|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
OP
|
$9,203.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906820023
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$277.93 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$1,840.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$547.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,322.46
|
| 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 |
$4,141.35
|
| Rate for Payer: Cash Price |
$4,141.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,981.95
|
| 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 |
$5,981.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,696.66
|
| Rate for Payer: Heritage Provider Network Senior |
$5,696.66
|
| 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 |
$1,665.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,300.75
|
| 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 |
$6,902.25
|
| 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
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
IP
|
$9,203.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906820023
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,665.74 |
| Max. Negotiated Rate |
$6,902.25 |
| Rate for Payer: Adventist Health Commercial |
$1,840.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,322.46
|
| Rate for Payer: Cash Price |
$4,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,230.43
|
| Rate for Payer: Heritage Provider Network Senior |
$6,230.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,665.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,300.75
|
| Rate for Payer: Multiplan Commercial |
$6,902.25
|
|
|
HC DEST BENIGN/PREMAL 1ST LESION
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| 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 |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| 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 |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| 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 |
$101.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| 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 |
$157.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$76.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$70.16
|
| 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 DEST BENIGN/PREMAL 1ST LESION
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC DEST FLAT WARTS UP TO 14 LESIONS
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
900501049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.40 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$195.11
|
| 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 |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$184.60
|
| 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 |
$192.27
|
| Rate for Payer: Heritage Provider Network Senior |
$192.27
|
| 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 |
$136.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.00
|
| 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 |
$213.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$103.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$94.88
|
| 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 DEST FLAT WARTS UP TO 14 LESIONS
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
900501049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.40 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$195.11
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$192.27
|
| Rate for Payer: Heritage Provider Network Senior |
$192.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.00
|
| Rate for Payer: Multiplan Commercial |
$213.00
|
|
|
HC DEST MALGNANT LESION LT 0.5 CM
|
Facility
IP
|
$426.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
900501361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.11 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Adventist Health Commercial |
$85.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$292.66
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$288.40
|
| Rate for Payer: Heritage Provider Network Senior |
$288.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.50
|
| Rate for Payer: Multiplan Commercial |
$319.50
|
|
|
HC DEST MALGNANT LESION LT 0.5 CM
|
Facility
OP
|
$426.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
900501361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.11 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$85.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$292.66
|
| 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 |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$276.90
|
| 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 |
$288.40
|
| Rate for Payer: Heritage Provider Network Senior |
$288.40
|
| 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 |
$205.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.50
|
| 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 |
$319.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$142.33
|
| 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 DEST OF LESIONS LT 10 SQ CM
|
Facility
OP
|
$614.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
900501553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.13 |
| 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 |
$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 |
$3,237.00
|
| 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 |
$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 |
$415.68
|
| Rate for Payer: Heritage Provider Network Senior |
$415.68
|
| 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 |
$295.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.50
|
| 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 |
$460.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$222.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$205.14
|
| 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 DEST OF LESIONS LT 10 SQ CM
|
Facility
IP
|
$614.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
900501553
|
|
Hospital Revenue Code
|
450
|
| 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 DESTUCT BY NEURO AGENT
|
Facility
OP
|
$2,262.00
|
|
|
Service Code
|
CPT 64630
|
| Hospital Charge Code |
950442347
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.33 |
| Max. Negotiated Rate |
$4,706.95 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,553.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$1,017.90
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,470.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,357.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,400.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.76
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: IEHP Medi-Cal |
$153.33
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,163.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$1,696.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,252.71
|
| Rate for Payer: TriValley Medical Group Senior |
$1,252.71
|
| 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 |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC DESTUCT BY NEURO AGENT
|
Facility
IP
|
$2,262.00
|
|
|
Service Code
|
CPT 64630
|
| Hospital Charge Code |
950442347
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$409.42 |
| Max. Negotiated Rate |
$1,696.50 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,553.99
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,531.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,531.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.50
|
| Rate for Payer: Multiplan Commercial |
$1,696.50
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
IP
|
$298.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$223.50 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.73
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.75
|
| Rate for Payer: Heritage Provider Network Senior |
$201.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
OP
|
$298.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$163.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$223.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.30
|
| Rate for Payer: Dignity Health Senior |
$253.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.75
|
| Rate for Payer: Heritage Provider Network Senior |
$201.75
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$143.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$108.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
|
|
HC DEVELOP TESTING W/INTERP & RPT OT
|
Facility
OP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905104361
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$318.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$206.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$281.25
|
| 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 |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$243.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$318.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$318.75
|
| Rate for Payer: Dignity Health Senior |
$318.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$232.12
|
| Rate for Payer: Heritage Provider Network Senior |
$232.12
|
| Rate for Payer: IEHP Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$180.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| 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 |
$318.75
|
| Rate for Payer: Vantage Medical Group Senior |
$318.75
|
|
|
HC DEVELOP TESTING W/INTERP & RPT OT
|
Facility
IP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905104361
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.62
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.88
|
| Rate for Payer: Heritage Provider Network Senior |
$253.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT PT
|
Facility
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905103400
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$223.35 |
| Max. Negotiated Rate |
$925.50 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.76
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$835.42
|
| Rate for Payer: Heritage Provider Network Senior |
$835.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.50
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT PT
|
Facility
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905103400
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$925.50
|
| 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 |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$802.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.90
|
| Rate for Payer: Dignity Health Senior |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$802.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$763.85
|
| Rate for Payer: Heritage Provider Network Senior |
$763.85
|
| Rate for Payer: IEHP Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$594.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.50
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$223.35 |
| Max. Negotiated Rate |
$925.50 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.76
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$835.42
|
| Rate for Payer: Heritage Provider Network Senior |
$835.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.50
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$925.50
|
| 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 |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$802.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.90
|
| Rate for Payer: Dignity Health Senior |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$802.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$763.85
|
| Rate for Payer: Heritage Provider Network Senior |
$763.85
|
| Rate for Payer: IEHP Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$594.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.50
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$223.35 |
| Max. Negotiated Rate |
$925.50 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.76
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$835.42
|
| Rate for Payer: Heritage Provider Network Senior |
$835.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.50
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$925.50
|
| 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 |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$802.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.90
|
| Rate for Payer: Dignity Health Senior |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$802.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$763.85
|
| Rate for Payer: Heritage Provider Network Senior |
$763.85
|
| Rate for Payer: IEHP Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$594.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.50
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$925.50
|
| 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 |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$802.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.90
|
| Rate for Payer: Dignity Health Senior |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$802.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$763.85
|
| Rate for Payer: Heritage Provider Network Senior |
$763.85
|
| Rate for Payer: IEHP Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$594.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.50
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$223.35 |
| Max. Negotiated Rate |
$925.50 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.76
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$835.42
|
| Rate for Payer: Heritage Provider Network Senior |
$835.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.50
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
|
|
HC DFIB BS DYNAGEN CRT G151
|
Facility
OP
|
$30,210.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,042.00 |
| Max. Negotiated Rate |
$25,678.50 |
| Rate for Payer: Adventist Health Commercial |
$6,042.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14,500.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,754.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25,678.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16,615.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22,657.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18,760.41
|
| Rate for Payer: Blue Shield of California EPN |
$17,733.27
|
| Rate for Payer: Cash Price |
$13,594.50
|
| Rate for Payer: Cash Price |
$13,594.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,896.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,678.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,678.50
|
| Rate for Payer: Dignity Health Senior |
$25,678.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,334.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,987.23
|
| Rate for Payer: Heritage Provider Network Senior |
$13,987.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,105.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,105.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,105.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,552.50
|
| Rate for Payer: Multiplan Commercial |
$22,657.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,014.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,093.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,678.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25,678.50
|
|
