|
HC DEB SKIN SUBQ FOREIGN MATERIAL
|
Facility
IP
|
$983.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
900501008
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.92 |
| Max. Negotiated Rate |
$737.25 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$675.32
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$665.49
|
| Rate for Payer: Heritage Provider Network Senior |
$665.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.75
|
| Rate for Payer: Multiplan Commercial |
$737.25
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
OP
|
$689.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.87
|
| Rate for Payer: Blue Shield of California EPN |
$404.44
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$447.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$426.49
|
| Rate for Payer: Heritage Provider Network Senior |
$426.49
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: IEHP Medi-Cal |
$162.04
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$946.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$548.02
|
| Rate for Payer: TriValley Medical Group Senior |
$498.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
OP
|
$689.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.87
|
| Rate for Payer: Blue Shield of California EPN |
$404.44
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$447.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$426.49
|
| Rate for Payer: Heritage Provider Network Senior |
$426.49
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: IEHP Medi-Cal |
$162.04
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$946.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$548.02
|
| Rate for Payer: TriValley Medical Group Senior |
$548.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
OP
|
$689.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$447.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.45
|
| Rate for Payer: Heritage Provider Network Senior |
$466.45
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$332.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$250.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$230.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
IP
|
$689.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$516.75 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.45
|
| Rate for Payer: Heritage Provider Network Senior |
$466.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
IP
|
$689.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$516.75 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.45
|
| Rate for Payer: Heritage Provider Network Senior |
$466.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
IP
|
$689.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$516.75 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.45
|
| Rate for Payer: Heritage Provider Network Senior |
$466.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
|
|
HC DEB SUBQ AND DERMIS TISSUE EACH ADDL 20 SQ CM
|
Facility
OP
|
$614.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
900101491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$122.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$421.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$521.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$337.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$460.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$381.29
|
| Rate for Payer: Blue Shield of California EPN |
$360.42
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$399.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$521.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$521.90
|
| Rate for Payer: Dignity Health Senior |
$521.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$380.07
|
| Rate for Payer: Heritage Provider Network Senior |
$380.07
|
| Rate for Payer: IEHP Medi-Cal |
$22.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$295.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.50
|
| Rate for Payer: Multiplan Commercial |
$460.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$307.00
|
| Rate for Payer: TriValley Medical Group Senior |
$307.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$521.90
|
| Rate for Payer: Vantage Medical Group Senior |
$521.90
|
|
|
HC DEB SUBQ AND DERMIS TISSUE EACH ADDL 20 SQ CM
|
Facility
IP
|
$614.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
900101491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.13 |
| Max. Negotiated Rate |
$460.50 |
| Rate for Payer: Adventist Health Commercial |
$122.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$421.82
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$415.68
|
| Rate for Payer: Heritage Provider Network Senior |
$415.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.50
|
| Rate for Payer: Multiplan Commercial |
$460.50
|
|
|
HC DECALCIFICATION PROCEDURE
|
Facility
IP
|
$186.00
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
903800028
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.92
|
| Rate for Payer: Heritage Provider Network Senior |
$125.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
|
|
HC DECALCIFICATION PROCEDURE
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
903800028
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.02
|
| Rate for Payer: Blue Shield of California Commercial |
$21.74
|
| Rate for Payer: Blue Shield of California EPN |
$20.54
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.75
|
| Rate for Payer: Dignity Health Senior |
$29.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: IEHP Medi-Cal |
$12.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
|
|
HC DECOMPRESSION LOWER LEG
|
Facility
OP
|
$5,230.00
|
|
|
Service Code
|
CPT 27600
|
| Hospital Charge Code |
900501510
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,046.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,593.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,353.50
|
| Rate for Payer: Cash Price |
$2,353.50
|
| Rate for Payer: Cash Price |
$2,353.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,399.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,540.71
|
| Rate for Payer: Heritage Provider Network Senior |
$3,540.71
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,520.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$946.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,307.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$3,922.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,899.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,747.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC DECOMPRESSION LOWER LEG
|
Facility
IP
|
$5,230.00
|
|
|
Service Code
|
CPT 27600
|
| Hospital Charge Code |
900501510
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$946.63 |
| Max. Negotiated Rate |
$3,922.50 |
| Rate for Payer: Adventist Health Commercial |
$1,046.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,593.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,207.06
|
| Rate for Payer: Blue Shield of California EPN |
$2,102.46
|
| Rate for Payer: Cash Price |
$2,353.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,540.71
|
| Rate for Payer: Heritage Provider Network Senior |
$3,540.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$946.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,307.50
|
| Rate for Payer: Multiplan Commercial |
$3,922.50
|
|
|
HC DELIVERY OF PLACENTA
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
902400375
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.74
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.40
|
| Rate for Payer: Heritage Provider Network Senior |
$91.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
|
|
HC DELIVERY OF PLACENTA
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
902400375
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$181.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: Dignity Health Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.40
|
| Rate for Payer: Heritage Provider Network Senior |
$91.40
|
| Rate for Payer: Humana Medicare |
$3,906.18
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$65.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,609.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,921.79
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$49.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$45.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$506.33 |
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$266.49
|
| 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 |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: Dignity Health Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$266.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.14
|
| Rate for Payer: Heritage Provider Network Senior |
$63.14
|
| Rate for Payer: Humana Medicare |
$266.49
|
| Rate for Payer: IEHP Medi-Cal |
$13.42
|
| Rate for Payer: IEHP Medicare Advantage |
$266.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$506.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$314.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.78
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
| 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 |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.07
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.05
|
| Rate for Payer: Heritage Provider Network Senior |
$69.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
|
|
HC DENTAL IMPLANT/NOBLEGUIDE
|
Facility
OP
|
$662.00
|
|
| Hospital Charge Code |
909201006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$119.82 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Adventist Health Commercial |
$132.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$353.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$454.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$562.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$364.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$496.50
|
| Rate for Payer: Blue Shield of California Commercial |
$411.10
|
| Rate for Payer: Blue Shield of California EPN |
$388.59
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$562.70
|
| Rate for Payer: Dignity Health Senior |
$562.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$319.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.50
|
| Rate for Payer: Multiplan Commercial |
$496.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$562.70
|
| Rate for Payer: Vantage Medical Group Senior |
$562.70
|
|
|
HC DENTAL IMPLANT/NOBLEGUIDE
|
Facility
IP
|
$662.00
|
|
| Hospital Charge Code |
909201006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$119.82 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$132.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$454.79
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$448.17
|
| Rate for Payer: Heritage Provider Network Senior |
$448.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.50
|
| Rate for Payer: Multiplan Commercial |
$496.50
|
|
|
HC DERMABOND
|
Facility
OP
|
$79.00
|
|
| Hospital Charge Code |
909081731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$59.25
|
| Rate for Payer: Blue Shield of California Commercial |
$49.06
|
| Rate for Payer: Blue Shield of California EPN |
$46.37
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Senior |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC DERMABOND
|
Facility
IP
|
$79.00
|
|
| Hospital Charge Code |
909081731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.27
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
|
HC DERMATOPHAGOIDES MICROCERAS IGE
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
|
|
HC DERMATOPHAGOIDES MICROCERAS IGE
|
Facility
OP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: IEHP Medi-Cal |
$7.24
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
IP
|
$9,032.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906811497
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,634.79 |
| Max. Negotiated Rate |
$6,774.00 |
| Rate for Payer: Adventist Health Commercial |
$1,806.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,204.98
|
| Rate for Payer: Cash Price |
$4,064.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,114.66
|
| Rate for Payer: Heritage Provider Network Senior |
$6,114.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,634.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,258.00
|
| Rate for Payer: Multiplan Commercial |
$6,774.00
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
OP
|
$9,032.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906811497
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$277.93 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$1,806.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$547.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,204.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,017.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$4,064.40
|
| Rate for Payer: Cash Price |
$4,064.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,870.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,870.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,590.81
|
| Rate for Payer: Heritage Provider Network Senior |
$5,590.81
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$277.93
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,634.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,258.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$6,774.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
