|
HC INJECT/ASPIRATE LIVER CYST
|
Facility
OP
|
$6,065.00
|
|
|
Service Code
|
CPT 47015
|
| Hospital Charge Code |
909081848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$784.07 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,213.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,166.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,155.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,335.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,548.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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 |
$2,729.25
|
| Rate for Payer: Cash Price |
$2,729.25
|
| Rate for Payer: Cash Price |
$2,729.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,942.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,155.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,155.25
|
| Rate for Payer: Dignity Health Senior |
$5,155.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,754.24
|
| Rate for Payer: Heritage Provider Network Senior |
$3,754.24
|
| Rate for Payer: IEHP Medi-Cal |
$784.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,923.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.25
|
| Rate for Payer: Multiplan Commercial |
$4,548.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,155.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,155.25
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
OP
|
$577.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.44 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$115.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$396.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$375.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$390.63
|
| Rate for Payer: Heritage Provider Network Senior |
$390.63
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$278.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$209.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$192.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
IP
|
$577.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.44 |
| Max. Negotiated Rate |
$432.75 |
| Rate for Payer: Adventist Health Commercial |
$115.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$396.40
|
| Rate for Payer: Cash Price |
$259.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$390.63
|
| Rate for Payer: Heritage Provider Network Senior |
$390.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.25
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
|
|
HC INJECTION EYE DRUG
|
Facility
OP
|
$1,116.00
|
|
|
Service Code
|
CPT 67028
|
| Hospital Charge Code |
900501532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$223.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$766.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$725.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: Dignity Health Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$725.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$423.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$755.53
|
| Rate for Payer: Heritage Provider Network Senior |
$755.53
|
| Rate for Payer: Humana Medicare |
$423.14
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$423.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$537.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$499.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$533.16
|
| Rate for Payer: Multiplan Commercial |
$837.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$405.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$372.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC INJECTION EYE DRUG
|
Facility
IP
|
$1,116.00
|
|
|
Service Code
|
CPT 67028
|
| Hospital Charge Code |
900501532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$837.00 |
| Rate for Payer: Adventist Health Commercial |
$223.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$766.69
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$755.53
|
| Rate for Payer: Heritage Provider Network Senior |
$755.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.00
|
| Rate for Payer: Multiplan Commercial |
$837.00
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
IP
|
$884.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Adventist Health Commercial |
$176.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$607.31
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$598.47
|
| Rate for Payer: Heritage Provider Network Senior |
$598.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.00
|
| Rate for Payer: Multiplan Commercial |
$663.00
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
IP
|
$884.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Adventist Health Commercial |
$176.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$607.31
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$598.47
|
| Rate for Payer: Heritage Provider Network Senior |
$598.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.00
|
| Rate for Payer: Multiplan Commercial |
$663.00
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
OP
|
$884.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.66 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$176.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$607.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| 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 |
$397.80
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$574.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$547.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,062.77
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: IEHP Medi-Cal |
$76.66
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,641.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$663.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$950.44
|
| Rate for Payer: TriValley Medical Group Senior |
$950.44
|
| 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 |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC INJECTION OTHER PERIPHERAL NERVE
|
Facility
OP
|
$884.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
900501175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$176.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$607.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$574.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$574.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$598.47
|
| Rate for Payer: Heritage Provider Network Senior |
$598.47
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$426.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$663.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$320.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$295.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
OP
|
$1,878.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.89 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$375.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,290.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| 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 |
$845.10
|
| Rate for Payer: Cash Price |
$845.10
|
| Rate for Payer: Cash Price |
$845.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,220.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,126.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,162.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.76
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: IEHP Medi-Cal |
$250.89
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,163.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$1,408.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,252.71
|
| Rate for Payer: TriValley Medical Group Senior |
$1,252.71
|
| 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 |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
IP
|
$1,878.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$339.92 |
| Max. Negotiated Rate |
$1,408.50 |
| Rate for Payer: Adventist Health Commercial |
$375.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,290.19
|
| Rate for Payer: Cash Price |
$845.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,271.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1,271.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.50
|
| Rate for Payer: Multiplan Commercial |
$1,408.50
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
IP
|
$1,878.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$339.92 |
| Max. Negotiated Rate |
$1,408.50 |
| Rate for Payer: Adventist Health Commercial |
$375.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,290.19
|
| Rate for Payer: Cash Price |
$845.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,271.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1,271.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.50
|
| Rate for Payer: Multiplan Commercial |
$1,408.50
|
|
|
HC INJECTION PARAVERTEBRAL JOINT
|
Facility
OP
|
$1,878.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
909000230
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$339.92 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$375.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,290.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$845.10
|
| Rate for Payer: Cash Price |
$845.10
|
| Rate for Payer: Cash Price |
$845.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,220.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,220.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,271.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1,271.41
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$905.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$1,408.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$681.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$627.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJECTION TREATMENT OF NERVE
|
Facility
IP
|
$6,557.00
|
|
|
Service Code
|
CPT 64610
|
| Hospital Charge Code |
909000272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,186.82 |
| Max. Negotiated Rate |
$4,917.75 |
| Rate for Payer: Adventist Health Commercial |
$1,311.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,504.66
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,439.09
|
| Rate for Payer: Heritage Provider Network Senior |
$4,439.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,186.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,639.25
|
| Rate for Payer: Multiplan Commercial |
$4,917.75
|
|
|
HC INJECTION TREATMENT OF NERVE
|
Facility
OP
|
$6,557.00
|
|
|
Service Code
|
CPT 64610
|
| Hospital Charge Code |
909000272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$320.02 |
| Max. Negotiated Rate |
$7,096.00 |
| Rate for Payer: Adventist Health Commercial |
$1,311.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,504.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| 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 |
$2,950.65
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,262.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: Dignity Health Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,934.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,412.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,058.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2,967.23
|
| Rate for Payer: Humana Medicare |
$2,412.38
|
| Rate for Payer: IEHP Medi-Cal |
$320.02
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,583.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,186.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,639.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,039.60
|
| Rate for Payer: Multiplan Commercial |
$4,917.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,653.62
|
| Rate for Payer: TriValley Medical Group Senior |
$2,653.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
IP
|
$839.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$151.86 |
| Max. Negotiated Rate |
$629.25 |
| Rate for Payer: Adventist Health Commercial |
$167.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$576.39
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$568.00
|
| Rate for Payer: Heritage Provider Network Senior |
$568.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.75
|
| Rate for Payer: Multiplan Commercial |
$629.25
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
IP
|
$839.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.86 |
| Max. Negotiated Rate |
$629.25 |
| Rate for Payer: Adventist Health Commercial |
$167.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$576.39
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$568.00
|
| Rate for Payer: Heritage Provider Network Senior |
$568.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.75
|
| Rate for Payer: Multiplan Commercial |
$629.25
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
OP
|
$839.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.28 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$167.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$576.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| 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 |
$377.55
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$545.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: Dignity Health Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$503.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$519.34
|
| Rate for Payer: Heritage Provider Network Senior |
$455.17
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$88.28
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$703.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$466.28
|
| Rate for Payer: Multiplan Commercial |
$629.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$407.07
|
| Rate for Payer: TriValley Medical Group Senior |
$407.07
|
| 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 |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJECTION TRIGEMINAL NERVE
|
Facility
OP
|
$839.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
900501328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.86 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$167.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$576.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$545.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: Dignity Health Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$545.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$568.00
|
| Rate for Payer: Heritage Provider Network Senior |
$568.00
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$404.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$466.28
|
| Rate for Payer: Multiplan Commercial |
$629.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$304.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$280.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJECTION VITREOUS SUBSTITUTE
|
Facility
IP
|
$6,637.00
|
|
|
Service Code
|
CPT 67025
|
| Hospital Charge Code |
950510062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,201.30 |
| Max. Negotiated Rate |
$4,977.75 |
| Rate for Payer: Adventist Health Commercial |
$1,327.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,559.62
|
| Rate for Payer: Cash Price |
$2,986.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,493.25
|
| Rate for Payer: Heritage Provider Network Senior |
$4,493.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,201.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,659.25
|
| Rate for Payer: Multiplan Commercial |
$4,977.75
|
|
|
HC INJECTION VITREOUS SUBSTITUTE
|
Facility
OP
|
$6,637.00
|
|
|
Service Code
|
CPT 67025
|
| Hospital Charge Code |
950510062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$4,977.75 |
| Rate for Payer: Adventist Health Commercial |
$1,327.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,559.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,986.65
|
| Rate for Payer: Cash Price |
$2,986.65
|
| Rate for Payer: Cash Price |
$2,986.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,314.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,314.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,493.25
|
| Rate for Payer: Heritage Provider Network Senior |
$4,493.25
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,199.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,201.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,659.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: Multiplan Commercial |
$4,977.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,409.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,217.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC INJECT SINUS TRACT; THERAPEUTIC
|
Facility
IP
|
$3,026.00
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
909020500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$547.71 |
| Max. Negotiated Rate |
$2,269.50 |
| Rate for Payer: Adventist Health Commercial |
$605.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,078.86
|
| Rate for Payer: Cash Price |
$1,361.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,048.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,048.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$547.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.50
|
| Rate for Payer: Multiplan Commercial |
$2,269.50
|
|
|
HC INJECT SINUS TRACT; THERAPEUTIC
|
Facility
OP
|
$3,026.00
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
909020500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.94 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$605.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,078.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,879.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,776.26
|
| Rate for Payer: Cash Price |
$1,361.70
|
| Rate for Payer: Cash Price |
$1,361.70
|
| Rate for Payer: Cash Price |
$1,361.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,966.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: Dignity Health Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,873.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,873.09
|
| Rate for Payer: Humana Medicare |
$1,905.44
|
| Rate for Payer: IEHP Medi-Cal |
$164.94
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,620.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$547.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,400.85
|
| Rate for Payer: Multiplan Commercial |
$2,269.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,905.44
|
| Rate for Payer: TriValley Medical Group Senior |
$1,905.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
IP
|
$380.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Adventist Health Commercial |
$76.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$261.06
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$257.26
|
| Rate for Payer: Heritage Provider Network Senior |
$257.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.00
|
| Rate for Payer: Multiplan Commercial |
$285.00
|
|
|
HC INJECT THER/PROP/DIAG SC/IM
|
Facility
IP
|
$380.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
910196372
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Adventist Health Commercial |
$76.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$261.06
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$257.26
|
| Rate for Payer: Heritage Provider Network Senior |
$257.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.00
|
| Rate for Payer: Multiplan Commercial |
$285.00
|
|
