|
HC ASPIRATION INJECTION SM JONT W US GUID
|
Facility
IP
|
$768.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
906620604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$139.01 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Adventist Health Commercial |
$153.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$527.62
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$519.94
|
| Rate for Payer: Heritage Provider Network Senior |
$519.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
|
|
HC ASPIRATION/INJ GANGLION CYSTS
|
Facility
IP
|
$888.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
909020036
|
|
Hospital Revenue Code
|
450
|
| 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/INJ GANGLION CYSTS
|
Facility
OP
|
$888.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
909020036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.80 |
| 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 |
$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 |
$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 |
$84.80
|
| 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/INJ GANGLION CYSTS
|
Facility
OP
|
$888.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
909020036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.73 |
| 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 |
$4,547.00
|
| 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 |
$601.18
|
| Rate for Payer: Heritage Provider Network Senior |
$601.18
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$428.02
|
| 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: United Healthcare All Other HMO/non HMO |
$322.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$296.68
|
| 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/INJ GANGLION CYSTS
|
Facility
IP
|
$888.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
909020036
|
|
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 ASPIR INJECT THYROID CYST
|
Facility
IP
|
$2,729.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
909020010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$493.95 |
| Max. Negotiated Rate |
$2,046.75 |
| Rate for Payer: Adventist Health Commercial |
$545.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,874.82
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,847.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,847.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.25
|
| Rate for Payer: Multiplan Commercial |
$2,046.75
|
|
|
HC ASPIR INJECT THYROID CYST
|
Facility
OP
|
$2,729.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
909020010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.26 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$545.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,874.82
|
| 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: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,773.85
|
| 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 |
$1,637.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,689.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$131.26
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.25
|
| 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 |
$2,046.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| 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 |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC ASPIR INJECT THYROID CYST
|
Facility
IP
|
$2,729.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
909020010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$493.95 |
| Max. Negotiated Rate |
$2,046.75 |
| Rate for Payer: Adventist Health Commercial |
$545.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,874.82
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,847.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,847.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.25
|
| Rate for Payer: Multiplan Commercial |
$2,046.75
|
|
|
HC ASPIR INJECT THYROID CYST
|
Facility
OP
|
$2,729.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
909020010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$493.95 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$545.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,874.82
|
| 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 |
$1,228.05
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,773.85
|
| 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 |
$1,773.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,847.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,847.53
|
| 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 |
$1,315.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.25
|
| 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 |
$2,046.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$990.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$911.76
|
| 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 ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
OP
|
$665.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$133.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$456.86
|
| 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: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$432.25
|
| 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 |
$450.20
|
| Rate for Payer: Heritage Provider Network Senior |
$450.20
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$320.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.25
|
| 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 |
$498.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$241.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$222.18
|
| 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 ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
IP
|
$665.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Adventist Health Commercial |
$133.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$456.86
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.20
|
| Rate for Payer: Heritage Provider Network Senior |
$450.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.25
|
| Rate for Payer: Multiplan Commercial |
$498.75
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
OP
|
$665.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$71.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$133.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$456.86
|
| 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 |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$432.25
|
| 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 |
$411.64
|
| Rate for Payer: Heritage Provider Network Senior |
$455.17
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$71.43
|
| 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 |
$120.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.25
|
| 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 |
$498.75
|
| 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 ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
IP
|
$665.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Adventist Health Commercial |
$133.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$456.86
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.20
|
| Rate for Payer: Heritage Provider Network Senior |
$450.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.25
|
| Rate for Payer: Multiplan Commercial |
$498.75
|
|
|
HC ASSESS APHASIA W/RPT 1HR MCAL
|
Facility
IP
|
$800.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
907000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$144.80 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Adventist Health Commercial |
$160.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$549.60
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$541.60
|
| Rate for Payer: Heritage Provider Network Senior |
$541.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.00
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
|
|
HC ASSESS APHASIA W/RPT 1HR MCAL
|
Facility
OP
|
$800.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
907000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$79.87 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Adventist Health Commercial |
$160.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$247.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$549.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$680.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$600.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$520.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$680.00
|
| Rate for Payer: Dignity Health Senior |
$680.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$520.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$495.20
|
| Rate for Payer: Heritage Provider Network Senior |
$495.20
|
| Rate for Payer: IEHP Medi-Cal |
$79.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$385.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.00
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$680.00
|
| Rate for Payer: Vantage Medical Group Senior |
$680.00
|
|
|
HC ASSESS APHASIA W/RPT 60 MIN
|
Facility
IP
|
$415.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
905601803
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$75.12 |
| Max. Negotiated Rate |
$311.25 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$285.10
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$280.96
|
| Rate for Payer: Heritage Provider Network Senior |
$280.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.75
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
|
|
HC ASSESS APHASIA W/RPT 60 MIN
|
Facility
OP
|
$415.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
905601803
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$75.12 |
| Max. Negotiated Rate |
$352.75 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$247.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$285.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$352.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$228.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$311.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$269.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$352.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$352.75
|
| Rate for Payer: Dignity Health Senior |
$352.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$269.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$256.88
|
| Rate for Payer: Heritage Provider Network Senior |
$256.88
|
| Rate for Payer: IEHP Medi-Cal |
$79.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$200.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.75
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$352.75
|
| Rate for Payer: Vantage Medical Group Senior |
$352.75
|
|
|
HC AST
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$43.28 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.28
|
| Rate for Payer: Blue Shield of California Commercial |
$40.36
|
| Rate for Payer: Blue Shield of California EPN |
$31.55
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: IEHP Medi-Cal |
$6.88
|
| Rate for Payer: IEHP Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC AST
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC AST INDIVIDUAL
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$43.28 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.28
|
| Rate for Payer: Blue Shield of California Commercial |
$40.36
|
| Rate for Payer: Blue Shield of California EPN |
$31.55
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: IEHP Medi-Cal |
$6.88
|
| Rate for Payer: IEHP Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC AST INDIVIDUAL
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC ATHERECTOMY AORTA
|
Facility
OP
|
$25,902.00
|
|
| Hospital Charge Code |
909080029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,688.26 |
| Max. Negotiated Rate |
$22,016.70 |
| Rate for Payer: Adventist Health Commercial |
$5,180.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,794.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22,016.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14,246.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19,426.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$11,655.90
|
| Rate for Payer: Cash Price |
$11,655.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,836.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,016.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,016.70
|
| Rate for Payer: Dignity Health Senior |
$22,016.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,541.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,033.34
|
| Rate for Payer: Heritage Provider Network Senior |
$16,033.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,484.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,688.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,475.50
|
| Rate for Payer: Multiplan Commercial |
$19,426.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,016.70
|
| Rate for Payer: Vantage Medical Group Senior |
$22,016.70
|
|
|
HC ATHERECTOMY AORTA
|
Facility
IP
|
$25,902.00
|
|
| Hospital Charge Code |
909080029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,688.26 |
| Max. Negotiated Rate |
$19,426.50 |
| Rate for Payer: Adventist Health Commercial |
$5,180.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,794.67
|
| Rate for Payer: Cash Price |
$11,655.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,535.65
|
| Rate for Payer: Heritage Provider Network Senior |
$17,535.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,688.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,475.50
|
| Rate for Payer: Multiplan Commercial |
$19,426.50
|
|
|
HC ATHERECTOMY BRACH/CEPH BRANCH
|
Facility
IP
|
$25,902.00
|
|
| Hospital Charge Code |
909080031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,688.26 |
| Max. Negotiated Rate |
$19,426.50 |
| Rate for Payer: Adventist Health Commercial |
$5,180.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,794.67
|
| Rate for Payer: Cash Price |
$11,655.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,535.65
|
| Rate for Payer: Heritage Provider Network Senior |
$17,535.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,688.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,475.50
|
| Rate for Payer: Multiplan Commercial |
$19,426.50
|
|
|
HC ATHERECTOMY BRACH/CEPH BRANCH
|
Facility
OP
|
$25,902.00
|
|
| Hospital Charge Code |
909080031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,688.26 |
| Max. Negotiated Rate |
$22,016.70 |
| Rate for Payer: Adventist Health Commercial |
$5,180.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,794.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22,016.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14,246.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19,426.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$11,655.90
|
| Rate for Payer: Cash Price |
$11,655.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,836.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,016.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,016.70
|
| Rate for Payer: Dignity Health Senior |
$22,016.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,541.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,033.34
|
| Rate for Payer: Heritage Provider Network Senior |
$16,033.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,484.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,688.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,475.50
|
| Rate for Payer: Multiplan Commercial |
$19,426.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,016.70
|
| Rate for Payer: Vantage Medical Group Senior |
$22,016.70
|
|
