|
HC ESOPH RETRO BALLOON
|
Facility
OP
|
$2,430.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
900100015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$365.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$486.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,669.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,093.50
|
| Rate for Payer: Cash Price |
$1,093.50
|
| Rate for Payer: Cash Price |
$1,093.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,579.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,504.17
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: IEHP Medi-Cal |
$365.32
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$607.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$1,822.50
|
| 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 |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPH RETRO BALLOON
|
Facility
IP
|
$2,666.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
900100015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$482.55 |
| Max. Negotiated Rate |
$1,999.50 |
| Rate for Payer: Adventist Health Commercial |
$533.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,831.54
|
| Rate for Payer: Cash Price |
$1,199.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,804.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,804.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$482.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.50
|
| Rate for Payer: Multiplan Commercial |
$1,999.50
|
|
|
HC ESOPH STENT PLACEMENT
|
Facility
OP
|
$10,120.00
|
|
|
Service Code
|
CPT 43212
|
| Hospital Charge Code |
900100014
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$257.87 |
| Max. Negotiated Rate |
$13,529.58 |
| Rate for Payer: Adventist Health Commercial |
$2,024.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,952.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,120.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$4,554.00
|
| Rate for Payer: Cash Price |
$4,554.00
|
| Rate for Payer: Cash Price |
$4,554.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,578.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,832.91
|
| Rate for Payer: Dignity Health Senior |
$7,120.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,120.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,264.28
|
| Rate for Payer: Heritage Provider Network Senior |
$8,758.62
|
| Rate for Payer: Humana Medicare |
$7,120.83
|
| Rate for Payer: IEHP Medi-Cal |
$257.87
|
| Rate for Payer: IEHP Medicare Advantage |
$7,120.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,529.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,831.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,402.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,530.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,972.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,972.25
|
| Rate for Payer: Multiplan Commercial |
$7,590.00
|
| 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 |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Vantage Medical Group Senior |
$7,120.83
|
|
|
HC ESOPH STENT PLACEMENT
|
Facility
IP
|
$6,240.00
|
|
|
Service Code
|
CPT 43212
|
| Hospital Charge Code |
900100014
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,129.44 |
| Max. Negotiated Rate |
$4,680.00 |
| Rate for Payer: Adventist Health Commercial |
$1,248.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,286.88
|
| Rate for Payer: Cash Price |
$2,808.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,224.48
|
| Rate for Payer: Heritage Provider Network Senior |
$4,224.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,129.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,560.00
|
| Rate for Payer: Multiplan Commercial |
$4,680.00
|
|
|
HC ESTABLISH BRAIN CAVITY SHUNT
|
Facility
OP
|
$8,289.00
|
|
|
Service Code
|
CPT 62180
|
| Hospital Charge Code |
900501661
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$8,054.00 |
| Rate for Payer: Adventist Health Commercial |
$1,657.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,198.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,694.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,045.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,558.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,216.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Cash Price |
$3,730.05
|
| Rate for Payer: Cash Price |
$3,730.05
|
| Rate for Payer: Cash Price |
$3,730.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,387.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,045.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,045.65
|
| Rate for Payer: Dignity Health Senior |
$7,045.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,387.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,611.65
|
| Rate for Payer: Heritage Provider Network Senior |
$5,611.65
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,995.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,500.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,072.25
|
| Rate for Payer: Multiplan Commercial |
$6,216.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,009.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,769.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,045.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7,045.65
|
|
|
HC ESTABLISH BRAIN CAVITY SHUNT
|
Facility
IP
|
$8,289.00
|
|
|
Service Code
|
CPT 62180
|
| Hospital Charge Code |
900501661
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,500.31 |
| Max. Negotiated Rate |
$6,216.75 |
| Rate for Payer: Adventist Health Commercial |
$1,657.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,694.54
|
| Rate for Payer: Cash Price |
$3,730.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,611.65
|
| Rate for Payer: Heritage Provider Network Senior |
$5,611.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,500.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,072.25
|
| Rate for Payer: Multiplan Commercial |
$6,216.75
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
IP
|
$473.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$324.95
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.22
|
| Rate for Payer: Heritage Provider Network Senior |
$320.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
IP
|
$473.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$324.95
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.22
|
| Rate for Payer: Heritage Provider Network Senior |
$320.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
OP
|
$473.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$180.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$324.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$247.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$181.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$165.16
|
| Rate for Payer: Blue Shield of California Commercial |
$293.73
|
| Rate for Payer: Blue Shield of California EPN |
$277.65
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$247.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.68
|
| Rate for Payer: Dignity Health Senior |
$165.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$292.79
|
| Rate for Payer: Heritage Provider Network Senior |
$292.79
|
| Rate for Payer: Humana Medicare |
$165.16
|
| Rate for Payer: IEHP Medicare Advantage |
$165.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$313.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.10
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$236.50
|
| Rate for Payer: TriValley Medical Group Senior |
$236.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$247.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.68
|
| Rate for Payer: Vantage Medical Group Senior |
$165.16
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
OP
|
$473.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$402.05 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$218.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$324.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$402.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$260.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$354.75
|
| Rate for Payer: Blue Shield of California Commercial |
$293.73
|
| Rate for Payer: Blue Shield of California EPN |
$277.65
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$402.05
|
| Rate for Payer: Dignity Health Senior |
$402.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$292.79
|
| Rate for Payer: Heritage Provider Network Senior |
$292.79
|
| Rate for Payer: IEHP Medi-Cal |
$89.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$227.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$236.50
|
| Rate for Payer: TriValley Medical Group Senior |
$236.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$402.05
|
| Rate for Payer: Vantage Medical Group Senior |
$402.05
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
OP
|
$294.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$100.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$201.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$161.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$220.50
|
| Rate for Payer: Blue Shield of California Commercial |
$182.57
|
| Rate for Payer: Blue Shield of California EPN |
$172.58
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.90
|
| Rate for Payer: Dignity Health Senior |
$249.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.99
|
| Rate for Payer: Heritage Provider Network Senior |
$181.99
|
| Rate for Payer: IEHP Medi-Cal |
$37.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$141.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Senior |
$147.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.90
|
| Rate for Payer: Vantage Medical Group Senior |
$249.90
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
IP
|
$294.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$201.98
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$199.04
|
| Rate for Payer: Heritage Provider Network Senior |
$199.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
IP
|
$294.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$201.98
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$199.04
|
| Rate for Payer: Heritage Provider Network Senior |
$199.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
OP
|
$294.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$313.80 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$180.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$201.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$247.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$181.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$165.16
|
| Rate for Payer: Blue Shield of California Commercial |
$182.57
|
| Rate for Payer: Blue Shield of California EPN |
$172.58
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$247.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.68
|
| Rate for Payer: Dignity Health Senior |
$165.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.99
|
| Rate for Payer: Heritage Provider Network Senior |
$181.99
|
| Rate for Payer: Humana Medicare |
$165.16
|
| Rate for Payer: IEHP Medicare Advantage |
$165.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$313.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.10
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Senior |
$147.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$247.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.68
|
| Rate for Payer: Vantage Medical Group Senior |
$165.16
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
OP
|
$192.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$105.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$144.00
|
| Rate for Payer: Blue Shield of California Commercial |
$119.23
|
| Rate for Payer: Blue Shield of California EPN |
$112.70
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.20
|
| Rate for Payer: Dignity Health Senior |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.85
|
| Rate for Payer: Heritage Provider Network Senior |
$118.85
|
| Rate for Payer: IEHP Medi-Cal |
$18.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$92.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Senior |
$96.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.20
|
| Rate for Payer: Vantage Medical Group Senior |
$163.20
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
IP
|
$192.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.90
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.98
|
| Rate for Payer: Heritage Provider Network Senior |
$129.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
IP
|
$192.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.90
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.98
|
| Rate for Payer: Heritage Provider Network Senior |
$129.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
OP
|
$192.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
908600110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$105.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$144.00
|
| Rate for Payer: Blue Shield of California Commercial |
$119.23
|
| Rate for Payer: Blue Shield of California EPN |
$112.70
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.20
|
| Rate for Payer: Dignity Health Senior |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.85
|
| Rate for Payer: Heritage Provider Network Senior |
$118.85
|
| Rate for Payer: IEHP Medi-Cal |
$18.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$92.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Senior |
$96.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.20
|
| Rate for Payer: Vantage Medical Group Senior |
$163.20
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
IP
|
$192.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
908600110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.90
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.98
|
| Rate for Payer: Heritage Provider Network Senior |
$129.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
OP
|
$192.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$313.80 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$180.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$247.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$181.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$165.16
|
| Rate for Payer: Blue Shield of California Commercial |
$119.23
|
| Rate for Payer: Blue Shield of California EPN |
$112.70
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$247.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.68
|
| Rate for Payer: Dignity Health Senior |
$165.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.85
|
| Rate for Payer: Heritage Provider Network Senior |
$118.85
|
| Rate for Payer: Humana Medicare |
$165.16
|
| Rate for Payer: IEHP Medicare Advantage |
$165.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$313.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.10
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Senior |
$96.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$247.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.68
|
| Rate for Payer: Vantage Medical Group Senior |
$165.16
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
IP
|
$255.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.18
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.64
|
| Rate for Payer: Heritage Provider Network Senior |
$172.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
IP
|
$393.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908710007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.13 |
| Max. Negotiated Rate |
$294.75 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.99
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$266.06
|
| Rate for Payer: Heritage Provider Network Senior |
$266.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.25
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
OP
|
$393.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908710007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$334.05 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$334.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$216.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.75
|
| Rate for Payer: Blue Shield of California Commercial |
$244.05
|
| Rate for Payer: Blue Shield of California EPN |
$230.69
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$334.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$334.05
|
| Rate for Payer: Dignity Health Senior |
$334.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$243.27
|
| Rate for Payer: Heritage Provider Network Senior |
$243.27
|
| Rate for Payer: IEHP Medi-Cal |
$17.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.25
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$196.50
|
| Rate for Payer: TriValley Medical Group Senior |
$196.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$334.05
|
| Rate for Payer: Vantage Medical Group Senior |
$334.05
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
IP
|
$427.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908603211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.29 |
| Max. Negotiated Rate |
$320.25 |
| Rate for Payer: Adventist Health Commercial |
$85.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$293.35
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$289.08
|
| Rate for Payer: Heritage Provider Network Senior |
$289.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.75
|
| Rate for Payer: Multiplan Commercial |
$320.25
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
OP
|
$255.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$180.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$247.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$181.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$165.16
|
| Rate for Payer: Blue Shield of California Commercial |
$158.36
|
| Rate for Payer: Blue Shield of California EPN |
$149.68
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$247.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.68
|
| Rate for Payer: Dignity Health Senior |
$165.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.84
|
| Rate for Payer: Heritage Provider Network Senior |
$157.84
|
| Rate for Payer: Humana Medicare |
$165.16
|
| Rate for Payer: IEHP Medicare Advantage |
$165.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$313.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.10
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$181.68
|
| Rate for Payer: TriValley Medical Group Senior |
$181.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$247.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.68
|
| Rate for Payer: Vantage Medical Group Senior |
$165.16
|
|
