|
HC BLOOD GAS SODIUM
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900801123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.12
|
| Rate for Payer: Blue Shield of California Commercial |
$37.56
|
| Rate for Payer: Blue Shield of California EPN |
$29.37
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: Dignity Health Senior |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: IEHP Medi-Cal |
$5.48
|
| Rate for Payer: IEHP Medicare Advantage |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.81
|
| Rate for Payer: TriValley Medical Group Senior |
$4.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC BLOOD OCCULT FECES
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
900911638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$124.21 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.02
|
| Rate for Payer: Blue Shield of California Commercial |
$124.21
|
| Rate for Payer: Blue Shield of California EPN |
$97.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.51
|
| Rate for Payer: Dignity Health Senior |
$15.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Humana Medicare |
$15.92
|
| Rate for Payer: IEHP Medi-Cal |
$22.06
|
| Rate for Payer: IEHP Medicare Advantage |
$15.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.06
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.92
|
| Rate for Payer: TriValley Medical Group Senior |
$15.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.51
|
| Rate for Payer: Vantage Medical Group Senior |
$15.92
|
|
|
HC BLOOD OCCULT FECES
|
Facility
IP
|
$122.00
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
900911638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.81
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.59
|
| Rate for Payer: Heritage Provider Network Senior |
$82.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.50
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
|
|
HC BLOOD PH PCO2 P02 (POC)
|
Facility
IP
|
$227.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
900912112
|
|
Hospital Revenue Code
|
301
|
| 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 BLOOD PH PCO2 P02 (POC)
|
Facility
OP
|
$227.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
900912112
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$170.25 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.95
|
| Rate for Payer: Blue Shield of California Commercial |
$151.15
|
| Rate for Payer: Blue Shield of California EPN |
$118.16
|
| 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 |
$39.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.68
|
| Rate for Payer: Dignity Health Senior |
$26.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.51
|
| Rate for Payer: Heritage Provider Network Senior |
$140.51
|
| Rate for Payer: Humana Medicare |
$26.07
|
| Rate for Payer: IEHP Medi-Cal |
$18.49
|
| Rate for Payer: IEHP Medicare Advantage |
$26.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.85
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.07
|
| Rate for Payer: TriValley Medical Group Senior |
$26.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.68
|
| Rate for Payer: Vantage Medical Group Senior |
$26.07
|
|
|
HC BLOOD/PLASMA VOLUME
|
Facility
OP
|
$1,951.00
|
|
|
Service Code
|
CPT 78111
|
| Hospital Charge Code |
909301331
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$81.76 |
| Max. Negotiated Rate |
$3,370.88 |
| Rate for Payer: Adventist Health Commercial |
$390.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$170.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,340.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Blue Shield of California Commercial |
$527.56
|
| Rate for Payer: Blue Shield of California EPN |
$300.01
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,268.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: Dignity Health Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,268.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,774.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,207.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,207.67
|
| Rate for Payer: Humana Medicare |
$1,774.15
|
| Rate for Payer: IEHP Medi-Cal |
$81.76
|
| Rate for Payer: IEHP Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,370.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,093.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,235.43
|
| Rate for Payer: Multiplan Commercial |
$1,463.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,951.56
|
| Rate for Payer: TriValley Medical Group Senior |
$1,774.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC BLOOD/PLASMA VOLUME
|
Facility
IP
|
$1,951.00
|
|
|
Service Code
|
CPT 78111
|
| Hospital Charge Code |
909301331
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$353.13 |
| Max. Negotiated Rate |
$1,463.25 |
| Rate for Payer: Adventist Health Commercial |
$390.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,340.34
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,320.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,320.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.75
|
| Rate for Payer: Multiplan Commercial |
$1,463.25
|
|
|
HC BODY FLUID LIPD ANAL ELECT TECH
|
Facility
IP
|
$96.69
|
|
|
Service Code
|
CPT 82664
|
| Hospital Charge Code |
900913920
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$72.52 |
| Rate for Payer: Adventist Health Commercial |
$19.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.43
|
| Rate for Payer: Cash Price |
$43.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.46
|
| Rate for Payer: Heritage Provider Network Senior |
$65.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.17
|
| Rate for Payer: Multiplan Commercial |
$72.52
|
|
|
HC BODY FLUID LIPD ANAL ELECT TECH
|
Facility
OP
|
$96.69
|
|
|
Service Code
|
CPT 82664
|
| Hospital Charge Code |
900913920
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$268.32 |
| Rate for Payer: Adventist Health Commercial |
$19.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$99.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$92.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$67.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$244.11
|
| Rate for Payer: Blue Shield of California Commercial |
$268.32
|
| Rate for Payer: Blue Shield of California EPN |
$209.76
|
| Rate for Payer: Cash Price |
$43.51
|
| Rate for Payer: Cash Price |
$43.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.65
|
| Rate for Payer: Dignity Health Senior |
$61.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$61.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.85
|
| Rate for Payer: Heritage Provider Network Senior |
$59.85
|
| Rate for Payer: Humana Medicare |
$61.50
|
| Rate for Payer: IEHP Medi-Cal |
$37.46
|
| Rate for Payer: IEHP Medicare Advantage |
$61.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$116.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.49
|
| Rate for Payer: Multiplan Commercial |
$72.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$61.50
|
| Rate for Payer: TriValley Medical Group Senior |
$61.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$66.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.65
|
| Rate for Payer: Vantage Medical Group Senior |
$61.50
|
|
|
HC BODY FLUID LIPD ANAL SPEC ANLYT
|
Facility
OP
|
$12.73
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900913918
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$58.55 |
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.55
|
| Rate for Payer: Blue Shield of California Commercial |
$54.61
|
| Rate for Payer: Blue Shield of California EPN |
$42.69
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.91
|
| Rate for Payer: Dignity Health Senior |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.88
|
| Rate for Payer: Heritage Provider Network Senior |
$7.88
|
| Rate for Payer: Humana Medicare |
$8.10
|
| Rate for Payer: IEHP Medi-Cal |
$10.11
|
| Rate for Payer: IEHP Medicare Advantage |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.21
|
| Rate for Payer: Multiplan Commercial |
$9.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Senior |
$8.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC BODY FLUID LIPD ANAL SPEC ANLYT
|
Facility
IP
|
$12.73
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900913918
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.75
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.62
|
| Rate for Payer: Heritage Provider Network Senior |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$9.55
|
|
|
HC BODY PLETHYSMOGRAPHY
|
Facility
OP
|
$652.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
900801003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$75.02 |
| Max. Negotiated Rate |
$745.12 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$99.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$447.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Blue Shield of California Commercial |
$238.13
|
| Rate for Payer: Blue Shield of California EPN |
$135.42
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$423.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$423.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$403.59
|
| Rate for Payer: Heritage Provider Network Senior |
$403.59
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: IEHP Medi-Cal |
$75.02
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$745.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$431.39
|
| Rate for Payer: TriValley Medical Group Senior |
$392.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC BODY PLETHYSMOGRAPHY
|
Facility
IP
|
$652.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
900801003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$118.01 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$447.92
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$441.40
|
| Rate for Payer: Heritage Provider Network Senior |
$441.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.00
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
|
|
HC BONE AGE
|
Facility
IP
|
$565.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
909001602
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.26 |
| Max. Negotiated Rate |
$423.75 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.16
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$382.50
|
| Rate for Payer: Heritage Provider Network Senior |
$382.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.25
|
| Rate for Payer: Multiplan Commercial |
$423.75
|
|
|
HC BONE AGE
|
Facility
OP
|
$565.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
909001602
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.69 |
| Max. Negotiated Rate |
$423.75 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.16
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$124.99
|
| Rate for Payer: Blue Shield of California Commercial |
$69.48
|
| Rate for Payer: Blue Shield of California EPN |
$39.51
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$367.25
|
| 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 |
$367.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$349.74
|
| Rate for Payer: Heritage Provider Network Senior |
$349.74
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$30.69
|
| 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 |
$102.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.25
|
| 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 |
$423.75
|
| 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 |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| 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 BONE BIOPSY DEEP, PERCUTAN
|
Facility
IP
|
$4,851.00
|
|
|
Service Code
|
CPT 20225
|
| Hospital Charge Code |
909000107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$878.03 |
| Max. Negotiated Rate |
$3,638.25 |
| Rate for Payer: Adventist Health Commercial |
$970.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,332.64
|
| Rate for Payer: Cash Price |
$2,182.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,284.13
|
| Rate for Payer: Heritage Provider Network Senior |
$3,284.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$878.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,212.75
|
| Rate for Payer: Multiplan Commercial |
$3,638.25
|
|
|
HC BONE BIOPSY DEEP, PERCUTAN
|
Facility
OP
|
$4,851.00
|
|
|
Service Code
|
CPT 20225
|
| Hospital Charge Code |
909000107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$970.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,332.64
|
| 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 |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$2,182.95
|
| Rate for Payer: Cash Price |
$2,182.95
|
| Rate for Payer: Cash Price |
$2,182.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,153.15
|
| 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 |
$3,002.77
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$232.32
|
| 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 |
$878.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,212.75
|
| 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 |
$3,638.25
|
| 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 |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| 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 BONE BIOPSY SUPFCL, PERCUT
|
Facility
IP
|
$1,705.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
909000106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.60 |
| Max. Negotiated Rate |
$1,278.75 |
| Rate for Payer: Adventist Health Commercial |
$341.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,171.34
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,154.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,154.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.25
|
| Rate for Payer: Multiplan Commercial |
$1,278.75
|
|
|
HC BONE BIOPSY SUPFCL, PERCUT
|
Facility
OP
|
$1,705.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
909000106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.01 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$341.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,171.34
|
| 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 |
$767.25
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,108.25
|
| 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 |
$1,055.40
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$133.01
|
| 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 |
$308.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.25
|
| 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 |
$1,278.75
|
| 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 BONE CEMENT
|
Facility
IP
|
$805.00
|
|
| Hospital Charge Code |
909081735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$386.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$544.98
|
| Rate for Payer: Heritage Provider Network Senior |
$544.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$293.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$268.95
|
|
|
HC BONE CEMENT
|
Facility
OP
|
$805.00
|
|
| Hospital Charge Code |
909081735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$386.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$603.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$499.90
|
| Rate for Payer: Blue Shield of California EPN |
$472.54
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$370.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: Dignity Health Senior |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$515.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$372.72
|
| Rate for Payer: Heritage Provider Network Senior |
$372.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$293.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$268.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC BONE, FINE NEEDLE ASPIRATION
|
Facility
IP
|
$1,515.00
|
|
|
Service Code
|
CPT 20615
|
| Hospital Charge Code |
909020019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$274.22 |
| Max. Negotiated Rate |
$1,136.25 |
| Rate for Payer: Adventist Health Commercial |
$303.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,040.80
|
| Rate for Payer: Cash Price |
$681.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,025.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,025.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.75
|
| Rate for Payer: Multiplan Commercial |
$1,136.25
|
|
|
HC BONE, FINE NEEDLE ASPIRATION
|
Facility
OP
|
$1,515.00
|
|
|
Service Code
|
CPT 20615
|
| Hospital Charge Code |
909020019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$263.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$303.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,040.80
|
| 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 |
$681.75
|
| Rate for Payer: Cash Price |
$681.75
|
| Rate for Payer: Cash Price |
$681.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$984.75
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$937.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$263.09
|
| 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 |
$274.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.75
|
| 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 |
$1,136.25
|
| 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 BONE LENGTH
|
Facility
OP
|
$606.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
909001603
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Adventist Health Commercial |
$121.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$416.32
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$189.17
|
| Rate for Payer: Blue Shield of California Commercial |
$114.87
|
| Rate for Payer: Blue Shield of California EPN |
$65.32
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$393.90
|
| 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 |
$393.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.11
|
| Rate for Payer: Heritage Provider Network Senior |
$375.11
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$50.00
|
| 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 |
$109.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.50
|
| 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 |
$454.50
|
| 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 |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| 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 BONE LENGTH
|
Facility
IP
|
$606.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
909001603
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.69 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Adventist Health Commercial |
$121.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$416.32
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.26
|
| Rate for Payer: Heritage Provider Network Senior |
$410.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.50
|
| Rate for Payer: Multiplan Commercial |
$454.50
|
|
