|
HC ATHRECTOMY VISCERAL
|
Facility
OP
|
$38,726.00
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
909020078
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,841.00 |
| Max. Negotiated Rate |
$32,917.10 |
| Rate for Payer: Adventist Health Commercial |
$7,745.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,604.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,917.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21,299.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29,044.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$17,426.70
|
| Rate for Payer: Cash Price |
$17,426.70
|
| Rate for Payer: Cash Price |
$17,426.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25,171.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,917.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,917.10
|
| Rate for Payer: Dignity Health Senior |
$32,917.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,235.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,971.39
|
| Rate for Payer: Heritage Provider Network Senior |
$23,971.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,665.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,009.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,681.50
|
| Rate for Payer: Multiplan Commercial |
$29,044.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,917.10
|
| Rate for Payer: Vantage Medical Group Senior |
$32,917.10
|
|
|
HC ATHRECTOMY VISCERAL
|
Facility
OP
|
$32,366.00
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
906820161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,841.00 |
| Max. Negotiated Rate |
$27,511.10 |
| Rate for Payer: Adventist Health Commercial |
$6,473.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,235.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27,511.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17,801.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24,274.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21,037.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27,511.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,511.10
|
| Rate for Payer: Dignity Health Senior |
$27,511.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,419.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,034.55
|
| Rate for Payer: Heritage Provider Network Senior |
$20,034.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,600.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,858.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,091.50
|
| Rate for Payer: Multiplan Commercial |
$24,274.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,511.10
|
| Rate for Payer: Vantage Medical Group Senior |
$27,511.10
|
|
|
HC ATHRECTOMY VISCERAL
|
Facility
IP
|
$38,726.00
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
909020078
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,009.41 |
| Max. Negotiated Rate |
$29,044.50 |
| Rate for Payer: Adventist Health Commercial |
$7,745.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,604.76
|
| Rate for Payer: Cash Price |
$17,426.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,217.50
|
| Rate for Payer: Heritage Provider Network Senior |
$26,217.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,009.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,681.50
|
| Rate for Payer: Multiplan Commercial |
$29,044.50
|
|
|
HC ATRIAL BALLOON SEPTOSTOMY
|
Facility
OP
|
$9,586.00
|
|
|
Service Code
|
CPT 33741
|
| Hospital Charge Code |
906811741
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$195.73 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,917.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,585.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8,148.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,272.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,189.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$4,313.70
|
| Rate for Payer: Cash Price |
$4,313.70
|
| Rate for Payer: Cash Price |
$4,313.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,230.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,148.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,148.10
|
| Rate for Payer: Dignity Health Senior |
$8,148.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,933.73
|
| Rate for Payer: Heritage Provider Network Senior |
$5,933.73
|
| Rate for Payer: IEHP Medi-Cal |
$195.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,620.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,735.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,396.50
|
| Rate for Payer: Multiplan Commercial |
$7,189.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,148.10
|
| Rate for Payer: Vantage Medical Group Senior |
$8,148.10
|
|
|
HC ATRIAL BALLOON SEPTOSTOMY
|
Facility
OP
|
$10,462.00
|
|
|
Service Code
|
CPT 33741
|
| Hospital Charge Code |
906820317
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$195.73 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,092.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,187.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8,892.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,754.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,846.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$4,707.90
|
| Rate for Payer: Cash Price |
$4,707.90
|
| Rate for Payer: Cash Price |
$4,707.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,800.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,892.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,892.70
|
| Rate for Payer: Dignity Health Senior |
$8,892.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,475.98
|
| Rate for Payer: Heritage Provider Network Senior |
$6,475.98
|
| Rate for Payer: IEHP Medi-Cal |
$195.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,042.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,893.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,615.50
|
| Rate for Payer: Multiplan Commercial |
$7,846.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,892.70
|
| Rate for Payer: Vantage Medical Group Senior |
$8,892.70
|
|
|
HC ATRIAL BALLOON SEPTOSTOMY
|
Facility
IP
|
$10,462.00
|
|
|
Service Code
|
CPT 33741
|
| Hospital Charge Code |
906820317
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,893.62 |
| Max. Negotiated Rate |
$7,846.50 |
| Rate for Payer: Adventist Health Commercial |
$2,092.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,187.39
|
| Rate for Payer: Cash Price |
$4,707.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,082.77
|
| Rate for Payer: Heritage Provider Network Senior |
$7,082.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,893.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,615.50
|
| Rate for Payer: Multiplan Commercial |
$7,846.50
|
|
|
HC ATRIAL BALLOON SEPTOSTOMY
|
Facility
IP
|
$9,586.00
|
|
|
Service Code
|
CPT 33741
|
| Hospital Charge Code |
906811741
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,735.07 |
| Max. Negotiated Rate |
$7,189.50 |
| Rate for Payer: Adventist Health Commercial |
$1,917.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,585.58
|
| Rate for Payer: Cash Price |
$4,313.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,489.72
|
| Rate for Payer: Heritage Provider Network Senior |
$6,489.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,735.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,396.50
|
| Rate for Payer: Multiplan Commercial |
$7,189.50
|
|
|
HC AUD EP SCRN AP W/BB STIMULI AA
|
Facility
OP
|
$988.00
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
900600650
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$40.06 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Adventist Health Commercial |
$197.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$68.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$678.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$839.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$543.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$741.00
|
| Rate for Payer: Blue Shield of California Commercial |
$613.55
|
| Rate for Payer: Blue Shield of California EPN |
$579.96
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$642.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$839.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$839.80
|
| Rate for Payer: Dignity Health Senior |
$839.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$611.57
|
| Rate for Payer: Heritage Provider Network Senior |
$611.57
|
| Rate for Payer: IEHP Medi-Cal |
$40.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$476.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.00
|
| Rate for Payer: Multiplan Commercial |
$741.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$839.80
|
| Rate for Payer: Vantage Medical Group Senior |
$839.80
|
|
|
HC AUD EP SCRN AP W/BB STIMULI AA
|
Facility
IP
|
$988.00
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
900600650
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$178.83 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Adventist Health Commercial |
$197.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$678.76
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$668.88
|
| Rate for Payer: Heritage Provider Network Senior |
$668.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.00
|
| Rate for Payer: Multiplan Commercial |
$741.00
|
|
|
HC AUDIOLOGIC EVAL PURE TONE 30M
|
Facility
IP
|
$327.00
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
905601900
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$59.19 |
| Max. Negotiated Rate |
$245.25 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$224.65
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.38
|
| Rate for Payer: Heritage Provider Network Senior |
$221.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.75
|
| Rate for Payer: Multiplan Commercial |
$245.25
|
|
|
HC AUDIOLOGIC EVAL PURE TONE 30M
|
Facility
OP
|
$327.00
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
905601900
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$224.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$179.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$245.25
|
| Rate for Payer: Blue Shield of California Commercial |
$203.07
|
| Rate for Payer: Blue Shield of California EPN |
$191.95
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$212.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.95
|
| Rate for Payer: Dignity Health Senior |
$277.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.41
|
| Rate for Payer: Heritage Provider Network Senior |
$202.41
|
| Rate for Payer: IEHP Medi-Cal |
$15.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$157.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.75
|
| Rate for Payer: Multiplan Commercial |
$245.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.95
|
| Rate for Payer: Vantage Medical Group Senior |
$277.95
|
|
|
HC AUG/ALTR COMM
|
Facility
OP
|
$227.00
|
|
| Hospital Charge Code |
905601807
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$121.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$170.25
|
| 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 |
$102.15
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$147.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.95
|
| Rate for Payer: Dignity Health Senior |
$192.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.51
|
| Rate for Payer: Heritage Provider Network Senior |
$140.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$109.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.75
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| 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 |
$192.95
|
| Rate for Payer: Vantage Medical Group Senior |
$192.95
|
|
|
HC AUG/ALTR COMM
|
Facility
IP
|
$227.00
|
|
| Hospital Charge Code |
905601807
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$170.25 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.95
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$153.68
|
| Rate for Payer: Heritage Provider Network Senior |
$153.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.75
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
OP
|
$471.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.25 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$94.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$323.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$306.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$318.87
|
| Rate for Payer: Heritage Provider Network Senior |
$318.87
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$227.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$353.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$171.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$157.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
IP
|
$471.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.25 |
| Max. Negotiated Rate |
$353.25 |
| Rate for Payer: Adventist Health Commercial |
$94.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$323.58
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$318.87
|
| Rate for Payer: Heritage Provider Network Senior |
$318.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.75
|
| Rate for Payer: Multiplan Commercial |
$353.25
|
|
|
HC AVULSION EA ADD'L NAIL PLATE
|
Facility
IP
|
$247.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
900501224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.71 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Adventist Health Commercial |
$49.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.69
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.22
|
| Rate for Payer: Heritage Provider Network Senior |
$167.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.75
|
| Rate for Payer: Multiplan Commercial |
$185.25
|
|
|
HC AVULSION EA ADD'L NAIL PLATE
|
Facility
OP
|
$247.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
900501224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$49.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$209.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$135.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$185.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$160.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.95
|
| Rate for Payer: Dignity Health Senior |
$209.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.22
|
| Rate for Payer: Heritage Provider Network Senior |
$167.22
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$119.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.75
|
| Rate for Payer: Multiplan Commercial |
$185.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$89.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$82.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.95
|
| Rate for Payer: Vantage Medical Group Senior |
$209.95
|
|
|
HC AVX ANGIOJET, CATH
|
Facility
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909080036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$777.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,112.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$745.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,096.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,096.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$810.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$590.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.24
|
|
|
HC AVX ANGIOJET, CATH
|
Facility
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909080036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$777.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,112.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,006.02
|
| Rate for Payer: Blue Shield of California EPN |
$950.94
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$745.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: Dignity Health Senior |
$1,377.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,036.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$750.06
|
| Rate for Payer: Heritage Provider Network Senior |
$750.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$810.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$590.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC B ABORTUS AB
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT 86000
|
| Hospital Charge Code |
900911585
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.74
|
| Rate for Payer: Blue Shield of California Commercial |
$54.50
|
| Rate for Payer: Blue Shield of California EPN |
$42.61
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.68
|
| Rate for Payer: Dignity Health Senior |
$6.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.05
|
| Rate for Payer: Heritage Provider Network Senior |
$8.05
|
| Rate for Payer: Humana Medicare |
$6.98
|
| Rate for Payer: IEHP Medi-Cal |
$8.30
|
| Rate for Payer: IEHP Medicare Advantage |
$6.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.79
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.98
|
| Rate for Payer: TriValley Medical Group Senior |
$6.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6.98
|
|
|
HC B ABORTUS AB
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT 86000
|
| Hospital Charge Code |
900911585
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC BACTERIAL ANTIGEN
|
Facility
IP
|
$116.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
900912496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.69
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.53
|
| Rate for Payer: Heritage Provider Network Senior |
$78.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
|
|
HC BACTERIAL ANTIGEN
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
900912496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$82.84 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.84
|
| Rate for Payer: Blue Shield of California Commercial |
$79.60
|
| Rate for Payer: Blue Shield of California EPN |
$62.23
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.69
|
| Rate for Payer: Dignity Health Senior |
$11.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.00
|
| Rate for Payer: Heritage Provider Network Senior |
$52.00
|
| Rate for Payer: Humana Medicare |
$11.54
|
| Rate for Payer: IEHP Medi-Cal |
$14.40
|
| Rate for Payer: IEHP Medicare Advantage |
$11.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.54
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.54
|
| Rate for Payer: TriValley Medical Group Senior |
$11.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.69
|
| Rate for Payer: Vantage Medical Group Senior |
$11.54
|
|
|
HC BAG BILE DRAINAGE
|
Facility
IP
|
$10.60
|
|
| Hospital Charge Code |
909001075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$7.95 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.28
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.18
|
| Rate for Payer: Heritage Provider Network Senior |
$7.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: Multiplan Commercial |
$7.95
|
|
|
HC BAG BILE DRAINAGE
|
Facility
OP
|
$10.60
|
|
| Hospital Charge Code |
909001075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$9.01 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.95
|
| Rate for Payer: Blue Shield of California Commercial |
$6.58
|
| Rate for Payer: Blue Shield of California EPN |
$6.22
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.01
|
| Rate for Payer: Dignity Health Senior |
$9.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.56
|
| Rate for Payer: Heritage Provider Network Senior |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: Multiplan Commercial |
$7.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.01
|
| Rate for Payer: Vantage Medical Group Senior |
$9.01
|
|
