|
HC EXPLORE/TREAT FINGER JOINT EA
|
Facility
IP
|
$3,653.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
900501434
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.19 |
| Max. Negotiated Rate |
$2,739.75 |
| Rate for Payer: Adventist Health Commercial |
$730.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,509.61
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,473.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,473.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| Rate for Payer: Multiplan Commercial |
$2,739.75
|
|
|
HC EXPLOR W/RMVL DEEP F.B.FOREARM
|
Facility
IP
|
$4,774.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
900501469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$864.09 |
| Max. Negotiated Rate |
$3,580.50 |
| Rate for Payer: Adventist Health Commercial |
$954.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,279.74
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,232.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,232.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$864.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,193.50
|
| Rate for Payer: Multiplan Commercial |
$3,580.50
|
|
|
HC EXPLOR W/RMVL DEEP F.B.FOREARM
|
Facility
OP
|
$4,774.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
900501469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$864.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$954.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,279.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,103.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,232.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,232.00
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,301.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$864.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,193.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: Multiplan Commercial |
$3,580.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,733.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,594.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC EXT CAROTID UNI
|
Facility
IP
|
$21,162.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909020160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,830.32 |
| Max. Negotiated Rate |
$15,871.50 |
| Rate for Payer: Adventist Health Commercial |
$4,232.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,538.29
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,326.67
|
| Rate for Payer: Heritage Provider Network Senior |
$14,326.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,830.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,290.50
|
| Rate for Payer: Multiplan Commercial |
$15,871.50
|
|
|
HC EXT CAROTID UNI
|
Facility
IP
|
$21,162.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
906820228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,830.32 |
| Max. Negotiated Rate |
$15,871.50 |
| Rate for Payer: Adventist Health Commercial |
$4,232.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,538.29
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,326.67
|
| Rate for Payer: Heritage Provider Network Senior |
$14,326.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,830.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,290.50
|
| Rate for Payer: Multiplan Commercial |
$15,871.50
|
|
|
HC EXT CAROTID UNI
|
Facility
OP
|
$21,162.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
906820228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.23 |
| Max. Negotiated Rate |
$17,987.70 |
| Rate for Payer: Adventist Health Commercial |
$4,232.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,538.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17,987.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11,639.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15,871.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| 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 |
$9,522.90
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,755.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,987.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,987.70
|
| Rate for Payer: Dignity Health Senior |
$17,987.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,099.28
|
| Rate for Payer: Heritage Provider Network Senior |
$13,099.28
|
| Rate for Payer: IEHP Medi-Cal |
$138.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,200.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,830.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,290.50
|
| Rate for Payer: Multiplan Commercial |
$15,871.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,987.70
|
| Rate for Payer: Vantage Medical Group Senior |
$17,987.70
|
|
|
HC EXT CAROTID UNI
|
Facility
OP
|
$21,162.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909020160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.23 |
| Max. Negotiated Rate |
$17,987.70 |
| Rate for Payer: Adventist Health Commercial |
$4,232.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,538.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17,987.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11,639.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15,871.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| 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 |
$9,522.90
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,755.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,987.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,987.70
|
| Rate for Payer: Dignity Health Senior |
$17,987.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,099.28
|
| Rate for Payer: Heritage Provider Network Senior |
$13,099.28
|
| Rate for Payer: IEHP Medi-Cal |
$138.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,200.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,830.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,290.50
|
| Rate for Payer: Multiplan Commercial |
$15,871.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,987.70
|
| Rate for Payer: Vantage Medical Group Senior |
$17,987.70
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD
|
Facility
OP
|
$493.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
900203242
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Blue Shield of California Commercial |
$306.15
|
| Rate for Payer: Blue Shield of California EPN |
$289.39
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$320.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: Dignity Health Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$50.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.17
|
| Rate for Payer: Heritage Provider Network Senior |
$305.17
|
| Rate for Payer: Humana Medicare |
$50.11
|
| Rate for Payer: IEHP Medi-Cal |
$21.89
|
| Rate for Payer: IEHP Medicare Advantage |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.14
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$55.12
|
| Rate for Payer: TriValley Medical Group Senior |
$50.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD
|
Facility
IP
|
$493.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
900203242
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.76
|
| Rate for Payer: Heritage Provider Network Senior |
$333.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD SA
|
Facility
IP
|
$493.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
900203243
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.76
|
| Rate for Payer: Heritage Provider Network Senior |
$333.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD SA
|
Facility
OP
|
$493.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
900203243
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$92.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Blue Shield of California Commercial |
$306.15
|
| Rate for Payer: Blue Shield of California EPN |
$289.39
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$320.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.17
|
| Rate for Payer: Heritage Provider Network Senior |
$305.17
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.56
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC EXT ECG GT 7 DAY TO 15 DAY RCRD
|
Facility
IP
|
$493.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
900203246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.76
|
| Rate for Payer: Heritage Provider Network Senior |
$333.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
|
|
HC EXT ECG GT 7 DAY TO 15 DAY RCRD
|
Facility
OP
|
$493.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
900203246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Blue Shield of California Commercial |
$306.15
|
| Rate for Payer: Blue Shield of California EPN |
$289.39
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$320.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: Dignity Health Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$50.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.17
|
| Rate for Payer: Heritage Provider Network Senior |
$305.17
|
| Rate for Payer: Humana Medicare |
$50.11
|
| Rate for Payer: IEHP Medi-Cal |
$21.89
|
| Rate for Payer: IEHP Medicare Advantage |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.14
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$55.12
|
| Rate for Payer: TriValley Medical Group Senior |
$50.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC EXT ECG GT 7 DY TO 15 DY RCRD SA
|
Facility
OP
|
$493.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
900203247
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$92.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Blue Shield of California Commercial |
$306.15
|
| Rate for Payer: Blue Shield of California EPN |
$289.39
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$320.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.17
|
| Rate for Payer: Heritage Provider Network Senior |
$305.17
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.56
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC EXT ECG GT 7 DY TO 15 DY RCRD SA
|
Facility
IP
|
$493.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
900203247
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.76
|
| Rate for Payer: Heritage Provider Network Senior |
$333.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
|
|
HC EXTENDED LENGTH TRACH TUBE
|
Facility
OP
|
$749.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$636.65 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$514.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$636.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$411.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$561.75
|
| Rate for Payer: Blue Shield of California Commercial |
$465.13
|
| Rate for Payer: Blue Shield of California EPN |
$439.66
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$486.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$636.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$636.65
|
| Rate for Payer: Dignity Health Senior |
$636.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.63
|
| Rate for Payer: Heritage Provider Network Senior |
$463.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$361.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$636.65
|
| Rate for Payer: Vantage Medical Group Senior |
$636.65
|
|
|
HC EXTENDED LENGTH TRACH TUBE
|
Facility
IP
|
$749.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.57 |
| Max. Negotiated Rate |
$561.75 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$514.56
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.07
|
| Rate for Payer: Heritage Provider Network Senior |
$507.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
|
|
HC EXTERNAL EAR, UNLISTED PROCEDU
|
Facility
OP
|
$823.00
|
|
|
Service Code
|
CPT 69399
|
| Hospital Charge Code |
900501298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.96 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$164.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$439.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$565.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$370.35
|
| Rate for Payer: Cash Price |
$370.35
|
| Rate for Payer: Cash Price |
$370.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$534.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: Dignity Health Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$305.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.17
|
| Rate for Payer: Heritage Provider Network Senior |
$557.17
|
| Rate for Payer: Humana Medicare |
$305.19
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$396.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$617.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$298.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$274.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC EXTERNAL EAR, UNLISTED PROCEDU
|
Facility
IP
|
$823.00
|
|
|
Service Code
|
CPT 69399
|
| Hospital Charge Code |
900501298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.96 |
| Max. Negotiated Rate |
$617.25 |
| Rate for Payer: Adventist Health Commercial |
$164.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$565.40
|
| Rate for Payer: Cash Price |
$370.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.17
|
| Rate for Payer: Heritage Provider Network Senior |
$557.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.75
|
| Rate for Payer: Multiplan Commercial |
$617.25
|
|
|
HC EXTERNAL VERSION
|
Facility
IP
|
$6,690.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,210.89 |
| Max. Negotiated Rate |
$5,017.50 |
| Rate for Payer: Adventist Health Commercial |
$1,338.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,596.03
|
| Rate for Payer: Cash Price |
$3,010.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,529.13
|
| Rate for Payer: Heritage Provider Network Senior |
$4,529.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,210.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,672.50
|
| Rate for Payer: Multiplan Commercial |
$5,017.50
|
|
|
HC EXTERNAL VERSION
|
Facility
OP
|
$6,690.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$207.77 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,338.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$207.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,596.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,105.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,154.49
|
| Rate for Payer: Blue Shield of California EPN |
$3,927.03
|
| Rate for Payer: Cash Price |
$3,010.50
|
| Rate for Payer: Cash Price |
$3,010.50
|
| Rate for Payer: Cash Price |
$3,010.50
|
| Rate for Payer: Cash Price |
$3,010.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,348.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: Dignity Health Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,141.11
|
| Rate for Payer: Heritage Provider Network Senior |
$4,141.11
|
| Rate for Payer: Humana Medicare |
$3,906.18
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,421.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,210.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,609.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,672.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,921.79
|
| Rate for Payer: Multiplan Commercial |
$5,017.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,296.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,906.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
IP
|
$3,487.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$631.15 |
| Max. Negotiated Rate |
$2,615.25 |
| Rate for Payer: Adventist Health Commercial |
$697.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,395.57
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,360.70
|
| Rate for Payer: Heritage Provider Network Senior |
$2,360.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$871.75
|
| Rate for Payer: Multiplan Commercial |
$2,615.25
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
OP
|
$3,487.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$631.15 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$697.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,395.57
|
| 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 |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,266.55
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,360.70
|
| Rate for Payer: Heritage Provider Network Senior |
$2,360.70
|
| 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 |
$1,680.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,746.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$871.75
|
| 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 |
$2,615.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,266.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,165.01
|
| 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 EXTREMITY STUDY COMPLEX
|
Facility
IP
|
$1,719.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
908100119
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$311.14 |
| Max. Negotiated Rate |
$1,289.25 |
| Rate for Payer: Adventist Health Commercial |
$343.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,180.95
|
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,163.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,163.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.75
|
| Rate for Payer: Multiplan Commercial |
$1,289.25
|
|
|
HC EXTREMITY STUDY COMPLEX
|
Facility
OP
|
$1,719.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
908100119
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$151.88 |
| Max. Negotiated Rate |
$1,289.25 |
| Rate for Payer: Adventist Health Commercial |
$343.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$356.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,180.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Blue Shield of California Commercial |
$589.77
|
| Rate for Payer: Blue Shield of California EPN |
$335.38
|
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,117.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,117.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,064.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,064.06
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: IEHP Medi-Cal |
$151.88
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$1,289.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
