|
HC MARSUPIALIZATION OF BARTHOLINS GLAND CYST
|
Facility
|
IP
|
$8,333.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
900556440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,508.27 |
| Max. Negotiated Rate |
$6,249.75 |
| Rate for Payer: Adventist Health Commercial |
$1,666.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,366.45
|
| Rate for Payer: Cash Price |
$3,749.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,641.44
|
| Rate for Payer: Heritage Provider Network Senior |
$5,641.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,508.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,083.25
|
| Rate for Payer: Multiplan Commercial |
$6,249.75
|
|
|
HC MARSUPIALIZATION OF BARTHOLINS GLAND CYST
|
Facility
|
OP
|
$8,333.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
900556440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,508.27 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,666.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,149.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,958.18
|
| Rate for Payer: Blue Shield of California EPN |
$3,149.87
|
| Rate for Payer: Cash Price |
$3,749.85
|
| Rate for Payer: Cash Price |
$3,749.85
|
| Rate for Payer: Cash Price |
$3,749.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,416.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,163.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,641.44
|
| Rate for Payer: Heritage Provider Network Senior |
$5,641.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,974.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,508.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,788.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,083.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$6,249.75
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,999.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,999.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC MASSAGE 15 MIN MCAL
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900400048
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$32.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| 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: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| 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 |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC MASSAGE 15 MIN MCAL
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900400048
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.88
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
|
HC MASSAGE 15 MIN MCAL
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
901300056
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.88
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
|
HC MASSAGE 15 MIN MCAL
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
901300056
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Adventist Health Commercial |
$32.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| 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: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| 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 |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC MASSAGE 15 MIN OT
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
905104145
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.88
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
|
HC MASSAGE 15 MIN OT
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
905104145
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$32.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| 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: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| 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 |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC MASSAGE 15 MIN PT
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
905103145
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$32.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| 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: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| 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 |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC MASSAGE 15 MIN PT
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
905103145
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.88
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
|
HC MASSAGE 15 MIN PT COMM MCARE
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900417124
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.88
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
|
HC MASSAGE 15 MIN PT COMM MCARE
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900417124
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$32.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| 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: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| 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 |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC MASTOID CHILD
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
909001132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.17 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: Adventist Health Commercial |
$93.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$299.46
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$314.81
|
| Rate for Payer: Heritage Provider Network Senior |
$314.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.25
|
| Rate for Payer: Multiplan Commercial |
$348.75
|
|
|
HC MASTOID CHILD
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
909001132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: Adventist Health Commercial |
$93.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$287.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.88
|
| Rate for Payer: Blue Shield of California Commercial |
$131.04
|
| Rate for Payer: Blue Shield of California EPN |
$105.38
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cash Price |
$209.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$302.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$287.83
|
| Rate for Payer: Heritage Provider Network Senior |
$287.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$221.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$348.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| 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 |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC MASTOID COMPLETE
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
909001131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$519.00 |
| Rate for Payer: Adventist Health Commercial |
$138.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$427.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.52
|
| Rate for Payer: Blue Shield of California Commercial |
$166.80
|
| Rate for Payer: Blue Shield of California EPN |
$134.13
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$449.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$428.35
|
| Rate for Payer: Heritage Provider Network Senior |
$428.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$330.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$519.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| 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 |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC MASTOID COMPLETE
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
909001131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$519.00 |
| Rate for Payer: Adventist Health Commercial |
$138.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$445.65
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$468.48
|
| Rate for Payer: Heritage Provider Network Senior |
$468.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.00
|
| Rate for Payer: Multiplan Commercial |
$519.00
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$906.27 |
| Max. Negotiated Rate |
$3,755.25 |
| Rate for Payer: Adventist Health Commercial |
$1,001.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,224.51
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,389.74
|
| Rate for Payer: Heritage Provider Network Senior |
$3,389.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$906.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,251.75
|
| Rate for Payer: Multiplan Commercial |
$3,755.25
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$906.27 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,001.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,094.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,378.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,892.65
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Cash Price |
$2,253.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,254.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,389.74
|
| Rate for Payer: Heritage Provider Network Senior |
$3,389.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,388.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$906.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,251.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$3,755.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,004.20
|
| Rate for Payer: TriValley Medical Group Senior |
$3,004.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
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 |
$9.02
|
| 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 |
$6.48
|
| Rate for Payer: Heritage Provider Network Senior |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$5.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.64
|
|
|
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 Non-Gatekeeper |
$8.65
|
| 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 |
$7.77
|
| Rate for Payer: Blue Shield of California Commercial |
$8.54
|
| Rate for Payer: Blue Shield of California EPN |
$6.83
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$6.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.80
|
| 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 |
$5.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.90
|
| 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$465.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,497.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$934.65
|
| Rate for Payer: Blue Shield of California EPN |
$934.65
|
| 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 |
$1,076.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,076.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,162.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,162.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$840.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$769.81
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$465.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,436.85
|
| 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 |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$934.65
|
| Rate for Payer: Blue Shield of California EPN |
$934.65
|
| 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 Medicare Advantage |
$1,976.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,488.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,076.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,076.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,162.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,162.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,162.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,627.50
|
| Rate for Payer: Multiplan Commercial |
$1,743.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$840.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$769.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,976.25
|
| 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
|
OP
|
$3,985.00
|
|
| Hospital Charge Code |
909081832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Vantage Medical Group Senior |
$3,387.25
|
| Rate for Payer: Adventist Health Commercial |
$797.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,462.73
|
| 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 |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,601.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,601.97
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,992.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,992.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,992.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,789.50
|
| Rate for Payer: Multiplan Commercial |
$2,988.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,439.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,319.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,387.25
|
|
|
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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$797.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,566.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,601.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,601.97
|
| 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 |
$1,845.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,845.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,992.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,992.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$1,439.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,319.43
|
|
|
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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$880.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,833.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,768.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,768.80
|
| 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: EPIC Health Plan Commercial |
$2,376.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,037.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,037.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,200.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,200.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$1,589.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,456.84
|
|
