|
HC BIL STNT PLCMNT NEW ACC W CATH
|
Facility
OP
|
$21,061.00
|
|
|
Service Code
|
CPT 47540
|
| Hospital Charge Code |
909047540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,237.00 |
| Max. Negotiated Rate |
$15,795.75 |
| Rate for Payer: Adventist Health Commercial |
$4,212.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,468.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$9,477.45
|
| Rate for Payer: Cash Price |
$9,477.45
|
| Rate for Payer: Cash Price |
$9,477.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,689.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: Dignity Health Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,209.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,036.76
|
| Rate for Payer: Heritage Provider Network Senior |
$8,867.33
|
| Rate for Payer: Humana Medicare |
$7,209.21
|
| Rate for Payer: IEHP Medi-Cal |
$7,404.46
|
| Rate for Payer: IEHP Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,697.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,812.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,506.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,265.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,083.60
|
| Rate for Payer: Multiplan Commercial |
$15,795.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,930.13
|
| Rate for Payer: TriValley Medical Group Senior |
$7,930.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
HC BIL STNT PLCMT NEW ACC WO CATH
|
Facility
IP
|
$21,061.00
|
|
|
Service Code
|
CPT 47539
|
| Hospital Charge Code |
909047539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,812.04 |
| Max. Negotiated Rate |
$15,795.75 |
| Rate for Payer: Adventist Health Commercial |
$4,212.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,468.91
|
| Rate for Payer: Cash Price |
$9,477.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,258.30
|
| Rate for Payer: Heritage Provider Network Senior |
$14,258.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,812.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,265.25
|
| Rate for Payer: Multiplan Commercial |
$15,795.75
|
|
|
HC BIL STNT PLCMT NEW ACC WO CATH
|
Facility
OP
|
$21,061.00
|
|
|
Service Code
|
CPT 47539
|
| Hospital Charge Code |
909047539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,237.00 |
| Max. Negotiated Rate |
$15,795.75 |
| Rate for Payer: Adventist Health Commercial |
$4,212.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,468.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$9,477.45
|
| Rate for Payer: Cash Price |
$9,477.45
|
| Rate for Payer: Cash Price |
$9,477.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,689.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: Dignity Health Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,209.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,036.76
|
| Rate for Payer: Heritage Provider Network Senior |
$8,867.33
|
| Rate for Payer: Humana Medicare |
$7,209.21
|
| Rate for Payer: IEHP Medi-Cal |
$7,130.34
|
| Rate for Payer: IEHP Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,697.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,812.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,506.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,265.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,083.60
|
| Rate for Payer: Multiplan Commercial |
$15,795.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,930.13
|
| Rate for Payer: TriValley Medical Group Senior |
$7,930.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
HC BIOFEEDBACK TRNG 1ST 15 MIN
|
Facility
OP
|
$217.00
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
906790912
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$448.00 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$105.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Blue Shield of California Commercial |
$134.76
|
| Rate for Payer: Blue Shield of California EPN |
$127.38
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Senior |
$184.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.32
|
| Rate for Payer: Heritage Provider Network Senior |
$134.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$104.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.25
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$375.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC BIOFEEDBACK TRNG 1ST 15 MIN
|
Facility
IP
|
$217.00
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
906790912
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$162.75 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.08
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$146.91
|
| Rate for Payer: Heritage Provider Network Senior |
$146.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.25
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
|
|
HC BIOFEEDBACK TRNG EA ADD 15 MIN
|
Facility
OP
|
$87.00
|
|
|
Service Code
|
CPT 90913
|
| Hospital Charge Code |
906790913
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$448.00 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$58.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$73.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65.25
|
| Rate for Payer: Blue Shield of California Commercial |
$54.03
|
| Rate for Payer: Blue Shield of California EPN |
$51.07
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.95
|
| Rate for Payer: Dignity Health Senior |
$73.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.85
|
| Rate for Payer: Heritage Provider Network Senior |
$53.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$375.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.95
|
| Rate for Payer: Vantage Medical Group Senior |
$73.95
|
|
|
HC BIOFEEDBACK TRNG EA ADD 15 MIN
|
Facility
IP
|
$87.00
|
|
|
Service Code
|
CPT 90913
|
| Hospital Charge Code |
906790913
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.77
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.90
|
| Rate for Payer: Heritage Provider Network Senior |
$58.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
|
|
HC BIOPHYSICAL PROFILE W NST ADDL FETUS
|
Facility
IP
|
$1,463.00
|
|
|
Service Code
|
CPT 76818 59
|
| Hospital Charge Code |
910400112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$1,097.25 |
| Rate for Payer: Adventist Health Commercial |
$292.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,005.08
|
| Rate for Payer: Cash Price |
$658.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$990.45
|
| Rate for Payer: Heritage Provider Network Senior |
$990.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.75
|
| Rate for Payer: Multiplan Commercial |
$1,097.25
|
|
|
HC BIOPHYSICAL PROFILE W NST ADDL FETUS
|
Facility
OP
|
$1,463.00
|
|
|
Service Code
|
CPT 76818 59
|
| Hospital Charge Code |
910400112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Adventist Health Commercial |
$292.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$781.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,005.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,243.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$804.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,097.25
|
| Rate for Payer: Blue Shield of California Commercial |
$908.52
|
| Rate for Payer: Blue Shield of California EPN |
$858.78
|
| Rate for Payer: Cash Price |
$658.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$950.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,243.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,243.55
|
| Rate for Payer: Dignity Health Senior |
$1,243.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$950.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$905.60
|
| Rate for Payer: Heritage Provider Network Senior |
$905.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$705.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.75
|
| Rate for Payer: Multiplan Commercial |
$1,097.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,243.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,243.55
|
|
|
HC BIOPHYSICAL PROFILE W NST SINGLE FETUS
|
Facility
IP
|
$1,463.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
910400111
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$1,097.25 |
| Rate for Payer: Adventist Health Commercial |
$292.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,005.08
|
| Rate for Payer: Cash Price |
$658.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$990.45
|
| Rate for Payer: Heritage Provider Network Senior |
$990.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.75
|
| Rate for Payer: Multiplan Commercial |
$1,097.25
|
|
|
HC BIOPHYSICAL PROFILE W NST SINGLE FETUS
|
Facility
OP
|
$1,463.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
910400111
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,097.25 |
| Rate for Payer: Adventist Health Commercial |
$292.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,005.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$331.70
|
| Rate for Payer: Blue Shield of California EPN |
$188.63
|
| Rate for Payer: Cash Price |
$658.35
|
| Rate for Payer: Cash Price |
$658.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$950.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$950.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$905.60
|
| Rate for Payer: Heritage Provider Network Senior |
$905.60
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,097.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC BIOPHYSICAL PROFILE WO NST ADDL FETUS
|
Facility
IP
|
$638.00
|
|
|
Service Code
|
CPT 76819 59
|
| Hospital Charge Code |
910400114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$478.50 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.31
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$431.93
|
| Rate for Payer: Heritage Provider Network Senior |
$431.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
|
|
HC BIOPHYSICAL PROFILE WO NST ADDL FETUS
|
Facility
OP
|
$638.00
|
|
|
Service Code
|
CPT 76819 59
|
| Hospital Charge Code |
910400114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$542.30 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$341.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$542.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$350.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$478.50
|
| Rate for Payer: Blue Shield of California Commercial |
$396.20
|
| Rate for Payer: Blue Shield of California EPN |
$374.51
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$542.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$542.30
|
| Rate for Payer: Dignity Health Senior |
$542.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$394.92
|
| Rate for Payer: Heritage Provider Network Senior |
$394.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$307.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$542.30
|
| Rate for Payer: Vantage Medical Group Senior |
$542.30
|
|
|
HC BIOPHYSICAL PROFILE WO NST SINGLE FETUS
|
Facility
IP
|
$638.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
910400113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$478.50 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.31
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$431.93
|
| Rate for Payer: Heritage Provider Network Senior |
$431.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
|
|
HC BIOPHYSICAL PROFILE WO NST SINGLE FETUS
|
Facility
OP
|
$638.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
910400113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$478.50 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$120.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$331.70
|
| Rate for Payer: Blue Shield of California EPN |
$188.63
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$394.92
|
| Rate for Payer: Heritage Provider Network Senior |
$394.92
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$123.02
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC BIOPSY ANORECTAL WALL
|
Facility
IP
|
$4,986.00
|
|
|
Service Code
|
CPT 45100
|
| Hospital Charge Code |
906745100
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$902.47 |
| Max. Negotiated Rate |
$3,739.50 |
| Rate for Payer: Adventist Health Commercial |
$997.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,425.38
|
| Rate for Payer: Cash Price |
$2,243.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,375.52
|
| Rate for Payer: Heritage Provider Network Senior |
$3,375.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$902.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,246.50
|
| Rate for Payer: Multiplan Commercial |
$3,739.50
|
|
|
HC BIOPSY ANORECTAL WALL
|
Facility
OP
|
$5,770.00
|
|
|
Service Code
|
CPT 45100
|
| Hospital Charge Code |
906745100
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$263.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,154.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,963.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,508.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$2,596.50
|
| Rate for Payer: Cash Price |
$2,596.50
|
| Rate for Payer: Cash Price |
$2,596.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,750.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,858.96
|
| Rate for Payer: Dignity Health Senior |
$3,508.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,508.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,571.63
|
| Rate for Payer: Heritage Provider Network Senior |
$4,315.02
|
| Rate for Payer: Humana Medicare |
$3,508.15
|
| Rate for Payer: IEHP Medi-Cal |
$263.09
|
| Rate for Payer: IEHP Medicare Advantage |
$3,508.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,665.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,044.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,139.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,442.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,420.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,420.27
|
| Rate for Payer: Multiplan Commercial |
$4,327.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| 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 Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,508.15
|
|
|
HC BIOPSY EXTERNAL EAR
|
Facility
IP
|
$1,128.00
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
900501504
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.17 |
| Max. Negotiated Rate |
$846.00 |
| Rate for Payer: Adventist Health Commercial |
$225.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$774.94
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$763.66
|
| Rate for Payer: Heritage Provider Network Senior |
$763.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.00
|
| Rate for Payer: Multiplan Commercial |
$846.00
|
|
|
HC BIOPSY EXTERNAL EAR
|
Facility
OP
|
$1,128.00
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
900501504
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.02 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$225.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$100.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$774.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$733.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: Dignity Health Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$733.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$305.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$763.66
|
| Rate for Payer: Heritage Provider Network Senior |
$763.66
|
| Rate for Payer: Humana Medicare |
$305.19
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$543.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$846.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$409.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$376.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC BIOPSY OF CERVIX
|
Facility
OP
|
$1,456.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
900501433
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.54 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$291.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,000.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,004.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$946.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.87
|
| Rate for Payer: Dignity Health Senior |
$1,004.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,004.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$985.71
|
| Rate for Payer: Heritage Provider Network Senior |
$985.71
|
| Rate for Payer: Humana Medicare |
$1,004.43
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,004.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$701.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,265.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,265.58
|
| Rate for Payer: Multiplan Commercial |
$1,092.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$528.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$486.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1,004.43
|
|
|
HC BIOPSY OF CERVIX
|
Facility
IP
|
$1,456.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
900501433
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.54 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Adventist Health Commercial |
$291.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,000.27
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$985.71
|
| Rate for Payer: Heritage Provider Network Senior |
$985.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$1,092.00
|
|
|
HC BIOPSY OF HIP JOINT
|
Facility
OP
|
$7,876.00
|
|
|
Service Code
|
CPT 27052
|
| Hospital Charge Code |
909020043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$162.61 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,575.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,410.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| 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 |
$3,544.20
|
| Rate for Payer: Cash Price |
$3,544.20
|
| Rate for Payer: Cash Price |
$3,544.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,119.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,875.24
|
| Rate for Payer: Heritage Provider Network Senior |
$2,469.95
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$162.61
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,815.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,425.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,969.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: Multiplan Commercial |
$5,907.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,208.90
|
| Rate for Payer: TriValley Medical Group Senior |
$2,208.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC BIOPSY OF HIP JOINT
|
Facility
IP
|
$7,876.00
|
|
|
Service Code
|
CPT 27052
|
| Hospital Charge Code |
909020043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,425.56 |
| Max. Negotiated Rate |
$5,907.00 |
| Rate for Payer: Adventist Health Commercial |
$1,575.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,410.81
|
| Rate for Payer: Cash Price |
$3,544.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,332.05
|
| Rate for Payer: Heritage Provider Network Senior |
$5,332.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,425.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,969.00
|
| Rate for Payer: Multiplan Commercial |
$5,907.00
|
|
|
HC BIOPSY OF SOFT TISSUE PELVIS/HIP
|
Facility
OP
|
$2,254.00
|
|
|
Service Code
|
CPT 27040
|
| Hospital Charge Code |
904000006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$407.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$450.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,548.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,014.30
|
| Rate for Payer: Cash Price |
$1,014.30
|
| Rate for Payer: Cash Price |
$1,014.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,465.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,395.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$1,690.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| 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 |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BIOPSY OF SOFT TISSUE PELVIS/HIP
|
Facility
IP
|
$2,254.00
|
|
|
Service Code
|
CPT 27040
|
| Hospital Charge Code |
904000006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$407.97 |
| Max. Negotiated Rate |
$1,690.50 |
| Rate for Payer: Adventist Health Commercial |
$450.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,548.50
|
| Rate for Payer: Cash Price |
$1,014.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,525.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,525.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.50
|
| Rate for Payer: Multiplan Commercial |
$1,690.50
|
|
