|
HC ELECT STIM UNATTENDED/ULCERS MCAL
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901300083
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$39.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.04
|
| Rate for Payer: Heritage Provider Network Senior |
$60.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$67.90
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.45
|
| Rate for Payer: Vantage Medical Group Senior |
$82.45
|
|
|
HC ELECT STIM UNATTENDED/ULCERS OT
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
905104524
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$39.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.04
|
| Rate for Payer: Heritage Provider Network Senior |
$60.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$67.90
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.45
|
| Rate for Payer: Vantage Medical Group Senior |
$82.45
|
|
|
HC ELECT STIM UNATTENDED/ULCERS OT
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
905104524
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Adventist Health Commercial |
$19.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.47
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.67
|
| Rate for Payer: Heritage Provider Network Senior |
$65.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.25
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
|
|
HC ELECT STIM UNATTENDED/ULCERS PT
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
905103507
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Adventist Health Commercial |
$19.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.47
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.67
|
| Rate for Payer: Heritage Provider Network Senior |
$65.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.25
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
|
|
HC ELECT STIM UNATTENDED/ULCERS PT
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
905103507
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$39.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.04
|
| Rate for Payer: Heritage Provider Network Senior |
$60.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$67.90
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.45
|
| Rate for Payer: Vantage Medical Group Senior |
$82.45
|
|
|
HC ELECT STIM UNATTENDED/ULCERS PT COMM MCARE
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
900419077
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Adventist Health Commercial |
$19.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.47
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.67
|
| Rate for Payer: Heritage Provider Network Senior |
$65.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.25
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
|
|
HC ELECT STIM UNATTENDED/ULCERS PT COMM MCARE
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
900419077
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$39.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.04
|
| Rate for Payer: Heritage Provider Network Senior |
$60.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$67.90
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.45
|
| Rate for Payer: Vantage Medical Group Senior |
$82.45
|
|
|
HC ELECT STIM UNATTEND WOUND CARE
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
905103508
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.90
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.38
|
| Rate for Payer: Heritage Provider Network Senior |
$112.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
|
|
HC ELECT STIM UNATTEND WOUND CARE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
905103508
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$68.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$102.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$141.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.75
|
| Rate for Payer: Heritage Provider Network Senior |
$102.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$79.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$116.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.10
|
| Rate for Payer: Vantage Medical Group Senior |
$141.10
|
|
|
HC ELECT STIM UNATTEND WOUND CARE COMM MCARE
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900419078
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.90
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.38
|
| Rate for Payer: Heritage Provider Network Senior |
$112.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
|
|
HC ELECT STIM UNATTEND WOUND CARE COMM MCARE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900419078
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$68.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$102.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$141.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.75
|
| Rate for Payer: Heritage Provider Network Senior |
$102.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$79.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$116.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.10
|
| Rate for Payer: Vantage Medical Group Senior |
$141.10
|
|
|
HC ELECT STIM UNATTEND WOUND CARE MCAL
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900400044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$68.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$102.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$141.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.75
|
| Rate for Payer: Heritage Provider Network Senior |
$102.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$79.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$116.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.10
|
| Rate for Payer: Vantage Medical Group Senior |
$141.10
|
|
|
HC ELECT STIM UNATTEND WOUND CARE MCAL
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900400044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.90
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.38
|
| Rate for Payer: Heritage Provider Network Senior |
$112.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
|
|
HC ELEV DEPRESSED SKULL FX, SIMPL
|
Facility
|
OP
|
$8,923.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
900501690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,615.06 |
| Max. Negotiated Rate |
$9,728.00 |
| Rate for Payer: Adventist Health Commercial |
$1,784.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,514.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,728.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,238.43
|
| Rate for Payer: Blue Shield of California EPN |
$3,372.89
|
| Rate for Payer: Cash Price |
$4,015.35
|
| Rate for Payer: Cash Price |
$4,015.35
|
| Rate for Payer: Cash Price |
$4,015.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,799.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,799.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,264.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,040.87
|
| Rate for Payer: Heritage Provider Network Senior |
$6,040.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,256.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,615.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,903.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,230.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$6,692.25
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,353.80
|
| Rate for Payer: TriValley Medical Group Senior |
$5,353.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC ELEV DEPRESSED SKULL FX, SIMPL
|
Facility
|
IP
|
$8,923.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
900501690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,615.06 |
| Max. Negotiated Rate |
$6,692.25 |
| Rate for Payer: Adventist Health Commercial |
$1,784.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,746.41
|
| Rate for Payer: Cash Price |
$4,015.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,040.87
|
| Rate for Payer: Heritage Provider Network Senior |
$6,040.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,615.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,230.75
|
| Rate for Payer: Multiplan Commercial |
$6,692.25
|
|
|
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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$1,200.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,864.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,412.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,412.00
|
| 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 |
$2,778.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,778.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$2,167.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,986.60
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$1,200.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,708.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,100.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,300.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,412.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,412.00
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$3,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,000.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,200.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,167.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,986.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,100.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,100.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,100.00
|
|
|
HC EMBOLIZATION COILS .018
|
Facility
|
OP
|
$358.00
|
|
| Hospital Charge Code |
909081257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$221.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$304.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$196.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$268.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$143.92
|
| Rate for Payer: Blue Shield of California EPN |
$143.92
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$179.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$179.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$179.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$250.60
|
| Rate for Payer: Multiplan Commercial |
$268.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$129.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$118.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$304.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$304.30
|
| Rate for Payer: Vantage Medical Group Senior |
$304.30
|
|
|
HC EMBOLIZATION COILS .018
|
Facility
|
IP
|
$358.00
|
|
| Hospital Charge Code |
909081257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$230.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$143.92
|
| Rate for Payer: Blue Shield of California EPN |
$143.92
|
| 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 |
$165.75
|
| Rate for Payer: Heritage Provider Network Senior |
$165.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$179.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$179.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$129.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$118.53
|
|
|
HC EMBOLIZATION DEVICE PIPELINE
|
Facility
|
OP
|
$25,000.00
|
|
| Hospital Charge Code |
909020126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,525.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,450.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15,250.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,200.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,250.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,750.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,475.00
|
| Rate for Payer: Heritage Provider Network Senior |
$15,475.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11,925.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,525.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,500.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12,500.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC EMBOLIZATION DEVICE PIPELINE
|
Facility
|
IP
|
$25,000.00
|
|
| Hospital Charge Code |
909020126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,525.00 |
| Max. Negotiated Rate |
$18,750.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,100.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,925.00
|
| Rate for Payer: Heritage Provider Network Senior |
$16,925.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,525.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
|
|
HC EMBOLIZATION, EXTRACRANIAL
|
Facility
|
OP
|
$34,387.00
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
909081338
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,224.05 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Adventist Health Commercial |
$6,877.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,251.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$15,474.15
|
| Rate for Payer: Cash Price |
$15,474.15
|
| Rate for Payer: Cash Price |
$15,474.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,351.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,632.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,285.55
|
| Rate for Payer: Heritage Provider Network Senior |
$18,262.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,210.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,224.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,596.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$25,790.25
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$16,332.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC EMBOLIZATION, EXTRACRANIAL
|
Facility
|
IP
|
$34,387.00
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
909081338
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,224.05 |
| Max. Negotiated Rate |
$25,790.25 |
| Rate for Payer: Adventist Health Commercial |
$6,877.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,145.23
|
| Rate for Payer: Cash Price |
$15,474.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,280.00
|
| Rate for Payer: Heritage Provider Network Senior |
$23,280.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,224.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,596.75
|
| Rate for Payer: Multiplan Commercial |
$25,790.25
|
|
|
HC EMBOLIZATION FOAM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
909081259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$225.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$140.70
|
| Rate for Payer: Blue Shield of California EPN |
$140.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.05
|
| Rate for Payer: Heritage Provider Network Senior |
$162.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$126.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$115.89
|
|
|
HC EMBOLIZATION FOAM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
909081259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$140.70
|
| Rate for Payer: Blue Shield of California EPN |
$140.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$161.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.05
|
| Rate for Payer: Heritage Provider Network Senior |
$162.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$126.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$115.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
