
|
|
|
Service Code
|
CPT 15003
|
| Hospital Charge Code |
900101496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$647.62 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,211.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,967.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,683.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,182.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,746.06
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,325.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,041.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,041.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,214.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2,214.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,706.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$647.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,504.60
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,789.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,789.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,789.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,789.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,041.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,041.30
|
|
|
HC SUSCEPTIBILITY PANEL YEAST
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900914672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.26
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.76
|
| Rate for Payer: Heritage Provider Network Senior |
$71.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
|
|
HC SUSCEPTIBILITY PANEL YEAST
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900914672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$82.08 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.08
|
| Rate for Payer: Blue Shield of California Commercial |
$69.58
|
| Rate for Payer: Blue Shield of California Commercial |
$69.58
|
| Rate for Payer: Blue Shield of California EPN |
$55.81
|
| Rate for Payer: Blue Shield of California EPN |
$55.81
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.04
|
| Rate for Payer: Heritage Provider Network Senior |
$65.61
|
| Rate for Payer: Heritage Provider Network Senior |
$47.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$50.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.65
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$9.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC SUTR RMVL UNDER ANES SAME PHYS
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
907201032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$134.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$415.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$571.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$504.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$319.20
|
| Rate for Payer: Blue Shield of California EPN |
$254.02
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$436.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$571.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$571.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$571.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$454.94
|
| Rate for Payer: Heritage Provider Network Senior |
$454.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$320.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$470.40
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$403.20
|
| Rate for Payer: TriValley Medical Group Senior |
$403.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$571.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$571.20
|
| Rate for Payer: Vantage Medical Group Senior |
$571.20
|
|
|
HC SUTR RMVL UNDER ANES SAME PHYS
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
907201032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.63 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$134.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$432.77
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$454.94
|
| Rate for Payer: Heritage Provider Network Senior |
$454.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
|
|
HC SUTR/STPL RMVL NOT REQUIRING ANES
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
907205853
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$167.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$516.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$710.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$459.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$397.10
|
| Rate for Payer: Blue Shield of California EPN |
$316.01
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$543.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$710.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$710.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$710.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$565.97
|
| Rate for Payer: Heritage Provider Network Senior |
$565.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$398.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$585.20
|
| Rate for Payer: Multiplan Commercial |
$627.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$501.60
|
| Rate for Payer: TriValley Medical Group Senior |
$501.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$710.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$710.60
|
| Rate for Payer: Vantage Medical Group Senior |
$710.60
|
|
|
HC SUTR/STPL RMVL NOT REQUIRING ANES
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
907205853
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.32 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Adventist Health Commercial |
$167.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$538.38
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$565.97
|
| Rate for Payer: Heritage Provider Network Senior |
$565.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.00
|
| Rate for Payer: Multiplan Commercial |
$627.00
|
|
|
HC SUTURE EYELID, FULL THICKNESS
|
Facility
|
OP
|
$4,880.00
|
|
|
Service Code
|
CPT 67935
|
| Hospital Charge Code |
900501309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$883.28 |
| Max. Negotiated Rate |
$5,158.00 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,015.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,318.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,844.64
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,172.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,172.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,057.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,327.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$883.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,928.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,928.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC SUTURE EYELID, FULL THICKNESS
|
Facility
|
IP
|
$4,880.00
|
|
|
Service Code
|
CPT 67935
|
| Hospital Charge Code |
900501309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$883.28 |
| Max. Negotiated Rate |
$3,660.00 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,142.72
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$883.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
|
|
HC SUTURE EYELID,PARTIAL THICKNES
|
Facility
|
OP
|
$4,880.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
900501413
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$883.28 |
| Max. Negotiated Rate |
$4,723.01 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,015.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,318.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,844.64
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,172.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,172.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,057.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,327.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$883.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,928.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,928.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC SUTURE EYELID,PARTIAL THICKNES
|
Facility
|
IP
|
$4,880.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
900501413
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$883.28 |
| Max. Negotiated Rate |
$3,660.00 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,142.72
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$883.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
|
|
HC SUTURE HAND/FOOT 1 DIGIT NERVE
|
Facility
|
IP
|
$9,136.00
|
|
|
Service Code
|
CPT 64831
|
| Hospital Charge Code |
900501398
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,653.62 |
| Max. Negotiated Rate |
$6,852.00 |
| Rate for Payer: Adventist Health Commercial |
$1,827.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,883.58
|
| Rate for Payer: Cash Price |
$4,111.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,185.07
|
| Rate for Payer: Heritage Provider Network Senior |
$6,185.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,653.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,284.00
|
| Rate for Payer: Multiplan Commercial |
$6,852.00
|
|
|
HC SUTURE HAND/FOOT 1 DIGIT NERVE
|
Facility
|
OP
|
$9,136.00
|
|
|
Service Code
|
CPT 64831
|
| Hospital Charge Code |
900501398
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,653.62 |
| Max. Negotiated Rate |
$6,852.00 |
| Rate for Payer: Adventist Health Commercial |
$1,827.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,646.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,339.60
|
| Rate for Payer: Blue Shield of California EPN |
$3,453.41
|
| Rate for Payer: Cash Price |
$4,111.20
|
| Rate for Payer: Cash Price |
$4,111.20
|
| Rate for Payer: Cash Price |
$4,111.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,938.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,938.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,511.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,185.07
|
| Rate for Payer: Heritage Provider Network Senior |
$6,185.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,357.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,653.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,888.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$6,852.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,481.60
|
| Rate for Payer: TriValley Medical Group Senior |
$5,481.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC SUTURE HAND/FOOT NERVE EA ADDL
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
CPT 64832
|
| Hospital Charge Code |
900501552
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,497.78 |
| Max. Negotiated Rate |
$6,206.25 |
| Rate for Payer: Adventist Health Commercial |
$1,655.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,329.10
|
| Rate for Payer: Cash Price |
$3,723.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,602.18
|
| Rate for Payer: Heritage Provider Network Senior |
$5,602.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,497.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,068.75
|
| Rate for Payer: Multiplan Commercial |
$6,206.25
|
|
|
HC SUTURE HAND/FOOT NERVE EA ADDL
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
CPT 64832
|
| Hospital Charge Code |
900501552
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,497.78 |
| Max. Negotiated Rate |
$7,033.75 |
| Rate for Payer: Adventist Health Commercial |
$1,655.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,113.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,033.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,551.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,206.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,930.62
|
| Rate for Payer: Blue Shield of California EPN |
$3,127.95
|
| Rate for Payer: Cash Price |
$3,723.75
|
| Rate for Payer: Cash Price |
$3,723.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,378.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,033.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,033.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,033.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,378.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,602.18
|
| Rate for Payer: Heritage Provider Network Senior |
$5,602.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,947.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,497.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,068.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,792.50
|
| Rate for Payer: Multiplan Commercial |
$6,206.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,965.00
|
| Rate for Payer: TriValley Medical Group Senior |
$4,965.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,033.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,033.75
|
| Rate for Payer: Vantage Medical Group Senior |
$7,033.75
|
|
|
HC SWALLOW CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8996
|
| Hospital Charge Code |
900018418
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC SWALLOW CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8996
|
| Hospital Charge Code |
900018118
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SWALLOW CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8996
|
| Hospital Charge Code |
900018118
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC SWALLOW CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8996
|
| Hospital Charge Code |
900018218
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC SWALLOW CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8996
|
| Hospital Charge Code |
900018218
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
