|
HC JEJUNOSTOMY PERC
|
Facility
OP
|
$1,756.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.77 |
| Max. Negotiated Rate |
$1,492.60 |
| Rate for Payer: Adventist Health Commercial |
$351.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$231.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,206.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,492.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$965.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,317.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$627.64
|
| Rate for Payer: Blue Shield of California Commercial |
$533.43
|
| Rate for Payer: Blue Shield of California EPN |
$303.35
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,141.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,492.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,492.60
|
| Rate for Payer: Dignity Health Senior |
$1,492.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,141.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,086.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,086.96
|
| Rate for Payer: IEHP Medi-Cal |
$160.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$846.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.00
|
| Rate for Payer: Multiplan Commercial |
$1,317.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,492.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,492.60
|
|
|
HC JEJUNOSTOMY PERC
|
Facility
IP
|
$1,756.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$317.84 |
| Max. Negotiated Rate |
$1,317.00 |
| Rate for Payer: Adventist Health Commercial |
$351.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,206.37
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.00
|
| Rate for Payer: Multiplan Commercial |
$1,317.00
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
OP
|
$505.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$286.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$346.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$277.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$378.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| 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 |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$328.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.25
|
| Rate for Payer: Dignity Health Senior |
$429.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.60
|
| Rate for Payer: Heritage Provider Network Senior |
$312.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$243.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.25
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$429.25
|
| Rate for Payer: Vantage Medical Group Senior |
$429.25
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
IP
|
$737.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$552.75 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.32
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$498.95
|
| Rate for Payer: Heritage Provider Network Senior |
$498.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
|
|
HC JO-1 AUTO AB
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$140.09 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.47
|
| Rate for Payer: Blue Shield of California Commercial |
$140.09
|
| Rate for Payer: Blue Shield of California EPN |
$109.51
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: IEHP Medi-Cal |
$22.76
|
| Rate for Payer: IEHP Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.59
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC JO-1 AUTO AB
|
Facility
IP
|
$162.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.29
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.67
|
| Rate for Payer: Heritage Provider Network Senior |
$109.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
OP
|
$1,090.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$59.23 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$218.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$748.83
|
| 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 |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$708.50
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$674.71
|
| Rate for Payer: Heritage Provider Network Senior |
$455.17
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$59.23
|
| 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 |
$197.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.50
|
| 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 |
$817.50
|
| 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 JOINT ASPIR/INJ-INTER JOINT
|
Facility
IP
|
$1,090.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$197.29 |
| Max. Negotiated Rate |
$817.50 |
| Rate for Payer: Adventist Health Commercial |
$218.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$748.83
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.93
|
| Rate for Payer: Heritage Provider Network Senior |
$737.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.50
|
| Rate for Payer: Multiplan Commercial |
$817.50
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
IP
|
$1,366.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$247.25 |
| Max. Negotiated Rate |
$1,024.50 |
| Rate for Payer: Adventist Health Commercial |
$273.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$938.44
|
| Rate for Payer: Cash Price |
$614.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$924.78
|
| Rate for Payer: Heritage Provider Network Senior |
$924.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.50
|
| Rate for Payer: Multiplan Commercial |
$1,024.50
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
OP
|
$1,366.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$120.14 |
| Max. Negotiated Rate |
$1,024.50 |
| Rate for Payer: Adventist Health Commercial |
$273.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$186.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$938.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$366.46
|
| Rate for Payer: Blue Shield of California EPN |
$208.40
|
| Rate for Payer: Cash Price |
$614.70
|
| Rate for Payer: Cash Price |
$614.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$887.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.55
|
| Rate for Payer: Heritage Provider Network Senior |
$845.55
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: IEHP Medi-Cal |
$120.14
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,024.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC KIDNEY SCAN
|
Facility
OP
|
$1,825.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$186.93 |
| Max. Negotiated Rate |
$1,368.75 |
| Rate for Payer: Adventist Health Commercial |
$365.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$419.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,253.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$725.33
|
| Rate for Payer: Blue Shield of California EPN |
$412.47
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,186.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,129.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,129.68
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: IEHP Medi-Cal |
$186.93
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,368.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC KIDNEY SCAN
|
Facility
IP
|
$1,825.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$330.32 |
| Max. Negotiated Rate |
$1,368.75 |
| Rate for Payer: Adventist Health Commercial |
$365.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,253.78
|
| Rate for Payer: Cash Price |
$821.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,235.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,235.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.25
|
| Rate for Payer: Multiplan Commercial |
$1,368.75
|
|
|
HC KIT NDL BIOPSY TRAY 102MM
|
Facility
OP
|
$749.80
|
|
|
Service Code
|
CPT C1830
|
| Hospital Charge Code |
909081707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.71 |
| Max. Negotiated Rate |
$2,004.82 |
| Rate for Payer: Adventist Health Commercial |
$149.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,004.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$515.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$637.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$412.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$562.35
|
| Rate for Payer: Blue Shield of California Commercial |
$465.63
|
| Rate for Payer: Blue Shield of California EPN |
$440.13
|
| Rate for Payer: Cash Price |
$337.41
|
| Rate for Payer: Cash Price |
$337.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$487.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$637.33
|
| Rate for Payer: Dignity Health Senior |
$637.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$487.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$464.13
|
| Rate for Payer: Heritage Provider Network Senior |
$464.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$361.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.45
|
| Rate for Payer: Multiplan Commercial |
$562.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$637.33
|
| Rate for Payer: Vantage Medical Group Senior |
$637.33
|
|
|
HC KIT NDL BIOPSY TRAY 102MM
|
Facility
IP
|
$749.80
|
|
|
Service Code
|
CPT C1830
|
| Hospital Charge Code |
909081707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.71 |
| Max. Negotiated Rate |
$562.35 |
| Rate for Payer: Adventist Health Commercial |
$149.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$515.11
|
| Rate for Payer: Cash Price |
$337.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.61
|
| Rate for Payer: Heritage Provider Network Senior |
$507.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.45
|
| Rate for Payer: Multiplan Commercial |
$562.35
|
|
|
HC KIT NDL BIOPSY TRAY 152MM
|
Facility
IP
|
$89.04
|
|
|
Service Code
|
CPT C1830
|
| Hospital Charge Code |
909081706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Adventist Health Commercial |
$17.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.17
|
| Rate for Payer: Cash Price |
$40.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.28
|
| Rate for Payer: Heritage Provider Network Senior |
$60.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.26
|
| Rate for Payer: Multiplan Commercial |
$66.78
|
|
|
HC KIT NDL BIOPSY TRAY 152MM
|
Facility
OP
|
$89.04
|
|
|
Service Code
|
CPT C1830
|
| Hospital Charge Code |
909081706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$2,004.82 |
| Rate for Payer: Adventist Health Commercial |
$17.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,004.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$75.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$48.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$66.78
|
| Rate for Payer: Blue Shield of California Commercial |
$55.29
|
| Rate for Payer: Blue Shield of California EPN |
$52.27
|
| Rate for Payer: Cash Price |
$40.07
|
| Rate for Payer: Cash Price |
$40.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.68
|
| Rate for Payer: Dignity Health Senior |
$75.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.12
|
| Rate for Payer: Heritage Provider Network Senior |
$55.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.26
|
| Rate for Payer: Multiplan Commercial |
$66.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.68
|
| Rate for Payer: Vantage Medical Group Senior |
$75.68
|
|
|
HC KNEE 1-2 VIEWS
|
Facility
OP
|
$520.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
909001621
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.67 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$357.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.99
|
| Rate for Payer: Blue Shield of California Commercial |
$104.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.57
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$338.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$321.88
|
| Rate for Payer: Heritage Provider Network Senior |
$321.88
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$29.67
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC KNEE 1-2 VIEWS
|
Facility
IP
|
$520.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
909001621
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.12 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$357.24
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$352.04
|
| Rate for Payer: Heritage Provider Network Senior |
$352.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
|
|
HC KNEE 3 VIEWS
|
Facility
IP
|
$963.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
909001675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.30 |
| Max. Negotiated Rate |
$722.25 |
| Rate for Payer: Adventist Health Commercial |
$192.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$661.58
|
| Rate for Payer: Cash Price |
$433.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$651.95
|
| Rate for Payer: Heritage Provider Network Senior |
$651.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$722.25
|
|
|
HC KNEE 3 VIEWS
|
Facility
OP
|
$963.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
909001675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.47 |
| Max. Negotiated Rate |
$722.25 |
| Rate for Payer: Adventist Health Commercial |
$192.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$59.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$661.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.54
|
| Rate for Payer: Blue Shield of California Commercial |
$117.39
|
| Rate for Payer: Blue Shield of California EPN |
$66.75
|
| Rate for Payer: Cash Price |
$433.35
|
| Rate for Payer: Cash Price |
$433.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$625.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.10
|
| Rate for Payer: Heritage Provider Network Senior |
$596.10
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$36.47
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$722.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC KNEE COMPLETE 4 VIEWS
|
Facility
IP
|
$841.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
909001622
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.22 |
| Max. Negotiated Rate |
$630.75 |
| Rate for Payer: Adventist Health Commercial |
$168.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$577.77
|
| Rate for Payer: Cash Price |
$378.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$569.36
|
| Rate for Payer: Heritage Provider Network Senior |
$569.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.25
|
| Rate for Payer: Multiplan Commercial |
$630.75
|
|
|
HC KNEE COMPLETE 4 VIEWS
|
Facility
OP
|
$841.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
909001622
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.21 |
| Max. Negotiated Rate |
$630.75 |
| Rate for Payer: Adventist Health Commercial |
$168.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$577.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.88
|
| Rate for Payer: Blue Shield of California Commercial |
$127.22
|
| Rate for Payer: Blue Shield of California EPN |
$72.34
|
| Rate for Payer: Cash Price |
$378.45
|
| Rate for Payer: Cash Price |
$378.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$546.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$546.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$520.58
|
| Rate for Payer: Heritage Provider Network Senior |
$520.58
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$43.21
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$630.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC KNEE STANDING
|
Facility
IP
|
$404.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
909001624
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.12 |
| Max. Negotiated Rate |
$303.00 |
| Rate for Payer: Adventist Health Commercial |
$80.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$277.55
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$273.51
|
| Rate for Payer: Heritage Provider Network Senior |
$273.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.00
|
| Rate for Payer: Multiplan Commercial |
$303.00
|
|
|
HC KNEE STANDING
|
Facility
OP
|
$404.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
909001624
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.67 |
| Max. Negotiated Rate |
$303.00 |
| Rate for Payer: Adventist Health Commercial |
$80.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$277.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.17
|
| Rate for Payer: Blue Shield of California Commercial |
$98.89
|
| Rate for Payer: Blue Shield of California EPN |
$56.23
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$262.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$250.08
|
| Rate for Payer: Heritage Provider Network Senior |
$250.08
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$29.67
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC KO ADJ JTS CUSTOM FIT
|
Facility
OP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
905351832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.20 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$220.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$528.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$756.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$605.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$825.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$683.72
|
| Rate for Payer: Blue Shield of California EPN |
$646.29
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$506.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$935.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.85
|
| Rate for Payer: Dignity Health Senior |
$935.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$509.76
|
| Rate for Payer: Heritage Provider Network Senior |
$509.76
|
| Rate for Payer: IEHP Medi-Cal |
$599.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$550.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$550.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$550.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.25
|
| Rate for Payer: Multiplan Commercial |
$825.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$401.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$367.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.85
|
| Rate for Payer: Vantage Medical Group Senior |
$935.85
|
|
