|
HC ELECT STIMULATION UNATTENDED OT
|
Facility
OP
|
$285.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
905104105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.53 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$57.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$195.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$242.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$156.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$213.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$185.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$242.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$242.25
|
| Rate for Payer: Dignity Health Senior |
$242.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$176.42
|
| Rate for Payer: Heritage Provider Network Senior |
$176.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$137.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.25
|
| Rate for Payer: Multiplan Commercial |
$213.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$242.25
|
| Rate for Payer: Vantage Medical Group Senior |
$242.25
|
|
|
HC ELECT STIMULATION UNATTENDED PT
|
Facility
OP
|
$212.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
905103105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.53 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.00
|
| 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 |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$137.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Senior |
$180.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.23
|
| Rate for Payer: Heritage Provider Network Senior |
$131.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$102.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| 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 |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC ELECT STIMULATION UNATTENDED PT
|
Facility
IP
|
$212.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
905103105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.64
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.52
|
| Rate for Payer: Heritage Provider Network Senior |
$143.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
|
|
HC ELECT STIM UNATTENDED ULCERS MCAL
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901301303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$88.50 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.89
|
| Rate for Payer: Heritage Provider Network Senior |
$79.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
|
|
HC ELECT STIM UNATTENDED ULCERS MCAL
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901301303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$100.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$64.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.50
|
| 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 |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.30
|
| Rate for Payer: Dignity Health Senior |
$100.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.04
|
| Rate for Payer: Heritage Provider Network Senior |
$73.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| 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 |
$100.30
|
| Rate for Payer: Vantage Medical Group Senior |
$100.30
|
|
|
HC ELECT STIM UNATTENDED/ULCERS MCAL
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901300083
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$100.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$64.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.50
|
| 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 |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.30
|
| Rate for Payer: Dignity Health Senior |
$100.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.04
|
| Rate for Payer: Heritage Provider Network Senior |
$73.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| 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 |
$100.30
|
| Rate for Payer: Vantage Medical Group Senior |
$100.30
|
|
|
HC ELECT STIM UNATTENDED/ULCERS MCAL
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901300083
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$88.50 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.89
|
| Rate for Payer: Heritage Provider Network Senior |
$79.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
|
|
HC ELECT STIM UNATTENDED/ULCERS OT
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
905104524
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$88.50 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.89
|
| Rate for Payer: Heritage Provider Network Senior |
$79.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
|
|
HC ELECT STIM UNATTENDED/ULCERS OT
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
905104524
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$100.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$64.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.50
|
| 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 |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.30
|
| Rate for Payer: Dignity Health Senior |
$100.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.04
|
| Rate for Payer: Heritage Provider Network Senior |
$73.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| 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 |
$100.30
|
| Rate for Payer: Vantage Medical Group Senior |
$100.30
|
|
|
HC ELECT STIM UNATTENDED/ULCERS PT
|
Facility
IP
|
$88.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
905103507
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.46
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.58
|
| Rate for Payer: Heritage Provider Network Senior |
$59.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
|
|
HC ELECT STIM UNATTENDED/ULCERS PT
|
Facility
OP
|
$88.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
905103507
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$48.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$66.00
|
| 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 |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.80
|
| Rate for Payer: Dignity Health Senior |
$74.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.47
|
| Rate for Payer: Heritage Provider Network Senior |
$54.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| 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 |
$74.80
|
| Rate for Payer: Vantage Medical Group Senior |
$74.80
|
|
|
HC ELECT STIM UNATTENDED/ULCERS PT COMM MCARE
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
900419077
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$100.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$64.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.50
|
| 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 |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.30
|
| Rate for Payer: Dignity Health Senior |
$100.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.04
|
| Rate for Payer: Heritage Provider Network Senior |
$73.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| 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 |
$100.30
|
| Rate for Payer: Vantage Medical Group Senior |
$100.30
|
|
|
HC ELECT STIM UNATTENDED/ULCERS PT COMM MCARE
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
900419077
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$88.50 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.89
|
| Rate for Payer: Heritage Provider Network Senior |
$79.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
|
|
HC ELECT STIM UNATTEND WOUND CARE
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
905103508
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$106.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$68.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$93.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.25
|
| Rate for Payer: Dignity Health Senior |
$106.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.25
|
| Rate for Payer: Vantage Medical Group Senior |
$106.25
|
|
|
HC ELECT STIM UNATTEND WOUND CARE
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
905103508
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC ELECT STIM UNATTEND WOUND CARE COMM MCARE
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900419078
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$106.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$68.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$93.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.25
|
| Rate for Payer: Dignity Health Senior |
$106.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.25
|
| Rate for Payer: Vantage Medical Group Senior |
$106.25
|
|
|
HC ELECT STIM UNATTEND WOUND CARE COMM MCARE
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900419078
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC ELECT STIM UNATTEND WOUND CARE MCAL
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900400044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$106.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$68.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$93.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.25
|
| Rate for Payer: Dignity Health Senior |
$106.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.25
|
| Rate for Payer: Vantage Medical Group Senior |
$106.25
|
|
|
HC ELECT STIM UNATTEND WOUND CARE MCAL
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900400044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC ELEV DEPRESSED SKULL FX, SIMPL
|
Facility
IP
|
$8,326.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
900501690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,507.01 |
| Max. Negotiated Rate |
$6,244.50 |
| Rate for Payer: Adventist Health Commercial |
$1,665.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,719.96
|
| Rate for Payer: Cash Price |
$3,746.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,636.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,636.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,507.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,081.50
|
| Rate for Payer: Multiplan Commercial |
$6,244.50
|
|
|
HC ELEV DEPRESSED SKULL FX, SIMPL
|
Facility
OP
|
$8,326.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
900501690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$8,576.00 |
| Rate for Payer: Adventist Health Commercial |
$1,665.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,971.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,719.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Cash Price |
$3,746.70
|
| Rate for Payer: Cash Price |
$3,746.70
|
| Rate for Payer: Cash Price |
$3,746.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,411.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: Dignity Health Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,411.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,636.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,636.70
|
| Rate for Payer: Humana Medicare |
$4,022.69
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,013.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,507.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,746.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,081.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,068.59
|
| Rate for Payer: Multiplan Commercial |
$6,244.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,023.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,781.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC EMBOLIC ONYX
|
Facility
OP
|
$6,000.00
|
|
| Hospital Charge Code |
909081019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$1,200.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,880.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,122.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,100.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,300.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,726.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,522.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,760.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,100.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,100.00
|
| Rate for Payer: Dignity Health Senior |
$5,100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,840.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,778.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,778.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,000.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,000.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,000.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,187.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,004.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,100.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,100.00
|
|
|
HC EMBOLIC ONYX
|
Facility
IP
|
$6,000.00
|
|
| Hospital Charge Code |
909081019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,200.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,880.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,122.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,760.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,240.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,062.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,062.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,000.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,000.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,000.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,187.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,004.60
|
|
|
HC EMBOLIZATION COILS .018
|
Facility
IP
|
$358.00
|
|
| Hospital Charge Code |
909081257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$171.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$164.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$242.37
|
| Rate for Payer: Heritage Provider Network Senior |
$242.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$179.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.50
|
| Rate for Payer: Multiplan Commercial |
$268.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$130.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$119.61
|
|
|
HC EMBOLIZATION COILS .018
|
Facility
OP
|
$358.00
|
|
| Hospital Charge Code |
909081257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$171.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$304.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$196.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$268.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$222.32
|
| Rate for Payer: Blue Shield of California EPN |
$210.15
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$164.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$304.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$304.30
|
| Rate for Payer: Dignity Health Senior |
$304.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.75
|
| Rate for Payer: Heritage Provider Network Senior |
$165.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$179.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.50
|
| Rate for Payer: Multiplan Commercial |
$268.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$130.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$119.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$304.30
|
| Rate for Payer: Vantage Medical Group Senior |
$304.30
|
|
