|
HC RMVL FB CORNEA W SLIT LAMP
|
Facility
OP
|
$1,038.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.72 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$207.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$111.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$713.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$674.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$674.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$702.73
|
| Rate for Payer: Heritage Provider Network Senior |
$702.73
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$500.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$778.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$346.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC RMVL FB CORNEA W SLIT LAMP
|
Facility
IP
|
$1,038.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$778.50 |
| Rate for Payer: Adventist Health Commercial |
$207.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$713.11
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$702.73
|
| Rate for Payer: Heritage Provider Network Senior |
$702.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.50
|
| Rate for Payer: Multiplan Commercial |
$778.50
|
|
|
HC RMVL F.B. DEEP,THIGH/KNEE AREA
|
Facility
OP
|
$4,851.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
900501311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$878.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$970.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,332.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$2,182.95
|
| Rate for Payer: Cash Price |
$2,182.95
|
| Rate for Payer: Cash Price |
$2,182.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,153.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: Dignity Health Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,550.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,284.13
|
| Rate for Payer: Heritage Provider Network Senior |
$3,284.13
|
| Rate for Payer: Humana Medicare |
$3,550.26
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,338.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$878.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,189.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,212.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,473.33
|
| Rate for Payer: Multiplan Commercial |
$3,638.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,761.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,620.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC RMVL F.B. DEEP,THIGH/KNEE AREA
|
Facility
IP
|
$4,851.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
900501311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$878.03 |
| Max. Negotiated Rate |
$3,638.25 |
| Rate for Payer: Adventist Health Commercial |
$970.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,332.64
|
| Rate for Payer: Cash Price |
$2,182.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,284.13
|
| Rate for Payer: Heritage Provider Network Senior |
$3,284.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$878.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,212.75
|
| Rate for Payer: Multiplan Commercial |
$3,638.25
|
|
|
HC RMVL FB EXT AUDITORY CANAL
|
Facility
IP
|
$499.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.32 |
| Max. Negotiated Rate |
$374.25 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$342.81
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$337.82
|
| Rate for Payer: Heritage Provider Network Senior |
$337.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.75
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
|
|
HC RMVL FB EXT AUDITORY CANAL
|
Facility
OP
|
$499.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.32 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$115.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$342.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$324.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$337.82
|
| Rate for Payer: Heritage Provider Network Senior |
$337.82
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$240.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$181.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$166.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC RMVL F.B. FOOT, COMPLICATED
|
Facility
OP
|
$1,886.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
900501715
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$341.37 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$377.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,295.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare 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 |
$848.70
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,225.90
|
| 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 |
$1,276.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,276.82
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$909.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.50
|
| 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 |
$1,414.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$684.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$630.11
|
| 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 RMVL F.B. FOOT, COMPLICATED
|
Facility
IP
|
$1,886.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
900501715
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$341.37 |
| Max. Negotiated Rate |
$1,414.50 |
| Rate for Payer: Adventist Health Commercial |
$377.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,295.68
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,276.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,276.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.50
|
| Rate for Payer: Multiplan Commercial |
$1,414.50
|
|
|
HC RMVL F B FOOT, DEEP
|
Facility
IP
|
$3,346.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
900501460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$605.63 |
| Max. Negotiated Rate |
$2,509.50 |
| Rate for Payer: Adventist Health Commercial |
$669.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,298.70
|
| Rate for Payer: Cash Price |
$1,505.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,265.24
|
| Rate for Payer: Heritage Provider Network Senior |
$2,265.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$605.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$836.50
|
| Rate for Payer: Multiplan Commercial |
$2,509.50
|
|
|
HC RMVL F B FOOT, DEEP
|
Facility
OP
|
$3,346.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
900501460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$605.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$669.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,298.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare 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 |
$1,505.70
|
| Rate for Payer: Cash Price |
$1,505.70
|
| Rate for Payer: Cash Price |
$1,505.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,174.90
|
| 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 |
$2,265.24
|
| Rate for Payer: Heritage Provider Network Senior |
$2,265.24
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,612.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$605.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$836.50
|
| 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 |
$2,509.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,214.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,117.90
|
| 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 RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
OP
|
$2,018.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
900501097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$365.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$403.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,386.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$908.10
|
| Rate for Payer: Cash Price |
$908.10
|
| Rate for Payer: Cash Price |
$908.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,311.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,366.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,366.19
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$972.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$1,513.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$732.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$674.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC RMVL F.B. FOOT SUBCUTANEOUS
|
Facility
IP
|
$2,018.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
900501097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$365.26 |
| Max. Negotiated Rate |
$1,513.50 |
| Rate for Payer: Adventist Health Commercial |
$403.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,386.37
|
| Rate for Payer: Cash Price |
$908.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,366.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,366.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.50
|
| Rate for Payer: Multiplan Commercial |
$1,513.50
|
|
|
HC RMVL FB INTRAOCULAR
|
Facility
IP
|
$3,966.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
900501180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$717.85 |
| Max. Negotiated Rate |
$2,974.50 |
| Rate for Payer: Adventist Health Commercial |
$793.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,724.64
|
| Rate for Payer: Cash Price |
$1,784.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,684.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,684.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$717.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.50
|
| Rate for Payer: Multiplan Commercial |
$2,974.50
|
|
|
HC RMVL FB INTRAOCULAR
|
Facility
OP
|
$3,966.00
|
|
|
Service Code
|
CPT 65235
|
| Hospital Charge Code |
900501180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$717.85 |
| Max. Negotiated Rate |
$4,547.00 |
| Rate for Payer: Adventist Health Commercial |
$793.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,724.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,784.70
|
| Rate for Payer: Cash Price |
$1,784.70
|
| Rate for Payer: Cash Price |
$1,784.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,577.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,577.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,684.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,684.98
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,911.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$717.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: Multiplan Commercial |
$2,974.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,440.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,325.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC RMVL FB MSCLE/TNDN SHEATH DEEP
|
Facility
OP
|
$4,851.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
900501534
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$878.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$970.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,332.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,182.95
|
| Rate for Payer: Cash Price |
$2,182.95
|
| Rate for Payer: Cash Price |
$2,182.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,153.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: Dignity Health Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,550.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,284.13
|
| Rate for Payer: Heritage Provider Network Senior |
$3,284.13
|
| Rate for Payer: Humana Medicare |
$3,550.26
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,338.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$878.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,189.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,212.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,473.33
|
| Rate for Payer: Multiplan Commercial |
$3,638.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,761.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,620.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC RMVL FB MSCLE/TNDN SHEATH DEEP
|
Facility
IP
|
$4,851.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
900501534
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$878.03 |
| Max. Negotiated Rate |
$3,638.25 |
| Rate for Payer: Adventist Health Commercial |
$970.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,332.64
|
| Rate for Payer: Cash Price |
$2,182.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,284.13
|
| Rate for Payer: Heritage Provider Network Senior |
$3,284.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$878.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,212.75
|
| Rate for Payer: Multiplan Commercial |
$3,638.25
|
|
|
HC RMVL FB MSCLE/TNDN SHEATH SMPL
|
Facility
OP
|
$1,128.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
900501492
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.17 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$225.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$774.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$733.20
|
| 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 |
$763.66
|
| Rate for Payer: Heritage Provider Network Senior |
$763.66
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$543.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.00
|
| 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 |
$846.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$409.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$376.86
|
| 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 RMVL FB MSCLE/TNDN SHEATH SMPL
|
Facility
IP
|
$1,128.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
900501492
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.17 |
| Max. Negotiated Rate |
$846.00 |
| Rate for Payer: Adventist Health Commercial |
$225.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$774.94
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$763.66
|
| Rate for Payer: Heritage Provider Network Senior |
$763.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.00
|
| Rate for Payer: Multiplan Commercial |
$846.00
|
|
|
HC RMVL FB OUTER EAR CANAL W/ANES
|
Facility
IP
|
$4,862.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
900501755
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$880.02 |
| Max. Negotiated Rate |
$3,646.50 |
| Rate for Payer: Adventist Health Commercial |
$972.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,340.19
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,291.57
|
| Rate for Payer: Heritage Provider Network Senior |
$3,291.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$880.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,215.50
|
| Rate for Payer: Multiplan Commercial |
$3,646.50
|
|
|
HC RMVL FB OUTER EAR CANAL W/ANES
|
Facility
OP
|
$4,862.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
900501755
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$880.02 |
| Max. Negotiated Rate |
$3,646.50 |
| Rate for Payer: Adventist Health Commercial |
$972.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,340.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,160.30
|
| 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 |
$3,160.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,291.57
|
| Rate for Payer: Heritage Provider Network Senior |
$3,291.57
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,343.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$880.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,215.50
|
| 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 |
$3,646.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,765.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,624.39
|
| 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 RMVL FB PHARYNGEAL
|
Facility
IP
|
$520.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
900501152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.12 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$357.24
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$352.04
|
| Rate for Payer: Heritage Provider Network Senior |
$352.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
|
|
HC RMVL FB PHARYNGEAL
|
Facility
OP
|
$520.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
900501152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.12 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$357.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$338.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: Dignity Health Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$497.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$352.04
|
| Rate for Payer: Heritage Provider Network Senior |
$352.04
|
| Rate for Payer: Humana Medicare |
$497.82
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$250.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.25
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$173.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC RMVL F.B. UPPER ARM/ELBOW,SUBC
|
Facility
OP
|
$1,128.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
900501468
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.17 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$225.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$283.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$774.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$733.20
|
| 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 |
$763.66
|
| Rate for Payer: Heritage Provider Network Senior |
$763.66
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$543.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.00
|
| 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 |
$846.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$409.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$376.86
|
| 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 RMVL F.B. UPPER ARM/ELBOW,SUBC
|
Facility
IP
|
$1,128.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
900501468
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.17 |
| Max. Negotiated Rate |
$846.00 |
| Rate for Payer: Adventist Health Commercial |
$225.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$774.94
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$763.66
|
| Rate for Payer: Heritage Provider Network Senior |
$763.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.00
|
| Rate for Payer: Multiplan Commercial |
$846.00
|
|
|
HC RMVL FECAL IMPACTION W/ANESTHE
|
Facility
IP
|
$3,735.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
900501608
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$676.04 |
| Max. Negotiated Rate |
$2,801.25 |
| Rate for Payer: Adventist Health Commercial |
$747.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,565.94
|
| Rate for Payer: Cash Price |
$1,680.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,528.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,528.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$676.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$933.75
|
| Rate for Payer: Multiplan Commercial |
$2,801.25
|
|
