|
HC LACTOSE TOLERANCE
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910313
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$107.74 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.74
|
| Rate for Payer: Blue Shield of California Commercial |
$100.56
|
| Rate for Payer: Blue Shield of California EPN |
$78.62
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.33
|
| Rate for Payer: Heritage Provider Network Senior |
$30.33
|
| Rate for Payer: Humana Medicare |
$12.87
|
| Rate for Payer: IEHP Medi-Cal |
$17.58
|
| Rate for Payer: IEHP Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.87
|
| Rate for Payer: TriValley Medical Group Senior |
$12.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC LACTOSE TOLERANCE
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910313
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.15
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.11
|
| Rate for Payer: Heritage Provider Network Senior |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
|
|
HC LAMELLAR BODY COUNT AMNIOTIC
|
Facility
IP
|
$116.00
|
|
|
Service Code
|
CPT 83664
|
| Hospital Charge Code |
900912027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.69
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.53
|
| Rate for Payer: Heritage Provider Network Senior |
$78.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
|
|
HC LAMELLAR BODY COUNT AMNIOTIC
|
Facility
OP
|
$73.00
|
|
|
Service Code
|
CPT 83664
|
| Hospital Charge Code |
900912027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$147.74 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.50
|
| Rate for Payer: Blue Shield of California Commercial |
$147.74
|
| Rate for Payer: Blue Shield of California EPN |
$115.50
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Senior |
$19.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.19
|
| Rate for Payer: Heritage Provider Network Senior |
$45.19
|
| Rate for Payer: Humana Medicare |
$19.32
|
| Rate for Payer: IEHP Medi-Cal |
$8.14
|
| Rate for Payer: IEHP Medicare Advantage |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.34
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.32
|
| Rate for Payer: TriValley Medical Group Senior |
$19.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$19.32
|
|
|
HC LAPAROSCOPY SURGICAL, APPENDECTOMY
|
Facility
OP
|
$12,698.00
|
|
|
Service Code
|
CPT 44970
|
| Hospital Charge Code |
950442008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$85.38 |
| Max. Negotiated Rate |
$13,697.50 |
| Rate for Payer: Adventist Health Commercial |
$2,539.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,258.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,723.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$5,714.10
|
| Rate for Payer: Cash Price |
$5,714.10
|
| Rate for Payer: Cash Price |
$5,714.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,253.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: Dignity Health Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,209.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,860.06
|
| Rate for Payer: Heritage Provider Network Senior |
$8,867.33
|
| Rate for Payer: Humana Medicare |
$7,209.21
|
| Rate for Payer: IEHP Medi-Cal |
$85.38
|
| Rate for Payer: IEHP Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,697.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,298.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,506.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,174.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,083.60
|
| Rate for Payer: Multiplan Commercial |
$9,523.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,930.13
|
| Rate for Payer: TriValley Medical Group Senior |
$7,930.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
HC LAPAROSCOPY SURGICAL, APPENDECTOMY
|
Facility
IP
|
$12,698.00
|
|
|
Service Code
|
CPT 44970
|
| Hospital Charge Code |
950442008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,298.34 |
| Max. Negotiated Rate |
$9,523.50 |
| Rate for Payer: Adventist Health Commercial |
$2,539.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,723.53
|
| Rate for Payer: Cash Price |
$5,714.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,596.55
|
| Rate for Payer: Heritage Provider Network Senior |
$8,596.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,298.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,174.50
|
| Rate for Payer: Multiplan Commercial |
$9,523.50
|
|
|
HC LARYNGOSCOPY DIRECT
|
Facility
OP
|
$4,248.00
|
|
|
Service Code
|
CPT 31515
|
| Hospital Charge Code |
900501121
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$510.18 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$849.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,918.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$765.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$561.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$510.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,761.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.20
|
| Rate for Payer: Dignity Health Senior |
$510.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,875.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,875.90
|
| Rate for Payer: Humana Medicare |
$510.18
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$510.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,047.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$768.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,062.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$642.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$642.83
|
| Rate for Payer: Multiplan Commercial |
$3,186.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,542.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,419.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.20
|
| Rate for Payer: Vantage Medical Group Senior |
$510.18
|
|
|
HC LARYNGOSCOPY DIRECT
|
Facility
IP
|
$4,248.00
|
|
|
Service Code
|
CPT 31515
|
| Hospital Charge Code |
900501121
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$768.89 |
| Max. Negotiated Rate |
$3,186.00 |
| Rate for Payer: Adventist Health Commercial |
$849.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,918.38
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,875.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,875.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$768.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,062.00
|
| Rate for Payer: Multiplan Commercial |
$3,186.00
|
|
|
HC LARYNGOSCOPY FLEX FIBEROPTIC
|
Facility
OP
|
$487.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
900501260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.15 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$334.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$247.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$302.43
|
| Rate for Payer: Blue Shield of California EPN |
$285.87
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$316.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$371.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.24
|
| Rate for Payer: Dignity Health Senior |
$247.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$247.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$301.45
|
| Rate for Payer: Heritage Provider Network Senior |
$301.45
|
| Rate for Payer: Humana Medicare |
$247.49
|
| Rate for Payer: IEHP Medi-Cal |
$120.23
|
| Rate for Payer: IEHP Medicare Advantage |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$470.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$311.84
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$272.24
|
| Rate for Payer: TriValley Medical Group Senior |
$272.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Vantage Medical Group Senior |
$247.49
|
|
|
HC LARYNGOSCOPY FLEX FIBEROPTIC
|
Facility
IP
|
$487.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
900501260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.15 |
| Max. Negotiated Rate |
$365.25 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$334.57
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.70
|
| Rate for Payer: Heritage Provider Network Senior |
$329.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.75
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
|
|
HC LARYNGOSCOPY FLEX FIBEROPTIC
|
Facility
OP
|
$487.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
900501260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.15 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$334.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$247.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$316.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$371.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.24
|
| Rate for Payer: Dignity Health Senior |
$247.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$247.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.70
|
| Rate for Payer: Heritage Provider Network Senior |
$329.70
|
| Rate for Payer: Humana Medicare |
$247.49
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$234.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$311.84
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$176.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Vantage Medical Group Senior |
$247.49
|
|
|
HC LARYNGOSCOPY FLEX FIBEROPTIC
|
Facility
IP
|
$487.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
900501260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.15 |
| Max. Negotiated Rate |
$365.25 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$334.57
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.70
|
| Rate for Payer: Heritage Provider Network Senior |
$329.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.75
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
|
|
HC LARYNGOSCOPY INDIRECT
|
Facility
OP
|
$456.00
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
900501120
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.54 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$313.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$247.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$296.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$371.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.24
|
| Rate for Payer: Dignity Health Senior |
$247.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$247.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$308.71
|
| Rate for Payer: Heritage Provider Network Senior |
$308.71
|
| Rate for Payer: Humana Medicare |
$247.49
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$219.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$311.84
|
| Rate for Payer: Multiplan Commercial |
$342.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$165.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$152.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Vantage Medical Group Senior |
$247.49
|
|
|
HC LARYNGOSCOPY INDIRECT
|
Facility
IP
|
$456.00
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
900501120
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.54 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$313.27
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$308.71
|
| Rate for Payer: Heritage Provider Network Senior |
$308.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$342.00
|
|
|
HC LARYNGOSCOPY W/RMVL F.B.
|
Facility
OP
|
$2,204.00
|
|
|
Service Code
|
CPT 31577
|
| Hospital Charge Code |
900501549
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$398.92 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$440.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,514.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$765.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$561.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$510.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$991.80
|
| Rate for Payer: Cash Price |
$991.80
|
| Rate for Payer: Cash Price |
$991.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,432.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.20
|
| Rate for Payer: Dignity Health Senior |
$510.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,492.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1,492.11
|
| Rate for Payer: Humana Medicare |
$510.18
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$510.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,062.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$642.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$642.83
|
| Rate for Payer: Multiplan Commercial |
$1,653.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$800.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$736.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.20
|
| Rate for Payer: Vantage Medical Group Senior |
$510.18
|
|
|
HC LARYNGOSCOPY W/RMVL F.B.
|
Facility
IP
|
$2,204.00
|
|
|
Service Code
|
CPT 31577
|
| Hospital Charge Code |
900501549
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$398.92 |
| Max. Negotiated Rate |
$1,653.00 |
| Rate for Payer: Adventist Health Commercial |
$440.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,514.15
|
| Rate for Payer: Cash Price |
$991.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,492.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1,492.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.00
|
| Rate for Payer: Multiplan Commercial |
$1,653.00
|
|
|
HC LARYNGOSCOPY W/TUMOR EXC W/SCO
|
Facility
OP
|
$8,094.00
|
|
|
Service Code
|
CPT 31541
|
| Hospital Charge Code |
900501640
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,618.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,560.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$3,642.30
|
| Rate for Payer: Cash Price |
$3,642.30
|
| Rate for Payer: Cash Price |
$3,642.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,261.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: Dignity Health Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,678.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,479.64
|
| Rate for Payer: Heritage Provider Network Senior |
$5,479.64
|
| Rate for Payer: Humana Medicare |
$4,678.93
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,901.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,465.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,521.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,023.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,895.45
|
| Rate for Payer: Multiplan Commercial |
$6,070.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,938.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,704.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC LARYNGOSCOPY W/TUMOR EXC W/SCO
|
Facility
IP
|
$8,094.00
|
|
|
Service Code
|
CPT 31541
|
| Hospital Charge Code |
900501640
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,465.01 |
| Max. Negotiated Rate |
$6,070.50 |
| Rate for Payer: Adventist Health Commercial |
$1,618.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,560.58
|
| Rate for Payer: Cash Price |
$3,642.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,479.64
|
| Rate for Payer: Heritage Provider Network Senior |
$5,479.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,465.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,023.50
|
| Rate for Payer: Multiplan Commercial |
$6,070.50
|
|
|
HC LASER TREATMENT
|
Facility
IP
|
$9,636.00
|
|
|
Service Code
|
CPT 31641
|
| Hospital Charge Code |
900803400
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,744.12 |
| Max. Negotiated Rate |
$7,227.00 |
| Rate for Payer: Adventist Health Commercial |
$1,927.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,619.93
|
| Rate for Payer: Cash Price |
$4,336.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,523.57
|
| Rate for Payer: Heritage Provider Network Senior |
$6,523.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,744.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,409.00
|
| Rate for Payer: Multiplan Commercial |
$7,227.00
|
|
|
HC LASER TREATMENT
|
Facility
OP
|
$9,636.00
|
|
|
Service Code
|
CPT 31641
|
| Hospital Charge Code |
900803400
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,927.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,619.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$4,336.20
|
| Rate for Payer: Cash Price |
$4,336.20
|
| Rate for Payer: Cash Price |
$4,336.20
|
| Rate for Payer: Cash Price |
$4,336.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,263.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: Dignity Health Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,678.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,964.68
|
| Rate for Payer: Heritage Provider Network Senior |
$5,964.68
|
| Rate for Payer: Humana Medicare |
$4,678.93
|
| Rate for Payer: IEHP Medi-Cal |
$328.72
|
| Rate for Payer: IEHP Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,889.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,744.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,521.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,409.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,895.45
|
| Rate for Payer: Multiplan Commercial |
$7,227.00
|
| 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 |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC LASIX RENOGRAM
|
Facility
OP
|
$2,699.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
909301423
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$284.90 |
| Max. Negotiated Rate |
$2,024.25 |
| Rate for Payer: Adventist Health Commercial |
$539.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$661.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,854.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Blue Shield of California Commercial |
$910.80
|
| Rate for Payer: Blue Shield of California EPN |
$517.94
|
| Rate for Payer: Cash Price |
$1,214.55
|
| Rate for Payer: Cash Price |
$1,214.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,754.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: Dignity Health Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,754.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$675.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,670.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,670.68
|
| Rate for Payer: Humana Medicare |
$675.33
|
| Rate for Payer: IEHP Medi-Cal |
$284.90
|
| Rate for Payer: IEHP Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,283.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$796.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$674.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$850.92
|
| Rate for Payer: Multiplan Commercial |
$2,024.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$742.86
|
| Rate for Payer: TriValley Medical Group Senior |
$675.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC LASIX RENOGRAM
|
Facility
IP
|
$2,699.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
909301423
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$488.52 |
| Max. Negotiated Rate |
$2,024.25 |
| Rate for Payer: Adventist Health Commercial |
$539.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,854.21
|
| Rate for Payer: Cash Price |
$1,214.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,827.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,827.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$674.75
|
| Rate for Payer: Multiplan Commercial |
$2,024.25
|
|
|
HC LATE CLOSURE SURGICAL WOUND
|
Facility
OP
|
$5,860.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
900501537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,172.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,025.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,637.00
|
| Rate for Payer: Cash Price |
$2,637.00
|
| Rate for Payer: Cash Price |
$2,637.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,809.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,967.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,967.22
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,824.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,060.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,465.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: Multiplan Commercial |
$4,395.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,127.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,957.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC LATE CLOSURE SURGICAL WOUND
|
Facility
IP
|
$5,860.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
900501537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,060.66 |
| Max. Negotiated Rate |
$4,395.00 |
| Rate for Payer: Adventist Health Commercial |
$1,172.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,025.82
|
| Rate for Payer: Cash Price |
$2,637.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,967.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,967.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,060.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,465.00
|
| Rate for Payer: Multiplan Commercial |
$4,395.00
|
|
|
HC LAY CLOS OF WND 12.6-20.0 CM
|
Facility
IP
|
$1,289.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.31 |
| Max. Negotiated Rate |
$966.75 |
| Rate for Payer: Adventist Health Commercial |
$257.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$885.54
|
| Rate for Payer: Cash Price |
$580.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$872.65
|
| Rate for Payer: Heritage Provider Network Senior |
$872.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.25
|
| Rate for Payer: Multiplan Commercial |
$966.75
|
|
