|
HC EGFR
|
Facility
OP
|
$364.00
|
|
|
Service Code
|
CPT 81235
|
| Hospital Charge Code |
903800314
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.88 |
| Max. Negotiated Rate |
$616.70 |
| Rate for Payer: Adventist Health Commercial |
$72.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$432.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$250.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$486.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$357.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$324.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.64
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$236.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$486.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.04
|
| Rate for Payer: Dignity Health Senior |
$324.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$324.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.32
|
| Rate for Payer: Heritage Provider Network Senior |
$225.32
|
| Rate for Payer: Humana Medicare |
$324.58
|
| Rate for Payer: IEHP Medi-Cal |
$280.80
|
| Rate for Payer: IEHP Medicare Advantage |
$324.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$616.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.97
|
| Rate for Payer: Multiplan Commercial |
$273.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$324.58
|
| Rate for Payer: TriValley Medical Group Senior |
$324.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$350.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$350.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$486.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.04
|
| Rate for Payer: Vantage Medical Group Senior |
$324.58
|
|
|
HC EKOS THROMLYSIS CATH
|
Facility
IP
|
$6,704.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.80 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,340.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,217.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,605.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,083.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,620.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,538.61
|
| Rate for Payer: Heritage Provider Network Senior |
$4,538.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,352.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,352.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,352.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,676.00
|
| Rate for Payer: Multiplan Commercial |
$5,028.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,444.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,239.81
|
|
|
HC EKOS THROMLYSIS CATH
|
Facility
OP
|
$6,704.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.80 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$1,340.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,217.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,605.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,698.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,687.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,028.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,163.18
|
| Rate for Payer: Blue Shield of California EPN |
$3,935.25
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,083.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,698.40
|
| Rate for Payer: Dignity Health Senior |
$5,698.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,290.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,103.95
|
| Rate for Payer: Heritage Provider Network Senior |
$3,103.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,352.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,352.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,352.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,676.00
|
| Rate for Payer: Multiplan Commercial |
$5,028.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,444.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,239.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,698.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,698.40
|
|
|
HC ELASTOPLAST
|
Facility
OP
|
$12.00
|
|
| Hospital Charge Code |
909001032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7.45
|
| Rate for Payer: Blue Shield of California EPN |
$7.04
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Senior |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
HC ELASTOPLAST
|
Facility
IP
|
$12.00
|
|
| Hospital Charge Code |
909001032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
IP
|
$474.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.79 |
| Max. Negotiated Rate |
$355.50 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$325.64
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.90
|
| Rate for Payer: Heritage Provider Network Senior |
$320.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.50
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
OP
|
$474.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.79 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$325.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$402.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$260.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$355.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$308.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$402.90
|
| Rate for Payer: Dignity Health Senior |
$402.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.90
|
| Rate for Payer: Heritage Provider Network Senior |
$320.90
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$228.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.50
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$172.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$158.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$402.90
|
| Rate for Payer: Vantage Medical Group Senior |
$402.90
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
OP
|
$474.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.79 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$325.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$402.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$260.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$355.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$308.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$402.90
|
| Rate for Payer: Dignity Health Senior |
$402.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$293.41
|
| Rate for Payer: Heritage Provider Network Senior |
$293.41
|
| Rate for Payer: IEHP Medi-Cal |
$318.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$228.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.50
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| 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 |
$402.90
|
| Rate for Payer: Vantage Medical Group Senior |
$402.90
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
IP
|
$474.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.79 |
| Max. Negotiated Rate |
$355.50 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$325.64
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.90
|
| Rate for Payer: Heritage Provider Network Senior |
$320.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.50
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
|
|
HC ELBOW COMPLETE
|
Facility
IP
|
$646.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
909001512
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$443.80
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.34
|
| Rate for Payer: Heritage Provider Network Senior |
$437.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
|
|
HC ELBOW COMPLETE
|
Facility
OP
|
$646.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
909001512
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.53 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$57.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$443.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.59
|
| Rate for Payer: Blue Shield of California Commercial |
$117.39
|
| Rate for Payer: Blue Shield of California EPN |
$66.75
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$419.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$399.87
|
| Rate for Payer: Heritage Provider Network Senior |
$399.87
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$40.53
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC ELBOW LIMITED 2 VIEW
|
Facility
IP
|
$505.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
909001511
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$378.75 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$346.94
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$341.88
|
| Rate for Payer: Heritage Provider Network Senior |
$341.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.25
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
|
|
HC ELBOW LIMITED 2 VIEW
|
Facility
OP
|
$505.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
909001511
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$378.75 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$346.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.99
|
| Rate for Payer: Blue Shield of California Commercial |
$104.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.57
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$328.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.60
|
| Rate for Payer: Heritage Provider Network Senior |
$312.60
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$32.42
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC ELECTROGSTROGRPHY DIAG TRANSCU
|
Facility
OP
|
$1,567.00
|
|
|
Service Code
|
CPT 91132
|
| Hospital Charge Code |
906791132
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$146.70 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$313.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$272.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,076.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$705.15
|
| Rate for Payer: Cash Price |
$705.15
|
| Rate for Payer: Cash Price |
$705.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,018.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$969.97
|
| Rate for Payer: Heritage Provider Network Senior |
$482.37
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: IEHP Medi-Cal |
$146.70
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$745.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$1,175.25
|
| 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 |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC ELECTROGSTROGRPHY DIAG TRANSCU
|
Facility
IP
|
$1,655.00
|
|
|
Service Code
|
CPT 91132
|
| Hospital Charge Code |
906791132
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$299.56 |
| Max. Negotiated Rate |
$1,241.25 |
| Rate for Payer: Adventist Health Commercial |
$331.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,136.98
|
| Rate for Payer: Cash Price |
$744.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,120.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.75
|
| Rate for Payer: Multiplan Commercial |
$1,241.25
|
|
|
HC ELECTROLYTE PANEL
|
Facility
IP
|
$246.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
900912165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.00
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$166.54
|
| Rate for Payer: Heritage Provider Network Senior |
$166.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
|
|
HC ELECTROLYTE PANEL
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
900912165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$58.72 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.72
|
| Rate for Payer: Blue Shield of California Commercial |
$54.78
|
| Rate for Payer: Blue Shield of California EPN |
$42.83
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.71
|
| Rate for Payer: Dignity Health Senior |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$7.01
|
| Rate for Payer: IEHP Medi-Cal |
$9.72
|
| Rate for Payer: IEHP Medicare Advantage |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.83
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.01
|
| Rate for Payer: TriValley Medical Group Senior |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.71
|
| Rate for Payer: Vantage Medical Group Senior |
$7.01
|
|
|
HC ELECTRON MICROSCOPY COMPLEX
|
Facility
OP
|
$952.00
|
|
|
Service Code
|
CPT 88348
|
| Hospital Charge Code |
903800039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$172.31 |
| Max. Negotiated Rate |
$2,041.30 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,351.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$654.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.15
|
| Rate for Payer: Blue Shield of California Commercial |
$591.19
|
| Rate for Payer: Blue Shield of California EPN |
$558.82
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$618.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: Dignity Health Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$618.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,074.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$589.29
|
| Rate for Payer: Heritage Provider Network Senior |
$589.29
|
| Rate for Payer: Humana Medicare |
$1,074.37
|
| Rate for Payer: IEHP Medi-Cal |
$370.83
|
| Rate for Payer: IEHP Medicare Advantage |
$1,074.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,041.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,267.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,353.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,353.71
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,074.37
|
| Rate for Payer: TriValley Medical Group Senior |
$1,074.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$722.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$722.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC ELECTRON MICROSCOPY COMPLEX
|
Facility
IP
|
$4,463.00
|
|
|
Service Code
|
CPT 88348
|
| Hospital Charge Code |
903800039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$807.80 |
| Max. Negotiated Rate |
$3,347.25 |
| Rate for Payer: Adventist Health Commercial |
$892.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,066.08
|
| Rate for Payer: Cash Price |
$2,008.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,021.45
|
| Rate for Payer: Heritage Provider Network Senior |
$3,021.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$807.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,115.75
|
| Rate for Payer: Multiplan Commercial |
$3,347.25
|
|
|
HC ELECTROPHYSIO EVAL
|
Facility
OP
|
$4,746.00
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
906820090
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$949.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,260.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,486.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,084.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.69
|
| Rate for Payer: Dignity Health Senior |
$1,486.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,084.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,486.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,937.77
|
| Rate for Payer: Heritage Provider Network Senior |
$1,829.00
|
| Rate for Payer: Humana Medicare |
$1,486.99
|
| Rate for Payer: IEHP Medi-Cal |
$818.77
|
| Rate for Payer: IEHP Medicare Advantage |
$1,486.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,825.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,754.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,186.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,873.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,873.61
|
| Rate for Payer: Multiplan Commercial |
$3,559.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,635.69
|
| Rate for Payer: TriValley Medical Group Senior |
$1,486.99
|
| 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 |
$2,230.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,486.99
|
|
|
HC ELECTROPHYSIO EVAL
|
Facility
IP
|
$4,746.00
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
906813411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$859.03 |
| Max. Negotiated Rate |
$3,559.50 |
| Rate for Payer: Adventist Health Commercial |
$949.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,260.50
|
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,213.04
|
| Rate for Payer: Heritage Provider Network Senior |
$3,213.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,186.50
|
| Rate for Payer: Multiplan Commercial |
$3,559.50
|
|
|
HC ELECTROPHYSIO EVAL
|
Facility
IP
|
$4,746.00
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
906820090
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$859.03 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$949.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,260.50
|
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,186.50
|
| Rate for Payer: Multiplan Commercial |
$3,559.50
|
|
|
HC ELECTROPHYSIO EVAL
|
Facility
OP
|
$4,746.00
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
906813411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$859.03 |
| Max. Negotiated Rate |
$4,547.00 |
| Rate for Payer: Adventist Health Commercial |
$949.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,260.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,486.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: Cash Price |
$2,135.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,084.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.69
|
| Rate for Payer: Dignity Health Senior |
$1,486.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,084.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,486.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,213.04
|
| Rate for Payer: Heritage Provider Network Senior |
$3,213.04
|
| Rate for Payer: Humana Medicare |
$1,486.99
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,486.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,287.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,754.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,186.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,873.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,873.61
|
| Rate for Payer: Multiplan Commercial |
$3,559.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,723.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,585.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,486.99
|
|
|
HC ELECT STIM MANUAL 15 MIN MC
|
Facility
IP
|
$242.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
901300049
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.25
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$163.83
|
| Rate for Payer: Heritage Provider Network Senior |
$163.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
|
|
HC ELECT STIM MANUAL 15 MIN MC
|
Facility
OP
|
$242.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
901300049
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.51 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$181.50
|
| 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 |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$157.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.70
|
| Rate for Payer: Dignity Health Senior |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.80
|
| Rate for Payer: Heritage Provider Network Senior |
$149.80
|
| Rate for Payer: IEHP Medi-Cal |
$13.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$116.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| 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 |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
