|
HC ARTHRODESIS SACROILIAC JOINT
|
Facility
IP
|
$40,774.00
|
|
|
Service Code
|
CPT 27279
|
| Hospital Charge Code |
909027279
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,380.09 |
| Max. Negotiated Rate |
$30,580.50 |
| Rate for Payer: Adventist Health Commercial |
$8,154.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,011.74
|
| Rate for Payer: Cash Price |
$18,348.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$27,604.00
|
| Rate for Payer: Heritage Provider Network Senior |
$27,604.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,380.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,193.50
|
| Rate for Payer: Multiplan Commercial |
$30,580.50
|
|
|
HC ARTHRODESIS SACROILIAC JOINT
|
Facility
OP
|
$40,774.00
|
|
|
Service Code
|
CPT 27279
|
| Hospital Charge Code |
909027279
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$151.59 |
| Max. Negotiated Rate |
$44,240.59 |
| Rate for Payer: Adventist Health Commercial |
$8,154.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,011.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34,926.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25,612.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23,284.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$18,348.30
|
| Rate for Payer: Cash Price |
$18,348.30
|
| Rate for Payer: Cash Price |
$18,348.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26,503.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,926.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,612.97
|
| Rate for Payer: Dignity Health Senior |
$23,284.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,284.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,239.11
|
| Rate for Payer: Heritage Provider Network Senior |
$28,639.96
|
| Rate for Payer: Humana Medicare |
$23,284.52
|
| Rate for Payer: IEHP Medi-Cal |
$151.59
|
| Rate for Payer: IEHP Medicare Advantage |
$23,284.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44,240.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,380.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,475.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,193.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,338.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,338.50
|
| Rate for Payer: Multiplan Commercial |
$30,580.50
|
| Rate for Payer: Multiplan WC |
$31,833.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,612.97
|
| Rate for Payer: TriValley Medical Group Senior |
$25,612.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,926.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,612.97
|
| Rate for Payer: Vantage Medical Group Senior |
$23,284.52
|
|
|
HC ARTHROGRAPH ANKLE
|
Facility
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 73615
|
| Hospital Charge Code |
909001663
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$183.35 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$695.93
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$685.80
|
| Rate for Payer: Heritage Provider Network Senior |
$685.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.25
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
|
|
HC ARTHROGRAPH ANKLE
|
Facility
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 73615
|
| Hospital Charge Code |
909001663
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$117.45 |
| Max. Negotiated Rate |
$912.95 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$169.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$695.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$500.79
|
| Rate for Payer: Blue Shield of California Commercial |
$428.67
|
| Rate for Payer: Blue Shield of California EPN |
$243.77
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$658.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: Dignity Health Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$627.05
|
| Rate for Payer: Heritage Provider Network Senior |
$627.05
|
| Rate for Payer: Humana Medicare |
$480.50
|
| Rate for Payer: IEHP Medi-Cal |
$117.45
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$605.43
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$480.50
|
| Rate for Payer: TriValley Medical Group Senior |
$480.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC ARTHROGRAPH ELBOW
|
Facility
IP
|
$902.00
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
909001481
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$163.26 |
| Max. Negotiated Rate |
$676.50 |
| Rate for Payer: Adventist Health Commercial |
$180.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$619.67
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$610.65
|
| Rate for Payer: Heritage Provider Network Senior |
$610.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.50
|
| Rate for Payer: Multiplan Commercial |
$676.50
|
|
|
HC ARTHROGRAPH ELBOW
|
Facility
OP
|
$902.00
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
909001481
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$112.04 |
| Max. Negotiated Rate |
$912.95 |
| Rate for Payer: Adventist Health Commercial |
$180.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$619.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$500.79
|
| Rate for Payer: Blue Shield of California Commercial |
$428.67
|
| Rate for Payer: Blue Shield of California EPN |
$243.77
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$586.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: Dignity Health Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$558.34
|
| Rate for Payer: Heritage Provider Network Senior |
$558.34
|
| Rate for Payer: Humana Medicare |
$480.50
|
| Rate for Payer: IEHP Medi-Cal |
$112.04
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$605.43
|
| Rate for Payer: Multiplan Commercial |
$676.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$480.50
|
| Rate for Payer: TriValley Medical Group Senior |
$480.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC ARTHROGRAPH HIP
|
Facility
IP
|
$1,612.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
909001659
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$291.77 |
| Max. Negotiated Rate |
$1,209.00 |
| Rate for Payer: Adventist Health Commercial |
$322.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,107.44
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,091.32
|
| Rate for Payer: Heritage Provider Network Senior |
$1,091.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.00
|
| Rate for Payer: Multiplan Commercial |
$1,209.00
|
|
|
HC ARTHROGRAPH HIP
|
Facility
OP
|
$1,612.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
909001659
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$117.45 |
| Max. Negotiated Rate |
$1,209.00 |
| Rate for Payer: Adventist Health Commercial |
$322.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$161.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,107.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$500.79
|
| Rate for Payer: Blue Shield of California Commercial |
$428.67
|
| Rate for Payer: Blue Shield of California EPN |
$243.77
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,047.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: Dignity Health Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,047.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$997.83
|
| Rate for Payer: Heritage Provider Network Senior |
$997.83
|
| Rate for Payer: Humana Medicare |
$480.50
|
| Rate for Payer: IEHP Medi-Cal |
$117.45
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$605.43
|
| Rate for Payer: Multiplan Commercial |
$1,209.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$480.50
|
| Rate for Payer: TriValley Medical Group Senior |
$480.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC ARTHROGRAPH KNEE
|
Facility
IP
|
$1,540.00
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
909001658
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$278.74 |
| Max. Negotiated Rate |
$1,155.00 |
| Rate for Payer: Adventist Health Commercial |
$308.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,057.98
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,042.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,042.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.00
|
| Rate for Payer: Multiplan Commercial |
$1,155.00
|
|
|
HC ARTHROGRAPH KNEE
|
Facility
OP
|
$1,540.00
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
909001658
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$107.98 |
| Max. Negotiated Rate |
$1,155.00 |
| Rate for Payer: Adventist Health Commercial |
$308.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$229.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,057.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$627.52
|
| Rate for Payer: Blue Shield of California Commercial |
$533.43
|
| Rate for Payer: Blue Shield of California EPN |
$303.35
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,001.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: Dignity Health Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,001.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$953.26
|
| Rate for Payer: Heritage Provider Network Senior |
$953.26
|
| Rate for Payer: Humana Medicare |
$480.50
|
| Rate for Payer: IEHP Medi-Cal |
$107.98
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$605.43
|
| Rate for Payer: Multiplan Commercial |
$1,155.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$480.50
|
| Rate for Payer: TriValley Medical Group Senior |
$480.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC ARTHROGRAPH SHOULDER
|
Facility
IP
|
$1,644.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
909001480
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$297.56 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$328.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,129.43
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,112.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,112.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.00
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
|
|
HC ARTHROGRAPH SHOULDER
|
Facility
OP
|
$1,644.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
909001480
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$79.08 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$328.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$179.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,129.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$500.79
|
| Rate for Payer: Blue Shield of California Commercial |
$428.67
|
| Rate for Payer: Blue Shield of California EPN |
$243.77
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,068.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: Dignity Health Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,068.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,017.64
|
| Rate for Payer: Heritage Provider Network Senior |
$1,017.64
|
| Rate for Payer: Humana Medicare |
$480.50
|
| Rate for Payer: IEHP Medi-Cal |
$79.08
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$605.43
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$480.50
|
| Rate for Payer: TriValley Medical Group Senior |
$480.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC ARTHROGRAPH WRIST
|
Facility
OP
|
$1,384.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
909001482
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$1,038.00 |
| Rate for Payer: Adventist Health Commercial |
$276.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$181.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$950.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$376.09
|
| Rate for Payer: Blue Shield of California Commercial |
$323.87
|
| Rate for Payer: Blue Shield of California EPN |
$184.18
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$899.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: Dignity Health Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$899.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$856.70
|
| Rate for Payer: Heritage Provider Network Senior |
$856.70
|
| Rate for Payer: Humana Medicare |
$480.50
|
| Rate for Payer: IEHP Medi-Cal |
$64.18
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$605.43
|
| Rate for Payer: Multiplan Commercial |
$1,038.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$480.50
|
| Rate for Payer: TriValley Medical Group Senior |
$480.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC ARTHROGRAPH WRIST
|
Facility
IP
|
$1,384.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
909001482
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$250.50 |
| Max. Negotiated Rate |
$1,038.00 |
| Rate for Payer: Adventist Health Commercial |
$276.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$950.81
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$936.97
|
| Rate for Payer: Heritage Provider Network Senior |
$936.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.00
|
| Rate for Payer: Multiplan Commercial |
$1,038.00
|
|
|
HC ARTHROTOMY ANKLE
|
Facility
IP
|
$7,400.00
|
|
|
Service Code
|
CPT 27610
|
| Hospital Charge Code |
900501781
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,339.40 |
| Max. Negotiated Rate |
$5,550.00 |
| Rate for Payer: Adventist Health Commercial |
$1,480.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,083.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,122.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,974.80
|
| Rate for Payer: Cash Price |
$3,330.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,009.80
|
| Rate for Payer: Heritage Provider Network Senior |
$5,009.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,339.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,850.00
|
| Rate for Payer: Multiplan Commercial |
$5,550.00
|
|
|
HC ARTHROTOMY ANKLE
|
Facility
OP
|
$7,400.00
|
|
|
Service Code
|
CPT 27610
|
| Hospital Charge Code |
900501781
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,480.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,083.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$3,330.00
|
| Rate for Payer: Cash Price |
$3,330.00
|
| Rate for Payer: Cash Price |
$3,330.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,810.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,009.80
|
| Rate for Payer: Heritage Provider Network Senior |
$5,009.80
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,566.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,339.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,850.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$5,550.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,686.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,472.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC ASPARAGUS IGE
|
Facility
OP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913632
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: IEHP Medi-Cal |
$7.24
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC ASPARAGUS IGE
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913632
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
|
|
HC ASPIRATION/BLADDER BY NEEDLE
|
Facility
IP
|
$1,773.00
|
|
|
Service Code
|
CPT 51100
|
| Hospital Charge Code |
900501596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.91 |
| Max. Negotiated Rate |
$1,329.75 |
| Rate for Payer: Adventist Health Commercial |
$354.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,218.05
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,200.32
|
| Rate for Payer: Heritage Provider Network Senior |
$1,200.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.25
|
| Rate for Payer: Multiplan Commercial |
$1,329.75
|
|
|
HC ASPIRATION/BLADDER BY NEEDLE
|
Facility
OP
|
$1,773.00
|
|
|
Service Code
|
CPT 51100
|
| Hospital Charge Code |
900501596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$354.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,218.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cash Price |
$797.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,152.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: Dignity Health Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,200.32
|
| Rate for Payer: Heritage Provider Network Senior |
$1,200.32
|
| Rate for Payer: Humana Medicare |
$308.79
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$854.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$364.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.08
|
| Rate for Payer: Multiplan Commercial |
$1,329.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$643.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$592.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC ASPIRATION INJECTION INTERM JONT W US GUID
|
Facility
IP
|
$807.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
906620606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$146.07 |
| Max. Negotiated Rate |
$605.25 |
| Rate for Payer: Adventist Health Commercial |
$161.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$554.41
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$546.34
|
| Rate for Payer: Heritage Provider Network Senior |
$546.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.75
|
| Rate for Payer: Multiplan Commercial |
$605.25
|
|
|
HC ASPIRATION INJECTION INTERM JONT W US GUID
|
Facility
OP
|
$807.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
906620606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$161.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$554.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$524.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,062.77
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: IEHP Medi-Cal |
$127.80
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,641.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$605.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$950.44
|
| Rate for Payer: TriValley Medical Group Senior |
$950.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC ASPIRATION INJECTION MAJOR JONT W US GUID
|
Facility
IP
|
$888.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
906620611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$160.73 |
| Max. Negotiated Rate |
$666.00 |
| Rate for Payer: Adventist Health Commercial |
$177.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$610.06
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$601.18
|
| Rate for Payer: Heritage Provider Network Senior |
$601.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Multiplan Commercial |
$666.00
|
|
|
HC ASPIRATION INJECTION MAJOR JONT W US GUID
|
Facility
OP
|
$888.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
906620611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$142.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$177.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$610.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$577.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: Dignity Health Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$549.67
|
| Rate for Payer: Heritage Provider Network Senior |
$455.17
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$142.35
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$703.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$466.28
|
| Rate for Payer: Multiplan Commercial |
$666.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$407.07
|
| Rate for Payer: TriValley Medical Group Senior |
$407.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC ASPIRATION INJECTION SM JONT W US GUID
|
Facility
OP
|
$768.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
906620604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.08 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$153.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$527.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$499.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: Dignity Health Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$475.39
|
| Rate for Payer: Heritage Provider Network Senior |
$455.17
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$118.08
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$703.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$466.28
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$407.07
|
| Rate for Payer: TriValley Medical Group Senior |
$407.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
