|
HC FLUORO GUIDE SPINE OR PARASPINOUS
|
Facility
OP
|
$627.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
909001358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$532.95 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$430.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$532.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$344.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$470.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$307.79
|
| Rate for Payer: Blue Shield of California Commercial |
$127.50
|
| Rate for Payer: Blue Shield of California EPN |
$72.50
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$407.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$532.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$532.95
|
| Rate for Payer: Dignity Health Senior |
$532.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$407.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$388.11
|
| Rate for Payer: Heritage Provider Network Senior |
$388.11
|
| Rate for Payer: IEHP Medi-Cal |
$88.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$302.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.75
|
| Rate for Payer: Multiplan Commercial |
$470.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$532.95
|
| Rate for Payer: Vantage Medical Group Senior |
$532.95
|
|
|
HC FLUORO GUIDE SPINE OR PARASPINOUS
|
Facility
IP
|
$627.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
909001358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.49 |
| Max. Negotiated Rate |
$470.25 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$430.75
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$424.48
|
| Rate for Payer: Heritage Provider Network Senior |
$424.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.75
|
| Rate for Payer: Multiplan Commercial |
$470.25
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
OP
|
$692.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906811312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.62 |
| Max. Negotiated Rate |
$581.70 |
| Rate for Payer: Adventist Health Commercial |
$138.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$475.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.46
|
| Rate for Payer: Blue Shield of California Commercial |
$266.69
|
| Rate for Payer: Blue Shield of California EPN |
$151.66
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$449.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$449.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$428.35
|
| Rate for Payer: Heritage Provider Network Senior |
$428.35
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$43.62
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$519.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.16
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$141.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$141.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
IP
|
$692.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906811312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$519.00 |
| Rate for Payer: Adventist Health Commercial |
$138.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$475.40
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$468.48
|
| Rate for Payer: Heritage Provider Network Senior |
$468.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.00
|
| Rate for Payer: Multiplan Commercial |
$519.00
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
IP
|
$1,587.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906820105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$287.25 |
| Max. Negotiated Rate |
$1,190.25 |
| Rate for Payer: Adventist Health Commercial |
$317.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,090.27
|
| Rate for Payer: Cash Price |
$714.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,074.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,074.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.75
|
| Rate for Payer: Multiplan Commercial |
$1,190.25
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
OP
|
$1,587.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906820105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.62 |
| Max. Negotiated Rate |
$1,190.25 |
| Rate for Payer: Adventist Health Commercial |
$317.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,090.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.46
|
| Rate for Payer: Blue Shield of California Commercial |
$266.69
|
| Rate for Payer: Blue Shield of California EPN |
$151.66
|
| Rate for Payer: Cash Price |
$714.15
|
| Rate for Payer: Cash Price |
$714.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,031.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,031.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$982.35
|
| Rate for Payer: Heritage Provider Network Senior |
$982.35
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$43.62
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,190.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.16
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$141.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$141.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC FLUORO XM G/COLON TUBE
|
Facility
IP
|
$1,196.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$216.48 |
| Max. Negotiated Rate |
$897.00 |
| Rate for Payer: Adventist Health Commercial |
$239.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$821.65
|
| Rate for Payer: Cash Price |
$538.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$809.69
|
| Rate for Payer: Heritage Provider Network Senior |
$809.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.00
|
| Rate for Payer: Multiplan Commercial |
$897.00
|
|
|
HC FLUORO XM G/COLON TUBE
|
Facility
OP
|
$2,093.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$220.12 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$418.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,437.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| 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 |
$941.85
|
| Rate for Payer: Cash Price |
$941.85
|
| Rate for Payer: Cash Price |
$941.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,360.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,295.57
|
| Rate for Payer: Heritage Provider Network Senior |
$376.58
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$220.12
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,569.75
|
| 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 |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC FMRI BRAIN BY PHYS/PSYCH
|
Facility
IP
|
$4,858.00
|
|
|
Service Code
|
CPT 70555
|
| Hospital Charge Code |
908801023
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$879.30 |
| Max. Negotiated Rate |
$3,643.50 |
| Rate for Payer: Adventist Health Commercial |
$971.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,337.45
|
| Rate for Payer: Cash Price |
$2,186.10
|
| Rate for Payer: Cash Price |
$2,186.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,288.87
|
| Rate for Payer: Heritage Provider Network Senior |
$3,288.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$879.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,214.50
|
| Rate for Payer: Multiplan Commercial |
$3,643.50
|
|
|
HC FMRI BRAIN BY PHYS/PSYCH
|
Facility
OP
|
$1,352.00
|
|
|
Service Code
|
CPT 70555
|
| Hospital Charge Code |
908801023
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$154.46 |
| Max. Negotiated Rate |
$1,075.00 |
| Rate for Payer: Adventist Health Commercial |
$270.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$928.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$839.59
|
| Rate for Payer: Blue Shield of California EPN |
$793.62
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$154.46
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,014.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC FMRI BRAIN BY TECH
|
Facility
IP
|
$4,508.00
|
|
|
Service Code
|
CPT 70554
|
| Hospital Charge Code |
908801022
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$815.95 |
| Max. Negotiated Rate |
$3,381.00 |
| Rate for Payer: Adventist Health Commercial |
$901.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,097.00
|
| Rate for Payer: Cash Price |
$2,028.60
|
| Rate for Payer: Cash Price |
$2,028.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,051.92
|
| Rate for Payer: Heritage Provider Network Senior |
$3,051.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$815.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,127.00
|
| Rate for Payer: Multiplan Commercial |
$3,381.00
|
|
|
HC FMRI BRAIN BY TECH
|
Facility
OP
|
$1,352.00
|
|
|
Service Code
|
CPT 70554
|
| Hospital Charge Code |
908801022
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$244.71 |
| Max. Negotiated Rate |
$2,642.83 |
| Rate for Payer: Adventist Health Commercial |
$270.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$928.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2,642.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,502.89
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$583.41
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,014.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC FNA BX W/CT GDN 1ST LESION
|
Facility
IP
|
$1,601.00
|
|
|
Service Code
|
CPT 10009
|
| Hospital Charge Code |
909010009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.78 |
| Max. Negotiated Rate |
$1,200.75 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.89
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,083.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,083.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
|
|
HC FNA BX W/CT GDN 1ST LESION
|
Facility
OP
|
$1,601.00
|
|
|
Service Code
|
CPT 10009
|
| Hospital Charge Code |
909010009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,040.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$991.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$668.49
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC FNA BX W/CT GDN EA ADDL LSN
|
Facility
IP
|
$801.00
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
909010010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.98 |
| Max. Negotiated Rate |
$600.75 |
| Rate for Payer: Adventist Health Commercial |
$160.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.29
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$542.28
|
| Rate for Payer: Heritage Provider Network Senior |
$542.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.25
|
| Rate for Payer: Multiplan Commercial |
$600.75
|
|
|
HC FNA BX W/CT GDN EA ADDL LSN
|
Facility
OP
|
$801.00
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
909010010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$160.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$680.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$600.75
|
| 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 |
$360.45
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$520.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$680.85
|
| Rate for Payer: Dignity Health Senior |
$680.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$495.82
|
| Rate for Payer: Heritage Provider Network Senior |
$495.82
|
| Rate for Payer: IEHP Medi-Cal |
$400.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$386.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.25
|
| Rate for Payer: Multiplan Commercial |
$600.75
|
| 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 |
$680.85
|
| Rate for Payer: Vantage Medical Group Senior |
$680.85
|
|
|
HC FNA BX W/FLUOR GDN 1ST LESION
|
Facility
OP
|
$1,601.00
|
|
|
Service Code
|
CPT 10007
|
| Hospital Charge Code |
909010007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,040.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$991.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$404.80
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC FNA BX W/FLUOR GDN 1ST LESION
|
Facility
IP
|
$1,601.00
|
|
|
Service Code
|
CPT 10007
|
| Hospital Charge Code |
909010007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.78 |
| Max. Negotiated Rate |
$1,200.75 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.89
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,083.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,083.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
|
|
HC FNA BX W/FLUOR GDN EA ADDL LSN
|
Facility
IP
|
$801.00
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
909010008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.98 |
| Max. Negotiated Rate |
$600.75 |
| Rate for Payer: Adventist Health Commercial |
$160.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.29
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$542.28
|
| Rate for Payer: Heritage Provider Network Senior |
$542.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.25
|
| Rate for Payer: Multiplan Commercial |
$600.75
|
|
|
HC FNA BX W/FLUOR GDN EA ADDL LSN
|
Facility
OP
|
$801.00
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
909010008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$160.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$680.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$600.75
|
| 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 |
$360.45
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$520.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$680.85
|
| Rate for Payer: Dignity Health Senior |
$680.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$495.82
|
| Rate for Payer: Heritage Provider Network Senior |
$495.82
|
| Rate for Payer: IEHP Medi-Cal |
$227.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$386.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.25
|
| Rate for Payer: Multiplan Commercial |
$600.75
|
| 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 |
$680.85
|
| Rate for Payer: Vantage Medical Group Senior |
$680.85
|
|
|
HC FNA BX W/MR GDN 1ST LESION
|
Facility
OP
|
$1,601.00
|
|
|
Service Code
|
CPT 10011
|
| Hospital Charge Code |
909010011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,040.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$991.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC FNA BX W/MR GDN 1ST LESION
|
Facility
IP
|
$1,601.00
|
|
|
Service Code
|
CPT 10011
|
| Hospital Charge Code |
909010011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.78 |
| Max. Negotiated Rate |
$1,200.75 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.89
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,083.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,083.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
|
|
HC FNA BX W/US GDN 1ST LESION
|
Facility
IP
|
$1,601.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
909010005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.78 |
| Max. Negotiated Rate |
$1,200.75 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.89
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,083.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,083.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
|
|
HC FNA BX W/US GDN 1ST LESION
|
Facility
OP
|
$1,601.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
909010005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| 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 |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,040.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$991.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$174.24
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC FNA BX W/US GDN EA ADDL LSN
|
Facility
IP
|
$801.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
909010006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.98 |
| Max. Negotiated Rate |
$600.75 |
| Rate for Payer: Adventist Health Commercial |
$160.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.29
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$542.28
|
| Rate for Payer: Heritage Provider Network Senior |
$542.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.25
|
| Rate for Payer: Multiplan Commercial |
$600.75
|
|
