|
HC FISH PROBE CYTOGEN 3-5 CELLS
|
Facility
IP
|
$186.00
|
|
|
Service Code
|
CPT 88272
|
| Hospital Charge Code |
900918008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.92
|
| Rate for Payer: Heritage Provider Network Senior |
$125.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
|
|
HC FISH PROBE CYTOGEN EA
|
Facility
OP
|
$157.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900918007
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$1,420.05 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$107.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,420.05
|
| Rate for Payer: Blue Shield of California Commercial |
$167.31
|
| Rate for Payer: Blue Shield of California EPN |
$130.79
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Senior |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.18
|
| Rate for Payer: Heritage Provider Network Senior |
$97.18
|
| Rate for Payer: Humana Medicare |
$21.42
|
| Rate for Payer: IEHP Medi-Cal |
$26.21
|
| Rate for Payer: IEHP Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.99
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC FISH PROBE CYTOGEN EA
|
Facility
IP
|
$218.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900918007
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.77
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.59
|
| Rate for Payer: Heritage Provider Network Senior |
$147.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
|
|
HC FISTULA/SINUS TRACT INJ
|
Facility
OP
|
$599.00
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
909000108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$411.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$509.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$329.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$449.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$389.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$509.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$509.15
|
| Rate for Payer: Dignity Health Senior |
$509.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.78
|
| Rate for Payer: Heritage Provider Network Senior |
$370.78
|
| Rate for Payer: IEHP Medi-Cal |
$348.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$288.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.75
|
| Rate for Payer: Multiplan Commercial |
$449.25
|
| 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 |
$509.15
|
| Rate for Payer: Vantage Medical Group Senior |
$509.15
|
|
|
HC FISTULA/SINUS TRACT INJ
|
Facility
IP
|
$599.00
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
909000108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$411.51
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$405.52
|
| Rate for Payer: Heritage Provider Network Senior |
$405.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.75
|
| Rate for Payer: Multiplan Commercial |
$449.25
|
|
|
HC FIT & INSERT PESSARY SUPPORT D
|
Facility
IP
|
$804.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
900501760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.52 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Adventist Health Commercial |
$160.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$552.35
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$544.31
|
| Rate for Payer: Heritage Provider Network Senior |
$544.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.00
|
| Rate for Payer: Multiplan Commercial |
$603.00
|
|
|
HC FIT & INSERT PESSARY SUPPORT D
|
Facility
OP
|
$804.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
900501760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.11 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$160.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$101.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$552.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$522.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: Dignity Health Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$248.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$544.31
|
| Rate for Payer: Heritage Provider Network Senior |
$544.31
|
| Rate for Payer: Humana Medicare |
$248.97
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$248.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$387.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.70
|
| Rate for Payer: Multiplan Commercial |
$603.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$291.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$268.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
OP
|
$5,575.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,115.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,830.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,508.75
|
| Rate for Payer: Cash Price |
$2,508.75
|
| Rate for Payer: Cash Price |
$2,508.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,623.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,774.28
|
| Rate for Payer: Heritage Provider Network Senior |
$3,774.28
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,687.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,009.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$4,181.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,024.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,862.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
IP
|
$5,575.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,009.08 |
| Max. Negotiated Rate |
$4,181.25 |
| Rate for Payer: Adventist Health Commercial |
$1,115.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,830.02
|
| Rate for Payer: Cash Price |
$2,508.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,774.28
|
| Rate for Payer: Heritage Provider Network Senior |
$3,774.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,009.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.75
|
| Rate for Payer: Multiplan Commercial |
$4,181.25
|
|
|
HC FK 506 (TACROLIMUS)
|
Facility
IP
|
$216.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
900911039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Adventist Health Commercial |
$43.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.39
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$146.23
|
| Rate for Payer: Heritage Provider Network Senior |
$146.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
|
|
HC FK 506 (TACROLIMUS)
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
900911039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.20
|
| Rate for Payer: Blue Shield of California Commercial |
$107.16
|
| Rate for Payer: Blue Shield of California EPN |
$83.77
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Senior |
$13.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Humana Medicare |
$13.73
|
| Rate for Payer: IEHP Medi-Cal |
$19.05
|
| Rate for Payer: IEHP Medicare Advantage |
$13.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.30
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.73
|
| Rate for Payer: TriValley Medical Group Senior |
$13.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC FLEX VIDEOSCOPE AMBU
|
Facility
OP
|
$1,357.00
|
|
| Hospital Charge Code |
900800002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$1,153.45 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$725.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$932.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$746.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,017.75
|
| Rate for Payer: Blue Shield of California Commercial |
$842.70
|
| Rate for Payer: Blue Shield of California EPN |
$796.56
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$882.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,153.45
|
| Rate for Payer: Dignity Health Senior |
$1,153.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$882.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$839.98
|
| Rate for Payer: Heritage Provider Network Senior |
$839.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$654.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.25
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,153.45
|
|
|
HC FLEX VIDEOSCOPE AMBU
|
Facility
IP
|
$1,357.00
|
|
| Hospital Charge Code |
900800002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$1,017.75 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$932.26
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$918.69
|
| Rate for Payer: Heritage Provider Network Senior |
$918.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.25
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
|
|
HC FLEX VIDEOSCOPE AMBU LARGE
|
Facility
OP
|
$1,561.00
|
|
| Hospital Charge Code |
900800003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.54 |
| Max. Negotiated Rate |
$1,326.85 |
| Rate for Payer: Adventist Health Commercial |
$312.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$834.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,072.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,326.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$858.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,170.75
|
| Rate for Payer: Blue Shield of California Commercial |
$969.38
|
| Rate for Payer: Blue Shield of California EPN |
$916.31
|
| Rate for Payer: Cash Price |
$702.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,014.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,326.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,326.85
|
| Rate for Payer: Dignity Health Senior |
$1,326.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$966.26
|
| Rate for Payer: Heritage Provider Network Senior |
$966.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$752.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.25
|
| Rate for Payer: Multiplan Commercial |
$1,170.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,326.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,326.85
|
|
|
HC FLEX VIDEOSCOPE AMBU LARGE
|
Facility
IP
|
$1,561.00
|
|
| Hospital Charge Code |
900800003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.54 |
| Max. Negotiated Rate |
$1,170.75 |
| Rate for Payer: Adventist Health Commercial |
$312.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,072.41
|
| Rate for Payer: Cash Price |
$702.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,056.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1,056.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.25
|
| Rate for Payer: Multiplan Commercial |
$1,170.75
|
|
|
HC FLEX VIDEOSCOPE AMBU SLIM
|
Facility
IP
|
$1,357.00
|
|
| Hospital Charge Code |
900800001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$1,017.75 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$932.26
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$918.69
|
| Rate for Payer: Heritage Provider Network Senior |
$918.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.25
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
|
|
HC FLEX VIDEOSCOPE AMBU SLIM
|
Facility
OP
|
$1,357.00
|
|
| Hospital Charge Code |
900800001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$1,153.45 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$725.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$932.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$746.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,017.75
|
| Rate for Payer: Blue Shield of California Commercial |
$842.70
|
| Rate for Payer: Blue Shield of California EPN |
$796.56
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$882.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,153.45
|
| Rate for Payer: Dignity Health Senior |
$1,153.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$882.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$839.98
|
| Rate for Payer: Heritage Provider Network Senior |
$839.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$654.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.25
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,153.45
|
|
|
HC FLOW VOLUME STUDY
|
Facility
IP
|
$479.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
900801022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$86.70 |
| Max. Negotiated Rate |
$359.25 |
| Rate for Payer: Adventist Health Commercial |
$95.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.07
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.28
|
| Rate for Payer: Heritage Provider Network Senior |
$324.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.75
|
| Rate for Payer: Multiplan Commercial |
$359.25
|
|
|
HC FLOW VOLUME STUDY
|
Facility
OP
|
$479.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
900801022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$36.22 |
| Max. Negotiated Rate |
$745.12 |
| Rate for Payer: Adventist Health Commercial |
$95.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Blue Shield of California Commercial |
$102.80
|
| Rate for Payer: Blue Shield of California EPN |
$58.46
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$311.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$296.50
|
| Rate for Payer: Heritage Provider Network Senior |
$296.50
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: IEHP Medi-Cal |
$36.22
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$745.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$359.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$431.39
|
| Rate for Payer: TriValley Medical Group Senior |
$392.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC FLUORESCENT STAIN FUNGI
|
Facility
IP
|
$160.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900912418
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.92
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
|
|
HC FLUORESCENT STAIN FUNGI
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900912418
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$44.97 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.97
|
| Rate for Payer: Blue Shield of California Commercial |
$41.92
|
| Rate for Payer: Blue Shield of California EPN |
$32.78
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Senior |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$5.39
|
| Rate for Payer: IEHP Medi-Cal |
$7.47
|
| Rate for Payer: IEHP Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.79
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Senior |
$5.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC FLUORO GUIDANCE CNTRL VNS ACCESS DVC
|
Facility
OP
|
$1,150.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
909081673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.15 |
| Max. Negotiated Rate |
$977.50 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$212.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$790.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$632.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$862.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.93
|
| Rate for Payer: Blue Shield of California Commercial |
$498.39
|
| Rate for Payer: Blue Shield of California EPN |
$283.42
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$747.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$977.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.50
|
| Rate for Payer: Dignity Health Senior |
$977.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$711.85
|
| Rate for Payer: Heritage Provider Network Senior |
$711.85
|
| Rate for Payer: IEHP Medi-Cal |
$99.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$554.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.50
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.50
|
| Rate for Payer: Vantage Medical Group Senior |
$977.50
|
|
|
HC FLUORO GUIDANCE CNTRL VNS ACCESS DVC
|
Facility
IP
|
$1,150.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
909081673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.15 |
| Max. Negotiated Rate |
$862.50 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$790.05
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$778.55
|
| Rate for Payer: Heritage Provider Network Senior |
$778.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.50
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
|
|
HC FLUORO GUIDE NDL PLCMNT THRPY INJ
|
Facility
IP
|
$705.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
909001368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$528.75 |
| Rate for Payer: Adventist Health Commercial |
$141.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$484.34
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$477.28
|
| Rate for Payer: Heritage Provider Network Senior |
$477.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.25
|
| Rate for Payer: Multiplan Commercial |
$528.75
|
|
|
HC FLUORO GUIDE NDL PLCMNT THRPY INJ
|
Facility
OP
|
$705.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
909001368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.76 |
| Max. Negotiated Rate |
$599.25 |
| Rate for Payer: Adventist Health Commercial |
$141.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$107.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$484.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$599.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$387.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$528.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$402.91
|
| Rate for Payer: Blue Shield of California Commercial |
$207.88
|
| Rate for Payer: Blue Shield of California EPN |
$118.22
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$458.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$599.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$599.25
|
| Rate for Payer: Dignity Health Senior |
$599.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$436.40
|
| Rate for Payer: Heritage Provider Network Senior |
$436.40
|
| Rate for Payer: IEHP Medi-Cal |
$103.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$339.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.25
|
| Rate for Payer: Multiplan Commercial |
$528.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$599.25
|
| Rate for Payer: Vantage Medical Group Senior |
$599.25
|
|
