|
HC CERV/THOR FACET INJ 3RD EA ADD
|
Facility
OP
|
$1,037.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
909020049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.03 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$207.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$712.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$881.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$570.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$777.75
|
| 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 |
$466.65
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$674.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$881.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$881.45
|
| Rate for Payer: Dignity Health Senior |
$881.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$641.90
|
| Rate for Payer: Heritage Provider Network Senior |
$641.90
|
| Rate for Payer: IEHP Medi-Cal |
$126.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$499.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.25
|
| Rate for Payer: Multiplan Commercial |
$777.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$881.45
|
| Rate for Payer: Vantage Medical Group Senior |
$881.45
|
|
|
HC CERV/THOR FACET INJ 3RD EA ADD
|
Facility
IP
|
$1,037.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
909020049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$187.70 |
| Max. Negotiated Rate |
$777.75 |
| Rate for Payer: Adventist Health Commercial |
$207.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$712.42
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$702.05
|
| Rate for Payer: Heritage Provider Network Senior |
$702.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.25
|
| Rate for Payer: Multiplan Commercial |
$777.75
|
|
|
HC CHANGE EXT/INT URETER STENT
|
Facility
OP
|
$5,263.00
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
909081852
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$704.50 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,615.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| 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 |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,420.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: Dignity Health Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,257.80
|
| Rate for Payer: Heritage Provider Network Senior |
$3,130.19
|
| Rate for Payer: Humana Medicare |
$2,544.87
|
| Rate for Payer: IEHP Medi-Cal |
$704.50
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,835.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$952.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,206.54
|
| Rate for Payer: Multiplan Commercial |
$3,947.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,799.36
|
| Rate for Payer: TriValley Medical Group Senior |
$2,799.36
|
| 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 |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC CHANGE EXT/INT URETER STENT
|
Facility
IP
|
$5,263.00
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
909081852
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$952.60 |
| Max. Negotiated Rate |
$3,947.25 |
| Rate for Payer: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,615.68
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,563.05
|
| Rate for Payer: Heritage Provider Network Senior |
$3,563.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$952.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.75
|
| Rate for Payer: Multiplan Commercial |
$3,947.25
|
|
|
HC CHANGE G-TUBE TO G-J TUBE
|
Facility
IP
|
$2,597.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
909020004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.06 |
| Max. Negotiated Rate |
$1,947.75 |
| Rate for Payer: Adventist Health Commercial |
$519.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,784.14
|
| Rate for Payer: Cash Price |
$1,168.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,758.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,758.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.25
|
| Rate for Payer: Multiplan Commercial |
$1,947.75
|
|
|
HC CHANGE G-TUBE TO G-J TUBE
|
Facility
OP
|
$2,597.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
909020004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.06 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$519.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,784.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| 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 |
$1,168.65
|
| Rate for Payer: Cash Price |
$1,168.65
|
| Rate for Payer: Cash Price |
$1,168.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,688.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,607.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: IEHP Medi-Cal |
$1,423.52
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$1,947.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,615.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,615.20
|
| 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 |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC CHANGE URETEROSTOMY TUBE
|
Facility
IP
|
$5,263.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
900501678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$952.60 |
| Max. Negotiated Rate |
$3,947.25 |
| Rate for Payer: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,615.68
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,563.05
|
| Rate for Payer: Heritage Provider Network Senior |
$3,563.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$952.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.75
|
| Rate for Payer: Multiplan Commercial |
$3,947.25
|
|
|
HC CHANGE URETEROSTOMY TUBE
|
Facility
OP
|
$5,263.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
900501678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,615.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,420.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: Dignity Health Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,563.05
|
| Rate for Payer: Heritage Provider Network Senior |
$3,563.05
|
| Rate for Payer: Humana Medicare |
$2,544.87
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,536.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$952.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,206.54
|
| Rate for Payer: Multiplan Commercial |
$3,947.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,911.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,758.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC CHECKOUT ORTHO PROSTH USE 15MIN MCAL
|
Facility
OP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900400050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$115.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$183.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$200.25
|
| 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 |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.95
|
| Rate for Payer: Dignity Health Senior |
$226.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.27
|
| Rate for Payer: Heritage Provider Network Senior |
$165.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| 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 |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC CHECKOUT ORTHO PROSTH USE 15MIN MCAL
|
Facility
IP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900400050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$200.25 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$183.43
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.76
|
| Rate for Payer: Heritage Provider Network Senior |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN MCAL
|
Facility
OP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
901300080
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$115.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$183.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$200.25
|
| 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 |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.95
|
| Rate for Payer: Dignity Health Senior |
$226.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.27
|
| Rate for Payer: Heritage Provider Network Senior |
$165.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| 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 |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN MCAL
|
Facility
IP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
901300080
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$200.25 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$183.43
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.76
|
| Rate for Payer: Heritage Provider Network Senior |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN OT
|
Facility
OP
|
$101.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
905104155
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$115.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$85.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$75.75
|
| 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 |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.85
|
| Rate for Payer: Dignity Health Senior |
$85.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.52
|
| Rate for Payer: Heritage Provider Network Senior |
$62.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| 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 |
$85.85
|
| Rate for Payer: Vantage Medical Group Senior |
$85.85
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN OT
|
Facility
IP
|
$101.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
905104155
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$75.75 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.39
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.38
|
| Rate for Payer: Heritage Provider Network Senior |
$68.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN PT
|
Facility
IP
|
$101.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
905103155
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$75.75 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.39
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.38
|
| Rate for Payer: Heritage Provider Network Senior |
$68.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN PT
|
Facility
OP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900417703
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$115.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$183.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$200.25
|
| 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 |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.95
|
| Rate for Payer: Dignity Health Senior |
$226.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.27
|
| Rate for Payer: Heritage Provider Network Senior |
$165.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| 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 |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN PT
|
Facility
IP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900417703
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$200.25 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$183.43
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.76
|
| Rate for Payer: Heritage Provider Network Senior |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN PT
|
Facility
OP
|
$101.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
905103155
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$115.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$85.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$75.75
|
| 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 |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.85
|
| Rate for Payer: Dignity Health Senior |
$85.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.52
|
| Rate for Payer: Heritage Provider Network Senior |
$62.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| 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 |
$85.85
|
| Rate for Payer: Vantage Medical Group Senior |
$85.85
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
OP
|
$1,146.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$229.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$787.30
|
| 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: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$515.70
|
| Rate for Payer: Cash Price |
$515.70
|
| Rate for Payer: Cash Price |
$515.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$744.90
|
| 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 |
$709.37
|
| Rate for Payer: Heritage Provider Network Senior |
$307.67
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: IEHP Medi-Cal |
$31.36
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.50
|
| 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 |
$859.50
|
| 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 |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| 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 CHEM CAUT OF GRANULATION TISS
|
Facility
IP
|
$1,146.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.43 |
| Max. Negotiated Rate |
$859.50 |
| Rate for Payer: Adventist Health Commercial |
$229.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$787.30
|
| Rate for Payer: Cash Price |
$515.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$775.84
|
| Rate for Payer: Heritage Provider Network Senior |
$775.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.50
|
| Rate for Payer: Multiplan Commercial |
$859.50
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
OP
|
$1,146.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$229.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$787.30
|
| 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 |
$515.70
|
| Rate for Payer: Cash Price |
$515.70
|
| Rate for Payer: Cash Price |
$515.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$744.90
|
| 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 |
$775.84
|
| Rate for Payer: Heritage Provider Network Senior |
$775.84
|
| 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 |
$552.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.50
|
| 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 |
$859.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$416.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$382.88
|
| 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 CHEM CAUT OF GRANULATION TISS
|
Facility
IP
|
$1,146.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$207.43 |
| Max. Negotiated Rate |
$859.50 |
| Rate for Payer: Adventist Health Commercial |
$229.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$787.30
|
| Rate for Payer: Cash Price |
$515.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$775.84
|
| Rate for Payer: Heritage Provider Network Senior |
$775.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.50
|
| Rate for Payer: Multiplan Commercial |
$859.50
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
OP
|
$2,616.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$199.11 |
| Max. Negotiated Rate |
$1,962.00 |
| Rate for Payer: Adventist Health Commercial |
$523.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$199.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,797.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$1,177.20
|
| Rate for Payer: Cash Price |
$1,177.20
|
| Rate for Payer: Cash Price |
$1,177.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,700.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: Dignity Health Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,700.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$423.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,619.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,619.30
|
| Rate for Payer: Humana Medicare |
$423.14
|
| Rate for Payer: IEHP Medi-Cal |
$203.80
|
| Rate for Payer: IEHP Medicare Advantage |
$423.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$803.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$499.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$533.16
|
| Rate for Payer: Multiplan Commercial |
$1,962.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$465.45
|
| Rate for Payer: TriValley Medical Group Senior |
$423.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$727.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$610.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
IP
|
$2,616.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$473.50 |
| Max. Negotiated Rate |
$1,962.00 |
| Rate for Payer: Adventist Health Commercial |
$523.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,797.19
|
| Rate for Payer: Cash Price |
$1,177.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,771.03
|
| Rate for Payer: Heritage Provider Network Senior |
$1,771.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.00
|
| Rate for Payer: Multiplan Commercial |
$1,962.00
|
|
|
HC CHEMO ADMIN INTRA-ART PUSH
|
Facility
OP
|
$1,109.00
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
911800810
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$65.79 |
| Max. Negotiated Rate |
$831.75 |
| Rate for Payer: Adventist Health Commercial |
$221.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$264.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$761.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.00
|
| Rate for Payer: Blue Shield of California Commercial |
$688.69
|
| Rate for Payer: Blue Shield of California EPN |
$650.98
|
| Rate for Payer: Cash Price |
$499.05
|
| Rate for Payer: Cash Price |
$499.05
|
| Rate for Payer: Cash Price |
$499.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$720.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: Dignity Health Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$423.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$686.47
|
| Rate for Payer: Heritage Provider Network Senior |
$686.47
|
| Rate for Payer: Humana Medicare |
$423.14
|
| Rate for Payer: IEHP Medi-Cal |
$65.79
|
| Rate for Payer: IEHP Medicare Advantage |
$423.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$803.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$499.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$533.16
|
| Rate for Payer: Multiplan Commercial |
$831.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$465.45
|
| Rate for Payer: TriValley Medical Group Senior |
$423.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$727.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$610.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
