|
HC HAND MUSCLE TESTING MANUAL OT
|
Facility
OP
|
$254.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
905104403
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$45.97 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$135.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$174.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$215.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$139.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$190.50
|
| 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 |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.90
|
| Rate for Payer: Dignity Health Senior |
$215.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.23
|
| Rate for Payer: Heritage Provider Network Senior |
$157.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$122.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.50
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
| 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 |
$215.90
|
| Rate for Payer: Vantage Medical Group Senior |
$215.90
|
|
|
HC HAND MUSCLE TESTING MANUAL OT
|
Facility
IP
|
$254.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
905104403
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$45.97 |
| Max. Negotiated Rate |
$190.50 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$174.50
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.96
|
| Rate for Payer: Heritage Provider Network Senior |
$171.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.50
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
|
|
HC HAND WRIST BOTH 1 VIEW
|
Facility
IP
|
$397.00
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
909073120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.86 |
| Max. Negotiated Rate |
$297.75 |
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$272.74
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.77
|
| Rate for Payer: Heritage Provider Network Senior |
$268.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.25
|
| Rate for Payer: Multiplan Commercial |
$297.75
|
|
|
HC HAND WRIST BOTH 1 VIEW
|
Facility
OP
|
$397.00
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
909073120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.86 |
| Max. Negotiated Rate |
$337.45 |
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$212.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$272.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$337.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$218.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$297.75
|
| Rate for Payer: Blue Shield of California Commercial |
$246.54
|
| Rate for Payer: Blue Shield of California EPN |
$233.04
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$258.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$337.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.45
|
| Rate for Payer: Dignity Health Senior |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.74
|
| Rate for Payer: Heritage Provider Network Senior |
$245.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$191.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.25
|
| Rate for Payer: Multiplan Commercial |
$297.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.45
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
HC HAPTOGLOBIN
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
900910844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$105.26 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.26
|
| Rate for Payer: Blue Shield of California Commercial |
$98.27
|
| Rate for Payer: Blue Shield of California EPN |
$76.82
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.84
|
| Rate for Payer: Dignity Health Senior |
$12.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.71
|
| Rate for Payer: Heritage Provider Network Senior |
$29.71
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: IEHP Medi-Cal |
$17.14
|
| Rate for Payer: IEHP Medicare Advantage |
$12.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.85
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.58
|
| Rate for Payer: TriValley Medical Group Senior |
$12.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Vantage Medical Group Senior |
$12.58
|
|
|
HC HAPTOGLOBIN
|
Facility
IP
|
$190.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
900910844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.39 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$130.53
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.63
|
| Rate for Payer: Heritage Provider Network Senior |
$128.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.50
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
IP
|
$681.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
900904699
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$123.26 |
| Max. Negotiated Rate |
$510.75 |
| Rate for Payer: Adventist Health Commercial |
$136.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$467.85
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.04
|
| Rate for Payer: Heritage Provider Network Senior |
$461.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$510.75
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
OP
|
$681.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
900904699
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$64.94 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$136.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$467.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$422.90
|
| Rate for Payer: Blue Shield of California EPN |
$399.75
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Cash Price |
$306.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$442.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: Dignity Health Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$542.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$421.54
|
| Rate for Payer: Heritage Provider Network Senior |
$421.54
|
| Rate for Payer: Humana Medicare |
$542.38
|
| Rate for Payer: IEHP Medicare Advantage |
$542.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,030.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$510.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$542.38
|
| Rate for Payer: TriValley Medical Group Senior |
$542.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC HAST
|
Facility
OP
|
$1,143.00
|
|
|
Service Code
|
CPT 94452
|
| Hospital Charge Code |
900801034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$103.69 |
| Max. Negotiated Rate |
$857.25 |
| Rate for Payer: Adventist Health Commercial |
$228.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$103.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$785.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Blue Shield of California Commercial |
$185.19
|
| Rate for Payer: Blue Shield of California EPN |
$105.31
|
| Rate for Payer: Cash Price |
$514.35
|
| Rate for Payer: Cash Price |
$514.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$742.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$742.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$707.52
|
| Rate for Payer: Heritage Provider Network Senior |
$707.52
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$857.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.56
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC HAST
|
Facility
IP
|
$1,143.00
|
|
|
Service Code
|
CPT 94452
|
| Hospital Charge Code |
900801034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$206.88 |
| Max. Negotiated Rate |
$857.25 |
| Rate for Payer: Adventist Health Commercial |
$228.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$785.24
|
| Rate for Payer: Cash Price |
$514.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$773.81
|
| Rate for Payer: Heritage Provider Network Senior |
$773.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.75
|
| Rate for Payer: Multiplan Commercial |
$857.25
|
|
|
HC HAST W/02 TITRATE
|
Facility
OP
|
$1,074.00
|
|
|
Service Code
|
CPT 94453
|
| Hospital Charge Code |
900801035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$142.22 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$142.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Blue Shield of California Commercial |
$275.41
|
| Rate for Payer: Blue Shield of California EPN |
$156.62
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$698.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$698.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$664.81
|
| Rate for Payer: Heritage Provider Network Senior |
$664.81
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.56
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC HAST W/02 TITRATE
|
Facility
IP
|
$1,074.00
|
|
|
Service Code
|
CPT 94453
|
| Hospital Charge Code |
900801035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.84
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
|
|
HC HBO THERAPY INTL 15 MIN INCREM
|
Facility
OP
|
$573.00
|
|
|
Service Code
|
CPT Z7606
|
| Hospital Charge Code |
900803114
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$30.78 |
| Max. Negotiated Rate |
$2,224.00 |
| Rate for Payer: Adventist Health Commercial |
$114.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$306.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$393.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$487.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$315.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$429.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$355.83
|
| Rate for Payer: Blue Shield of California EPN |
$336.35
|
| Rate for Payer: Cash Price |
$257.85
|
| Rate for Payer: Cash Price |
$257.85
|
| Rate for Payer: Cash Price |
$257.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$372.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$487.05
|
| Rate for Payer: Dignity Health Senior |
$487.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$354.69
|
| Rate for Payer: Heritage Provider Network Senior |
$354.69
|
| Rate for Payer: IEHP Medi-Cal |
$30.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$276.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.25
|
| Rate for Payer: Multiplan Commercial |
$429.75
|
| 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 |
$2,224.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,869.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$487.05
|
| Rate for Payer: Vantage Medical Group Senior |
$487.05
|
|
|
HC HBO THERAPY INTL 15 MIN INCREM
|
Facility
IP
|
$603.00
|
|
| Hospital Charge Code |
900803110
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$109.14 |
| Max. Negotiated Rate |
$452.25 |
| Rate for Payer: Adventist Health Commercial |
$120.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$414.26
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.23
|
| Rate for Payer: Heritage Provider Network Senior |
$408.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.75
|
| Rate for Payer: Multiplan Commercial |
$452.25
|
|
|
HC HBO THERAPY INTL 15 MIN INCREM
|
Facility
OP
|
$603.00
|
|
| Hospital Charge Code |
900803110
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$2,224.00 |
| Rate for Payer: Adventist Health Commercial |
$120.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$322.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$414.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$512.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$331.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$452.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$374.46
|
| Rate for Payer: Blue Shield of California EPN |
$353.96
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$391.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$512.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$512.55
|
| Rate for Payer: Dignity Health Senior |
$512.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$373.26
|
| Rate for Payer: Heritage Provider Network Senior |
$373.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$290.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.75
|
| Rate for Payer: Multiplan Commercial |
$452.25
|
| 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 |
$2,224.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,869.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$512.55
|
| Rate for Payer: Vantage Medical Group Senior |
$512.55
|
|
|
HC HBO THERAPY INTL 15 MIN INCREM
|
Facility
IP
|
$573.00
|
|
|
Service Code
|
CPT Z7606
|
| Hospital Charge Code |
900803114
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$103.71 |
| Max. Negotiated Rate |
$429.75 |
| Rate for Payer: Adventist Health Commercial |
$114.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$393.65
|
| Rate for Payer: Cash Price |
$257.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$387.92
|
| Rate for Payer: Heritage Provider Network Senior |
$387.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.25
|
| Rate for Payer: Multiplan Commercial |
$429.75
|
|
|
HC HBO THERAPY PER 30 MINUTES
|
Facility
IP
|
$1,159.00
|
|
|
Service Code
|
CPT G0277
|
| Hospital Charge Code |
900803100
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$209.78 |
| Max. Negotiated Rate |
$869.25 |
| Rate for Payer: Adventist Health Commercial |
$231.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$796.23
|
| Rate for Payer: Cash Price |
$521.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$784.64
|
| Rate for Payer: Heritage Provider Network Senior |
$784.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.75
|
| Rate for Payer: Multiplan Commercial |
$869.25
|
|
|
HC HBO THERAPY PER 30 MINUTES
|
Facility
OP
|
$1,159.00
|
|
|
Service Code
|
CPT G0277
|
| Hospital Charge Code |
900803100
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$2,224.00 |
| Rate for Payer: Adventist Health Commercial |
$231.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,467.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$796.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$260.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$190.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$173.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$719.74
|
| Rate for Payer: Blue Shield of California EPN |
$680.33
|
| Rate for Payer: Cash Price |
$521.55
|
| Rate for Payer: Cash Price |
$521.55
|
| Rate for Payer: Cash Price |
$521.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$753.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.71
|
| Rate for Payer: Dignity Health Senior |
$173.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$753.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$173.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$717.42
|
| Rate for Payer: Heritage Provider Network Senior |
$717.42
|
| Rate for Payer: Humana Medicare |
$173.37
|
| Rate for Payer: IEHP Medicare Advantage |
$173.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$329.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$218.45
|
| Rate for Payer: Multiplan Commercial |
$869.25
|
| 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 |
$2,224.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,869.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.71
|
| Rate for Payer: Vantage Medical Group Senior |
$173.37
|
|
|
HC HBO THERAPY SUB 15 MIN INCREM
|
Facility
OP
|
$573.00
|
|
|
Service Code
|
CPT Z7608
|
| Hospital Charge Code |
900803115
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$30.78 |
| Max. Negotiated Rate |
$2,224.00 |
| Rate for Payer: Adventist Health Commercial |
$114.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$306.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$393.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$487.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$315.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$429.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$355.83
|
| Rate for Payer: Blue Shield of California EPN |
$336.35
|
| Rate for Payer: Cash Price |
$257.85
|
| Rate for Payer: Cash Price |
$257.85
|
| Rate for Payer: Cash Price |
$257.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$372.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$487.05
|
| Rate for Payer: Dignity Health Senior |
$487.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$354.69
|
| Rate for Payer: Heritage Provider Network Senior |
$354.69
|
| Rate for Payer: IEHP Medi-Cal |
$30.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$276.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.25
|
| Rate for Payer: Multiplan Commercial |
$429.75
|
| 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 |
$2,224.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,869.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$487.05
|
| Rate for Payer: Vantage Medical Group Senior |
$487.05
|
|
|
HC HBO THERAPY SUB 15 MIN INCREM
|
Facility
IP
|
$573.00
|
|
|
Service Code
|
CPT Z7608
|
| Hospital Charge Code |
900803115
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$103.71 |
| Max. Negotiated Rate |
$429.75 |
| Rate for Payer: Adventist Health Commercial |
$114.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$393.65
|
| Rate for Payer: Cash Price |
$257.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$387.92
|
| Rate for Payer: Heritage Provider Network Senior |
$387.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.25
|
| Rate for Payer: Multiplan Commercial |
$429.75
|
|
|
HC HBO THERAPY SUB 15 MIN INCREM
|
Facility
OP
|
$603.00
|
|
| Hospital Charge Code |
900803111
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$2,224.00 |
| Rate for Payer: Adventist Health Commercial |
$120.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$322.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$414.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$512.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$331.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$452.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$374.46
|
| Rate for Payer: Blue Shield of California EPN |
$353.96
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$391.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$512.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$512.55
|
| Rate for Payer: Dignity Health Senior |
$512.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$373.26
|
| Rate for Payer: Heritage Provider Network Senior |
$373.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$290.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.75
|
| Rate for Payer: Multiplan Commercial |
$452.25
|
| 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 |
$2,224.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,869.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$512.55
|
| Rate for Payer: Vantage Medical Group Senior |
$512.55
|
|
|
HC HBO THERAPY SUB 15 MIN INCREM
|
Facility
IP
|
$603.00
|
|
| Hospital Charge Code |
900803111
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$109.14 |
| Max. Negotiated Rate |
$452.25 |
| Rate for Payer: Adventist Health Commercial |
$120.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$414.26
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.23
|
| Rate for Payer: Heritage Provider Network Senior |
$408.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.75
|
| Rate for Payer: Multiplan Commercial |
$452.25
|
|
|
HC HCV RNA QUANT
|
Facility
IP
|
$812.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$557.84
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$549.72
|
| Rate for Payer: Heritage Provider Network Senior |
$549.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
|
|
HC HCV RNA QUANT
|
Facility
OP
|
$231.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.81 |
| Max. Negotiated Rate |
$334.56 |
| Rate for Payer: Adventist Health Commercial |
$46.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$158.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.56
|
| Rate for Payer: Blue Shield of California Commercial |
$334.56
|
| Rate for Payer: Blue Shield of California EPN |
$261.54
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$150.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.99
|
| Rate for Payer: Heritage Provider Network Senior |
$142.99
|
| Rate for Payer: Humana Medicare |
$42.84
|
| Rate for Payer: IEHP Medi-Cal |
$49.16
|
| Rate for Payer: IEHP Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.98
|
| Rate for Payer: Multiplan Commercial |
$173.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC HEAD ECHO
|
Facility
IP
|
$928.00
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
906601400
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$167.97 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Adventist Health Commercial |
$185.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$637.54
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$628.26
|
| Rate for Payer: Heritage Provider Network Senior |
$628.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
|
