|
HC FSH
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
900910818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$155.53 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.53
|
| Rate for Payer: Blue Shield of California Commercial |
$145.17
|
| Rate for Payer: Blue Shield of California EPN |
$113.49
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.44
|
| Rate for Payer: Dignity Health Senior |
$18.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Humana Medicare |
$18.58
|
| Rate for Payer: IEHP Medi-Cal |
$25.60
|
| Rate for Payer: IEHP Medicare Advantage |
$18.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.41
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.58
|
| Rate for Payer: TriValley Medical Group Senior |
$18.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.58
|
|
|
HC FSH
|
Facility
IP
|
$244.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
900910818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.63
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.19
|
| Rate for Payer: Heritage Provider Network Senior |
$165.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
|
|
HC FULL THCKNESS GRAFT LT 20SQ CM
|
Facility
IP
|
$6,345.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
900501513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,148.44 |
| Max. Negotiated Rate |
$4,758.75 |
| Rate for Payer: Adventist Health Commercial |
$1,269.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,359.02
|
| Rate for Payer: Cash Price |
$2,855.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,295.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4,295.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,148.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,586.25
|
| Rate for Payer: Multiplan Commercial |
$4,758.75
|
|
|
HC FULL THCKNESS GRAFT LT 20SQ CM
|
Facility
OP
|
$6,345.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
900501513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,269.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,359.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$2,855.25
|
| Rate for Payer: Cash Price |
$2,855.25
|
| Rate for Payer: Cash Price |
$2,855.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,124.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,295.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4,295.56
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,058.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,148.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,586.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: Multiplan Commercial |
$4,758.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,303.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,119.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC FULL THCKNESS GRAFT,LT 20SQ CM
|
Facility
IP
|
$6,345.00
|
|
|
Service Code
|
CPT 15220
|
| Hospital Charge Code |
900501388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,148.44 |
| Max. Negotiated Rate |
$4,758.75 |
| Rate for Payer: Adventist Health Commercial |
$1,269.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,359.02
|
| Rate for Payer: Cash Price |
$2,855.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,295.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4,295.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,148.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,586.25
|
| Rate for Payer: Multiplan Commercial |
$4,758.75
|
|
|
HC FULL THCKNESS GRAFT,LT 20SQ CM
|
Facility
OP
|
$6,345.00
|
|
|
Service Code
|
CPT 15220
|
| Hospital Charge Code |
900501388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,269.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,359.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,855.25
|
| Rate for Payer: Cash Price |
$2,855.25
|
| Rate for Payer: Cash Price |
$2,855.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,124.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,295.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4,295.56
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,058.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,148.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,586.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: Multiplan Commercial |
$4,758.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,303.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,119.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC FULL THKNS GRFT LT 20SQ CM FCE
|
Facility
IP
|
$6,345.00
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
900501754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,148.44 |
| Max. Negotiated Rate |
$4,758.75 |
| Rate for Payer: Adventist Health Commercial |
$1,269.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,359.02
|
| Rate for Payer: Cash Price |
$2,855.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,295.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4,295.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,148.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,586.25
|
| Rate for Payer: Multiplan Commercial |
$4,758.75
|
|
|
HC FULL THKNS GRFT LT 20SQ CM FCE
|
Facility
OP
|
$6,345.00
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
900501754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,269.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,359.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,855.25
|
| Rate for Payer: Cash Price |
$2,855.25
|
| Rate for Payer: Cash Price |
$2,855.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,124.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,295.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4,295.56
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,058.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,148.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,586.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: Multiplan Commercial |
$4,758.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,303.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,119.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC FUSION OF TENDONS AT WRIST
|
Facility
IP
|
$6,736.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
900501447
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,219.22 |
| Max. Negotiated Rate |
$5,052.00 |
| Rate for Payer: Adventist Health Commercial |
$1,347.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,627.63
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,560.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4,560.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.00
|
| Rate for Payer: Multiplan Commercial |
$5,052.00
|
|
|
HC FUSION OF TENDONS AT WRIST
|
Facility
OP
|
$6,736.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
900501447
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,347.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,627.63
|
| 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 |
$5,505.00
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,378.40
|
| 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 |
$4,560.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4,560.27
|
| 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 |
$3,246.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.00
|
| 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 |
$5,052.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,445.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,250.50
|
| 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 GA-67 GALLIUM PER MCI
|
Facility
OP
|
$276.00
|
|
|
Service Code
|
CPT A9556
|
| Hospital Charge Code |
909301528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.08 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Adventist Health Commercial |
$55.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$234.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$207.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.08
|
| Rate for Payer: Blue Shield of California Commercial |
$171.40
|
| Rate for Payer: Blue Shield of California EPN |
$162.01
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$234.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.60
|
| Rate for Payer: Dignity Health Senior |
$234.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.79
|
| Rate for Payer: Heritage Provider Network Senior |
$127.79
|
| Rate for Payer: IEHP Medi-Cal |
$210.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$133.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$207.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$92.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.60
|
| Rate for Payer: Vantage Medical Group Senior |
$234.60
|
|
|
HC GA-67 GALLIUM PER MCI
|
Facility
IP
|
$276.00
|
|
|
Service Code
|
CPT A9556
|
| Hospital Charge Code |
909301528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.96 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$55.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$189.61
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.85
|
| Rate for Payer: Heritage Provider Network Senior |
$186.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$207.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$92.21
|
|
|
HC GADOLINIUM MR CONTRAST PER ML
|
Facility
IP
|
$12.00
|
|
|
Service Code
|
CPT A9579
|
| Hospital Charge Code |
909081000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.01
|
|
|
HC GADOLINIUM MR CONTRAST PER ML
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
CPT A9579
|
| Hospital Charge Code |
909081000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7.45
|
| Rate for Payer: Blue Shield of California EPN |
$7.04
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Senior |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: IEHP Medi-Cal |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
HC GADOXETATE DISODIUM PER ML
|
Facility
IP
|
$86.00
|
|
|
Service Code
|
CPT A9581
|
| Hospital Charge Code |
908801701
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.08
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.22
|
| Rate for Payer: Heritage Provider Network Senior |
$58.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.73
|
|
|
HC GADOXETATE DISODIUM PER ML
|
Facility
OP
|
$86.00
|
|
|
Service Code
|
CPT A9581
|
| Hospital Charge Code |
908801701
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$73.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$64.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.78
|
| Rate for Payer: Blue Shield of California Commercial |
$53.41
|
| Rate for Payer: Blue Shield of California EPN |
$50.48
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.10
|
| Rate for Payer: Dignity Health Senior |
$73.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.23
|
| Rate for Payer: Heritage Provider Network Senior |
$53.23
|
| Rate for Payer: IEHP Medi-Cal |
$23.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.10
|
| Rate for Payer: Vantage Medical Group Senior |
$73.10
|
|
|
HC GAIT TRAINING 15 MIN MCAL
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
900400037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC GAIT TRAINING 15 MIN MCAL
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
900400037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Senior |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: IEHP Medi-Cal |
$17.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$130.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC GAIT TRAINING 15 MIN PT
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
900417116
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$106.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$68.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$93.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.25
|
| Rate for Payer: Dignity Health Senior |
$106.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: IEHP Medi-Cal |
$17.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.25
|
| Rate for Payer: Vantage Medical Group Senior |
$106.25
|
|
|
HC GAIT TRAINING 15 MIN PT
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
905103143
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC GAIT TRAINING 15 MIN PT
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
905103143
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$106.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$68.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$93.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.25
|
| Rate for Payer: Dignity Health Senior |
$106.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: IEHP Medi-Cal |
$17.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.25
|
| Rate for Payer: Vantage Medical Group Senior |
$106.25
|
|
|
HC GAIT TRAINING 15 MIN PT
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
900417116
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC GAIT TRAINING 30 MIN PT
|
Facility
OP
|
$405.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
905103363
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$278.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$303.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$263.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.25
|
| Rate for Payer: Dignity Health Senior |
$344.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$250.70
|
| Rate for Payer: Heritage Provider Network Senior |
$250.70
|
| Rate for Payer: IEHP Medi-Cal |
$17.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$195.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.25
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.25
|
| Rate for Payer: Vantage Medical Group Senior |
$344.25
|
|
|
HC GAIT TRAINING 30 MIN PT
|
Facility
IP
|
$405.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
905103363
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$73.30 |
| Max. Negotiated Rate |
$303.75 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$278.24
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$274.18
|
| Rate for Payer: Heritage Provider Network Senior |
$274.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.25
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
|
|
HC GALLBLDR/LIVER FUNC
|
Facility
IP
|
$2,311.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
909301353
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$418.29 |
| Max. Negotiated Rate |
$1,733.25 |
| Rate for Payer: Adventist Health Commercial |
$462.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,587.66
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,564.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,564.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.75
|
| Rate for Payer: Multiplan Commercial |
$1,733.25
|
|
