|
HC MARSUPIALIZATION OF BARTHOLINS GLAND CYST
|
Facility
|
IP
|
$6,301.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
900556440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,140.48 |
| Max. Negotiated Rate |
$4,725.75 |
| Rate for Payer: Adventist Health Commercial |
$1,260.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,328.79
|
| Rate for Payer: Cash Price |
$2,835.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,265.78
|
| Rate for Payer: Heritage Provider Network Senior |
$4,265.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,140.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,575.25
|
| Rate for Payer: Multiplan Commercial |
$4,725.75
|
|
|
HC MASSAGE 15 MIN MCAL
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
901300056
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.25
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$163.83
|
| Rate for Payer: Heritage Provider Network Senior |
$163.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
|
|
HC MASSAGE 15 MIN MCAL
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900400048
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.25
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$163.83
|
| Rate for Payer: Heritage Provider Network Senior |
$163.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
|
|
HC MASSAGE 15 MIN MCAL
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900400048
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$157.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.70
|
| Rate for Payer: Dignity Health Senior |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.80
|
| Rate for Payer: Heritage Provider Network Senior |
$149.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$116.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC MASSAGE 15 MIN MCAL
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
901300056
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$157.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.70
|
| Rate for Payer: Dignity Health Senior |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.80
|
| Rate for Payer: Heritage Provider Network Senior |
$149.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$116.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC MASSAGE 15 MIN OT
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
905104145
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.30
|
| Rate for Payer: Dignity Health Senior |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.30
|
| Rate for Payer: Vantage Medical Group Senior |
$83.30
|
|
|
HC MASSAGE 15 MIN OT
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
905104145
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.33
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC MASSAGE 15 MIN PT
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
905103145
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.33
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC MASSAGE 15 MIN PT
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
905103145
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.30
|
| Rate for Payer: Dignity Health Senior |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.30
|
| Rate for Payer: Vantage Medical Group Senior |
$83.30
|
|
|
HC MASSAGE 15 MIN PT COMM MCARE
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900417124
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$157.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.70
|
| Rate for Payer: Dignity Health Senior |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.80
|
| Rate for Payer: Heritage Provider Network Senior |
$149.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$116.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC MASSAGE 15 MIN PT COMM MCARE
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900417124
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.25
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$163.83
|
| Rate for Payer: Heritage Provider Network Senior |
$163.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
|
|
HC MASTOID CHILD
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
909001132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.85 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$280.30
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$276.22
|
| Rate for Payer: Heritage Provider Network Senior |
$276.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
|
|
HC MASTOID CHILD
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
909001132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.53 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$57.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$280.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.88
|
| Rate for Payer: Blue Shield of California Commercial |
$127.22
|
| Rate for Payer: Blue Shield of California EPN |
$72.34
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$265.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$252.55
|
| Rate for Payer: Heritage Provider Network Senior |
$252.55
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| 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 |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC MASTOID COMPLETE
|
Facility
|
IP
|
$607.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
909001131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.87 |
| Max. Negotiated Rate |
$455.25 |
| Rate for Payer: Adventist Health Commercial |
$121.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$417.01
|
| Rate for Payer: Cash Price |
$273.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.94
|
| Rate for Payer: Heritage Provider Network Senior |
$410.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.75
|
| Rate for Payer: Multiplan Commercial |
$455.25
|
|
|
HC MASTOID COMPLETE
|
Facility
|
OP
|
$607.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
909001131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.51 |
| Max. Negotiated Rate |
$455.25 |
| Rate for Payer: Adventist Health Commercial |
$121.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$88.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$417.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.11
|
| Rate for Payer: Blue Shield of California Commercial |
$161.94
|
| Rate for Payer: Blue Shield of California EPN |
$92.09
|
| Rate for Payer: Cash Price |
$273.15
|
| Rate for Payer: Cash Price |
$273.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$394.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.73
|
| Rate for Payer: Heritage Provider Network Senior |
$375.73
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$71.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$455.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| 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 |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
|
OP
|
$4,583.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$829.52 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$916.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,148.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,062.35
|
| Rate for Payer: Cash Price |
$2,062.35
|
| Rate for Payer: Cash Price |
$2,062.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,978.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,102.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,102.69
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,209.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$829.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,145.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$3,437.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,664.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,531.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
|
IP
|
$4,583.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$829.52 |
| Max. Negotiated Rate |
$3,437.25 |
| Rate for Payer: Adventist Health Commercial |
$916.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,148.52
|
| Rate for Payer: Cash Price |
$2,062.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,102.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,102.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$829.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,145.75
|
| Rate for Payer: Multiplan Commercial |
$3,437.25
|
|
|
HC MATRISTEM MICROMATRIX PER 1MG
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT Q4118
|
| Hospital Charge Code |
900101466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.62
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.48
|
| Rate for Payer: Heritage Provider Network Senior |
$9.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.68
|
|
|
HC MATRISTEM MICROMATRIX PER 1MG
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT Q4118
|
| Hospital Charge Code |
900101466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.85
|
| Rate for Payer: Blue Shield of California Commercial |
$8.69
|
| Rate for Payer: Blue Shield of California EPN |
$8.22
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.90
|
| Rate for Payer: Dignity Health Senior |
$11.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.48
|
| Rate for Payer: Heritage Provider Network Senior |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Senior |
$5.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.90
|
| Rate for Payer: Vantage Medical Group Senior |
$11.90
|
|
|
HC MATRIX 3D FIRM/STD 10 COIL
|
Facility
|
IP
|
$2,325.00
|
|
| Hospital Charge Code |
909081831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$465.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,116.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,597.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,069.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,255.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,574.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,574.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,162.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,162.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,162.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.25
|
| Rate for Payer: Multiplan Commercial |
$1,743.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$847.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$776.78
|
|
|
HC MATRIX 3D FIRM/STD 10 COIL
|
Facility
|
OP
|
$2,325.00
|
|
| Hospital Charge Code |
909081831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$465.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,116.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,597.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,976.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,278.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,743.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,443.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,364.78
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,069.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,976.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,976.25
|
| Rate for Payer: Dignity Health Senior |
$1,976.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,488.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,076.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,076.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,162.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,162.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,162.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.25
|
| Rate for Payer: Multiplan Commercial |
$1,743.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$847.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$776.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,976.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,976.25
|
|
|
HC MATRIX 3D STANDARD 3-8 COIL
|
Facility
|
IP
|
$3,985.00
|
|
| Hospital Charge Code |
909081832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$797.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,912.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,737.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,793.25
|
| Rate for Payer: Cash Price |
$1,793.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,833.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,151.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,697.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,697.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,992.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,992.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.25
|
| Rate for Payer: Multiplan Commercial |
$2,988.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,452.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,331.39
|
|
|
HC MATRIX 3D STANDARD 3-8 COIL
|
Facility
|
OP
|
$3,985.00
|
|
| Hospital Charge Code |
909081832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$797.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,912.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,737.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,191.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,988.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,474.68
|
| Rate for Payer: Blue Shield of California EPN |
$2,339.20
|
| Rate for Payer: Cash Price |
$1,793.25
|
| Rate for Payer: Cash Price |
$1,793.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,833.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,387.25
|
| Rate for Payer: Dignity Health Senior |
$3,387.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,550.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,845.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,845.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,992.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,992.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.25
|
| Rate for Payer: Multiplan Commercial |
$2,988.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,452.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,331.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,387.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,387.25
|
|
|
HC MATRIX 3D X-FIRM COIL
|
Facility
|
IP
|
$4,400.00
|
|
| Hospital Charge Code |
909081830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$880.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,112.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,022.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,024.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,376.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,978.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2,978.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,200.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,200.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,100.00
|
| Rate for Payer: Multiplan Commercial |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,604.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,470.04
|
|
|
HC MATRIX 3D X-FIRM COIL
|
Facility
|
OP
|
$4,400.00
|
|
| Hospital Charge Code |
909081830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$880.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,112.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,022.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,420.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,732.40
|
| Rate for Payer: Blue Shield of California EPN |
$2,582.80
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,024.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,740.00
|
| Rate for Payer: Dignity Health Senior |
$3,740.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,816.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,037.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,037.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,200.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,200.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,100.00
|
| Rate for Payer: Multiplan Commercial |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,604.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,470.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,740.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,740.00
|
|
