|
HC LARYNGOSCOPY FLEX FIBEROPTIC
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
900501260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$106.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$328.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$256.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$252.70
|
| Rate for Payer: Blue Shield of California EPN |
$201.10
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$345.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$282.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$256.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$256.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$360.16
|
| Rate for Payer: Heritage Provider Network Senior |
$360.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$256.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$253.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$295.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$344.02
|
| Rate for Payer: Multiplan Commercial |
$399.00
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$319.20
|
| Rate for Payer: TriValley Medical Group Senior |
$319.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Vantage Medical Group Senior |
$256.73
|
|
|
HC LARYNGOSCOPY FLEX FIBEROPTIC
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
900501260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.29 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Adventist Health Commercial |
$106.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$342.61
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$360.16
|
| Rate for Payer: Heritage Provider Network Senior |
$360.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$399.00
|
|
|
HC LARYNGOSCOPY FLEX FIBEROPTIC
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
900501260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.29 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Adventist Health Commercial |
$106.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$342.61
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$360.16
|
| Rate for Payer: Heritage Provider Network Senior |
$360.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$399.00
|
|
|
HC LARYNGOSCOPY FLEX FIBEROPTIC
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
900501260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$106.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$328.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$256.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$324.52
|
| Rate for Payer: Blue Shield of California EPN |
$259.62
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$345.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$282.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$256.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$256.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.31
|
| Rate for Payer: Heritage Provider Network Senior |
$329.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$256.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$253.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$295.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$344.02
|
| Rate for Payer: Multiplan Commercial |
$399.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$282.40
|
| Rate for Payer: TriValley Medical Group Senior |
$282.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$266.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$266.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Vantage Medical Group Senior |
$256.73
|
|
|
HC LARYNGOSCOPY INDIRECT
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
900501120
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.14 |
| Max. Negotiated Rate |
$373.50 |
| Rate for Payer: Adventist Health Commercial |
$99.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$320.71
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$337.15
|
| Rate for Payer: Heritage Provider Network Senior |
$337.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.50
|
| Rate for Payer: Multiplan Commercial |
$373.50
|
|
|
HC LARYNGOSCOPY INDIRECT
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
900501120
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.14 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$99.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$307.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$256.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$236.55
|
| Rate for Payer: Blue Shield of California EPN |
$188.24
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$323.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$282.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$256.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$256.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$337.15
|
| Rate for Payer: Heritage Provider Network Senior |
$337.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$256.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$237.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$295.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$344.02
|
| Rate for Payer: Multiplan Commercial |
$373.50
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$298.80
|
| Rate for Payer: TriValley Medical Group Senior |
$298.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Vantage Medical Group Senior |
$256.73
|
|
|
HC LARYNGOSCOPY W/RMVL F.B.
|
Facility
|
IP
|
$2,408.00
|
|
|
Service Code
|
CPT 31577
|
| Hospital Charge Code |
900501549
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$435.85 |
| Max. Negotiated Rate |
$1,806.00 |
| Rate for Payer: Adventist Health Commercial |
$481.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,550.75
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,630.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,630.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$435.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.00
|
| Rate for Payer: Multiplan Commercial |
$1,806.00
|
|
|
HC LARYNGOSCOPY W/RMVL F.B.
|
Facility
|
OP
|
$2,408.00
|
|
|
Service Code
|
CPT 31577
|
| Hospital Charge Code |
900501549
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$435.85 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$481.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,488.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$754.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$553.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$503.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,143.80
|
| Rate for Payer: Blue Shield of California EPN |
$910.22
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,565.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$754.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$553.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$503.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$503.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,630.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,630.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$503.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,148.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$435.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$578.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$674.07
|
| Rate for Payer: Multiplan Commercial |
$1,806.00
|
| Rate for Payer: Multiplan WC |
$786.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,444.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,444.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$754.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$553.34
|
| Rate for Payer: Vantage Medical Group Senior |
$503.04
|
|
|
HC LARYNGOSCOPY W/TUMOR EXC W/SCO
|
Facility
|
IP
|
$8,842.00
|
|
|
Service Code
|
CPT 31541
|
| Hospital Charge Code |
900501640
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,600.40 |
| Max. Negotiated Rate |
$6,631.50 |
| Rate for Payer: Adventist Health Commercial |
$1,768.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,694.25
|
| Rate for Payer: Cash Price |
$3,978.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,986.03
|
| Rate for Payer: Heritage Provider Network Senior |
$5,986.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,600.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,210.50
|
| Rate for Payer: Multiplan Commercial |
$6,631.50
|
|
|
HC LARYNGOSCOPY W/TUMOR EXC W/SCO
|
Facility
|
OP
|
$8,842.00
|
|
|
Service Code
|
CPT 31541
|
| Hospital Charge Code |
900501640
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,600.40 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,768.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,464.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,199.95
|
| Rate for Payer: Blue Shield of California EPN |
$3,342.28
|
| Rate for Payer: Cash Price |
$3,978.90
|
| Rate for Payer: Cash Price |
$3,978.90
|
| Rate for Payer: Cash Price |
$3,978.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,747.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,795.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,986.03
|
| Rate for Payer: Heritage Provider Network Senior |
$5,986.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,217.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,600.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,514.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,210.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan Commercial |
$6,631.50
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,305.20
|
| Rate for Payer: TriValley Medical Group Senior |
$5,305.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
HC LASER TREATMENT
|
Facility
|
IP
|
$11,081.00
|
|
|
Service Code
|
CPT 31641
|
| Hospital Charge Code |
900803400
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2,005.66 |
| Max. Negotiated Rate |
$8,310.75 |
| Rate for Payer: Adventist Health Commercial |
$2,216.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,136.16
|
| Rate for Payer: Cash Price |
$4,986.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,501.84
|
| Rate for Payer: Heritage Provider Network Senior |
$7,501.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,005.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,770.25
|
| Rate for Payer: Multiplan Commercial |
$8,310.75
|
|
|
HC LASER TREATMENT
|
Facility
|
OP
|
$11,081.00
|
|
|
Service Code
|
CPT 31641
|
| Hospital Charge Code |
900803400
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,216.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,848.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$4,986.45
|
| Rate for Payer: Cash Price |
$4,986.45
|
| Rate for Payer: Cash Price |
$4,986.45
|
| Rate for Payer: Cash Price |
$4,986.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,202.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,795.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,859.14
|
| Rate for Payer: Heritage Provider Network Senior |
$6,859.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,285.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,005.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,514.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,770.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan Commercial |
$8,310.75
|
| 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 |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
HC LASIX RENOGRAM
|
Facility
|
IP
|
$2,949.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
909301423
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$533.77 |
| Max. Negotiated Rate |
$2,211.75 |
| Rate for Payer: Adventist Health Commercial |
$589.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,899.16
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,996.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,996.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$533.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$737.25
|
| Rate for Payer: Multiplan Commercial |
$2,211.75
|
|
|
HC LASIX RENOGRAM
|
Facility
|
OP
|
$2,949.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
909301423
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$533.77 |
| Max. Negotiated Rate |
$2,211.75 |
| Rate for Payer: Adventist Health Commercial |
$589.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,822.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,475.09
|
| Rate for Payer: Blue Shield of California Commercial |
$938.16
|
| Rate for Payer: Blue Shield of California EPN |
$754.44
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,916.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,916.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$698.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,825.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,825.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,406.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$533.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$803.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$737.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$2,211.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$768.18
|
| Rate for Payer: TriValley Medical Group Senior |
$698.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,474.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,474.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC LATE CLOSURE SURGICAL WOUND
|
Facility
|
IP
|
$6,402.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
900501537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,158.76 |
| Max. Negotiated Rate |
$4,801.50 |
| Rate for Payer: Adventist Health Commercial |
$1,280.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,122.89
|
| Rate for Payer: Cash Price |
$2,880.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,334.15
|
| Rate for Payer: Heritage Provider Network Senior |
$4,334.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,158.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,600.50
|
| Rate for Payer: Multiplan Commercial |
$4,801.50
|
|
|
HC LATE CLOSURE SURGICAL WOUND
|
Facility
|
OP
|
$6,402.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
900501537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,158.76 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,280.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,956.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,557.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,040.95
|
| Rate for Payer: Blue Shield of California EPN |
$2,419.96
|
| Rate for Payer: Cash Price |
$2,880.90
|
| Rate for Payer: Cash Price |
$2,880.90
|
| Rate for Payer: Cash Price |
$2,880.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,161.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,013.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,557.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,557.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,334.15
|
| Rate for Payer: Heritage Provider Network Senior |
$4,334.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,557.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,053.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,158.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,241.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,600.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,107.48
|
| Rate for Payer: Multiplan Commercial |
$4,801.50
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,841.20
|
| Rate for Payer: TriValley Medical Group Senior |
$3,841.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,836.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,013.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,557.82
|
|
|
HC LAY CLOS OF WND 12.6-20.0 CM
|
Facility
|
OP
|
$1,409.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$255.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$281.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$870.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$669.27
|
| Rate for Payer: Blue Shield of California EPN |
$532.60
|
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$915.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$953.89
|
| Rate for Payer: Heritage Provider Network Senior |
$953.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$672.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,056.75
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$845.40
|
| Rate for Payer: TriValley Medical Group Senior |
$845.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC LAY CLOS OF WND 12.6-20.0 CM
|
Facility
|
IP
|
$1,409.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$255.03 |
| Max. Negotiated Rate |
$1,056.75 |
| Rate for Payer: Adventist Health Commercial |
$281.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$907.40
|
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$953.89
|
| Rate for Payer: Heritage Provider Network Senior |
$953.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.25
|
| Rate for Payer: Multiplan Commercial |
$1,056.75
|
|
|
HC LAY CLOS OF WND 20.1-30.0 CM
|
Facility
|
IP
|
$1,666.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
900501244
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.55 |
| Max. Negotiated Rate |
$1,249.50 |
| Rate for Payer: Adventist Health Commercial |
$333.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,072.90
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,127.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$301.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.50
|
| Rate for Payer: Multiplan Commercial |
$1,249.50
|
|
|
HC LAY CLOS OF WND 20.1-30.0 CM
|
Facility
|
OP
|
$1,666.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
900501244
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.55 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Multiplan Commercial |
$1,249.50
|
| Rate for Payer: Adventist Health Commercial |
$333.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,029.59
|
| 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 |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$791.35
|
| Rate for Payer: Blue Shield of California EPN |
$629.75
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,082.90
|
| 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 |
$1,127.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,127.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$794.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$301.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$999.60
|
| Rate for Payer: TriValley Medical Group Senior |
$999.60
|
| 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 LAY CLOS OF WND 2.6-7.5CM
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
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 |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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: Cash Price |
$376.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$543.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$565.97
|
| Rate for Payer: Heritage Provider Network Senior |
$565.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$398.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$627.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| 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 |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC LAY CLOS OF WND 2.6-7.5CM
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
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 LAY CLOS OF WND 7.6-12.5 CM
|
Facility
|
IP
|
$1,083.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
900501031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.02 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Adventist Health Commercial |
$216.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$697.45
|
| Rate for Payer: Cash Price |
$487.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$733.19
|
| Rate for Payer: Heritage Provider Network Senior |
$733.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.75
|
| Rate for Payer: Multiplan Commercial |
$812.25
|
|
|
HC LAY CLOS OF WND 7.6-12.5 CM
|
Facility
|
OP
|
$1,083.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
900501031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$216.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$669.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$514.42
|
| Rate for Payer: Blue Shield of California EPN |
$409.37
|
| Rate for Payer: Cash Price |
$487.35
|
| Rate for Payer: Cash Price |
$487.35
|
| Rate for Payer: Cash Price |
$487.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$703.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$733.19
|
| Rate for Payer: Heritage Provider Network Senior |
$733.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$516.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$812.25
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$649.80
|
| Rate for Payer: TriValley Medical Group Senior |
$649.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC LAY CLOS OF WND GT 30.0 CM
|
Facility
|
IP
|
$1,924.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
900501643
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$348.24 |
| Max. Negotiated Rate |
$1,443.00 |
| Rate for Payer: Adventist Health Commercial |
$384.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,239.06
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,302.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,302.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$481.00
|
| Rate for Payer: Multiplan Commercial |
$1,443.00
|
|
