|
HC RMVL FB OUTER EAR CANAL W/ANES
|
Facility
|
OP
|
$5,312.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
900501755
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$961.47 |
| Max. Negotiated Rate |
$3,984.00 |
| Rate for Payer: Adventist Health Commercial |
$1,062.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,282.82
|
| 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 |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,523.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,007.94
|
| Rate for Payer: Cash Price |
$2,390.40
|
| Rate for Payer: Cash Price |
$2,390.40
|
| Rate for Payer: Cash Price |
$2,390.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,452.80
|
| 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 |
$3,452.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,596.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,596.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,533.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$961.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,328.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$3,984.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,187.20
|
| Rate for Payer: TriValley Medical Group Senior |
$3,187.20
|
| 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 RMVL FB OUTER EAR CANAL W/ANES
|
Facility
|
IP
|
$5,312.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
900501755
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$961.47 |
| Max. Negotiated Rate |
$3,984.00 |
| Rate for Payer: Adventist Health Commercial |
$1,062.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,420.93
|
| Rate for Payer: Cash Price |
$2,390.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,596.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,596.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$961.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,328.00
|
| Rate for Payer: Multiplan Commercial |
$3,984.00
|
|
|
HC RMVL FB PHARYNGEAL
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
900501152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.81 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$113.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$351.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$269.80
|
| Rate for Payer: Blue Shield of California EPN |
$214.70
|
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$369.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$574.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$384.54
|
| Rate for Payer: Heritage Provider Network Senior |
$384.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$270.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$426.00
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$340.80
|
| Rate for Payer: TriValley Medical Group Senior |
$340.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC RMVL FB PHARYNGEAL
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
900501152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.81 |
| Max. Negotiated Rate |
$426.00 |
| Rate for Payer: Adventist Health Commercial |
$113.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$365.79
|
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$384.54
|
| Rate for Payer: Heritage Provider Network Senior |
$384.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$426.00
|
|
|
HC RMVL F.B. UPPER ARM/ELBOW,SUBC
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
900501468
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.17 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$761.99
|
| 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 |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$585.67
|
| Rate for Payer: Blue Shield of California EPN |
$466.07
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$801.45
|
| 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 |
$834.74
|
| Rate for Payer: Heritage Provider Network Senior |
$834.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$588.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$223.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$739.80
|
| Rate for Payer: TriValley Medical Group Senior |
$739.80
|
| 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 RMVL F.B. UPPER ARM/ELBOW,SUBC
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
900501468
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.17 |
| Max. Negotiated Rate |
$924.75 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$794.05
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$834.74
|
| Rate for Payer: Heritage Provider Network Senior |
$834.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$223.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.25
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
|
|
HC RMVL FECAL IMPACTION W/ANESTHE
|
Facility
|
IP
|
$4,080.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
900501608
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$738.48 |
| Max. Negotiated Rate |
$3,060.00 |
| Rate for Payer: Adventist Health Commercial |
$816.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,627.52
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,762.16
|
| Rate for Payer: Heritage Provider Network Senior |
$2,762.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$738.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Multiplan Commercial |
$3,060.00
|
|
|
HC RMVL FECAL IMPACTION W/ANESTHE
|
Facility
|
OP
|
$4,080.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
900501608
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$738.48 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$816.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,521.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,938.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,542.24
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,652.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,539.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,762.16
|
| Rate for Payer: Heritage Provider Network Senior |
$2,762.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,946.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$738.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,769.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$3,060.00
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,448.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,448.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
HC RMVL FOREIGN BODY EYELID
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
900501599
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.10 |
| Max. Negotiated Rate |
$572.25 |
| Rate for Payer: Adventist Health Commercial |
$152.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$491.37
|
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$516.55
|
| Rate for Payer: Heritage Provider Network Senior |
$516.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.75
|
| Rate for Payer: Multiplan Commercial |
$572.25
|
|
|
HC RMVL FOREIGN BODY EYELID
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
900501599
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.10 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$152.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$471.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$362.43
|
| Rate for Payer: Blue Shield of California EPN |
$288.41
|
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$495.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$408.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$516.55
|
| Rate for Payer: Heritage Provider Network Senior |
$516.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$363.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$572.25
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$457.80
|
| Rate for Payer: TriValley Medical Group Senior |
$457.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC RMVL FOREIGN BODY LARYNX
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT 31511
|
| Hospital Charge Code |
900501339
|
|
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 RMVL FOREIGN BODY LARYNX
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 31511
|
| Hospital Charge Code |
900501339
|
|
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 RMVL IMPACTED CERUMEN
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
900501186
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.64 |
| Max. Negotiated Rate |
$408.75 |
| Rate for Payer: Adventist Health Commercial |
$109.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$350.98
|
| Rate for Payer: Cash Price |
$245.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$368.96
|
| Rate for Payer: Heritage Provider Network Senior |
$368.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.25
|
| Rate for Payer: Multiplan Commercial |
$408.75
|
|
|
HC RMVL IMPACTED CERUMEN
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
900501186
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.87 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$109.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$336.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$258.88
|
| Rate for Payer: Blue Shield of California EPN |
$206.01
|
| Rate for Payer: Cash Price |
$245.25
|
| Rate for Payer: Cash Price |
$245.25
|
| Rate for Payer: Cash Price |
$245.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$354.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$368.96
|
| Rate for Payer: Heritage Provider Network Senior |
$368.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$259.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$408.75
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$327.00
|
| Rate for Payer: TriValley Medical Group Senior |
$327.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC RMVL IMPACTED VAGINAL FB
|
Facility
|
IP
|
$7,383.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
900501347
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,336.32 |
| Max. Negotiated Rate |
$5,537.25 |
| Rate for Payer: Adventist Health Commercial |
$1,476.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,754.65
|
| Rate for Payer: Cash Price |
$3,322.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,998.29
|
| Rate for Payer: Heritage Provider Network Senior |
$4,998.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,336.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,845.75
|
| Rate for Payer: Multiplan Commercial |
$5,537.25
|
|
|
HC RMVL IMPACTED VAGINAL FB
|
Facility
|
OP
|
$7,383.00
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
900501347
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,336.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,476.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,562.69
|
| 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 |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,506.93
|
| Rate for Payer: Blue Shield of California EPN |
$2,790.77
|
| Rate for Payer: Cash Price |
$3,322.35
|
| Rate for Payer: Cash Price |
$3,322.35
|
| Rate for Payer: Cash Price |
$3,322.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,798.95
|
| 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 |
$4,998.29
|
| Rate for Payer: Heritage Provider Network Senior |
$4,998.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,521.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,336.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,788.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,845.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$5,537.25
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,429.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,429.80
|
| 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 RMVL INTRANASAL FB
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.10 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$175.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$543.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$417.52
|
| Rate for Payer: Blue Shield of California EPN |
$332.26
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$571.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$595.08
|
| Rate for Payer: Heritage Provider Network Senior |
$595.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$419.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$659.25
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$527.40
|
| Rate for Payer: TriValley Medical Group Senior |
$527.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC RMVL INTRANASAL FB
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
900501113
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.10 |
| Max. Negotiated Rate |
$659.25 |
| Rate for Payer: Adventist Health Commercial |
$175.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$566.08
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$595.08
|
| Rate for Payer: Heritage Provider Network Senior |
$595.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.75
|
| Rate for Payer: Multiplan Commercial |
$659.25
|
|
|
HC RMVL INTRANASAL LESION
|
Facility
|
OP
|
$3,885.00
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
900501734
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$703.18 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$777.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,400.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,845.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,468.53
|
| Rate for Payer: Cash Price |
$1,748.25
|
| Rate for Payer: Cash Price |
$1,748.25
|
| Rate for Payer: Cash Price |
$1,748.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,525.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,264.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,630.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2,630.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,853.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,903.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$971.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$2,913.75
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,331.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,331.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC RMVL INTRANASAL LESION
|
Facility
|
IP
|
$3,885.00
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
900501734
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$703.18 |
| Max. Negotiated Rate |
$2,913.75 |
| Rate for Payer: Adventist Health Commercial |
$777.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,501.94
|
| Rate for Payer: Cash Price |
$1,748.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,630.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2,630.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$971.25
|
| Rate for Payer: Multiplan Commercial |
$2,913.75
|
|
|
HC RMVL NASAL F.B.
|
Facility
|
IP
|
$3,939.00
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
900501618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$712.96 |
| Max. Negotiated Rate |
$2,954.25 |
| Rate for Payer: Adventist Health Commercial |
$787.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,536.72
|
| Rate for Payer: Cash Price |
$1,772.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,666.70
|
| Rate for Payer: Heritage Provider Network Senior |
$2,666.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$712.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$984.75
|
| Rate for Payer: Multiplan Commercial |
$2,954.25
|
|
|
HC RMVL NASAL F.B.
|
Facility
|
OP
|
$3,939.00
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
900501618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$712.96 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$787.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,434.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,871.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,488.94
|
| Rate for Payer: Cash Price |
$1,772.55
|
| Rate for Payer: Cash Price |
$1,772.55
|
| Rate for Payer: Cash Price |
$1,772.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,560.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,264.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,666.70
|
| Rate for Payer: Heritage Provider Network Senior |
$2,666.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,878.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$712.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,903.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$984.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$2,954.25
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,363.40
|
| Rate for Payer: TriValley Medical Group Senior |
$2,363.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC RMVL OF CORNEAL EPITELIUM
|
Facility
|
OP
|
$1,994.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
900501182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$360.91 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$398.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,232.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,282.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$947.15
|
| Rate for Payer: Blue Shield of California EPN |
$753.73
|
| Rate for Payer: Cash Price |
$897.30
|
| Rate for Payer: Cash Price |
$897.30
|
| Rate for Payer: Cash Price |
$897.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,296.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,410.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,282.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,296.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,282.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,349.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1,349.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,282.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$951.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$360.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,474.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,718.08
|
| Rate for Payer: Multiplan Commercial |
$1,495.50
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,196.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1,196.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Vantage Medical Group Senior |
$1,282.15
|
|
|
HC RMVL OF CORNEAL EPITELIUM
|
Facility
|
IP
|
$1,994.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
900501182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$360.91 |
| Max. Negotiated Rate |
$1,495.50 |
| Rate for Payer: Adventist Health Commercial |
$398.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,284.14
|
| Rate for Payer: Cash Price |
$897.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,349.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1,349.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$360.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.50
|
| Rate for Payer: Multiplan Commercial |
$1,495.50
|
|
|
HC RMVL OF IMPLANT,SUPERFICIAL
|
Facility
|
IP
|
$3,657.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
900501283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.92 |
| Max. Negotiated Rate |
$2,742.75 |
| Rate for Payer: Adventist Health Commercial |
$731.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,355.11
|
| Rate for Payer: Cash Price |
$1,645.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,475.79
|
| Rate for Payer: Heritage Provider Network Senior |
$2,475.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$661.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.25
|
| Rate for Payer: Multiplan Commercial |
$2,742.75
|
|
