|
HC NDL QC COAXIAL BX SET 18-9
|
Facility
IP
|
$314.94
|
|
| Hospital Charge Code |
909081712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.20 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Cash Price |
$141.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
|
|
HC NDL QC COAXIAL BX SET 20-15
|
Facility
OP
|
$314.94
|
|
| Hospital Charge Code |
909081729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$267.70 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$236.20
|
| Rate for Payer: Blue Shield of California Commercial |
$195.58
|
| Rate for Payer: Blue Shield of California EPN |
$184.87
|
| Rate for Payer: Cash Price |
$141.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.70
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$151.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC NDL QC COAXIAL BX SET 20-15
|
Facility
IP
|
$314.94
|
|
| Hospital Charge Code |
909081728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.20 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Cash Price |
$141.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
|
|
HC NDL QC COAXIAL BX SET 20-15
|
Facility
IP
|
$314.94
|
|
| Hospital Charge Code |
909081729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.20 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Cash Price |
$141.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
|
|
HC NDL QC COAXIAL BX SET 20-15
|
Facility
OP
|
$314.94
|
|
| Hospital Charge Code |
909081728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$267.70 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$236.20
|
| Rate for Payer: Blue Shield of California Commercial |
$195.58
|
| Rate for Payer: Blue Shield of California EPN |
$184.87
|
| Rate for Payer: Cash Price |
$141.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.70
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$151.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC NDL QC COAXIAL BX SET 20-9
|
Facility
IP
|
$314.94
|
|
| Hospital Charge Code |
909081733
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.20 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Cash Price |
$141.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
|
|
HC NDL QC COAXIAL BX SET 20-9
|
Facility
OP
|
$314.94
|
|
| Hospital Charge Code |
909081733
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$267.70 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$236.20
|
| Rate for Payer: Blue Shield of California Commercial |
$195.58
|
| Rate for Payer: Blue Shield of California EPN |
$184.87
|
| Rate for Payer: Cash Price |
$141.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.70
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$151.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC NDL SET 18G 15CM 10MM THROW
|
Facility
OP
|
$314.94
|
|
| Hospital Charge Code |
909081711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$267.70 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$236.20
|
| Rate for Payer: Blue Shield of California Commercial |
$195.58
|
| Rate for Payer: Blue Shield of California EPN |
$184.87
|
| Rate for Payer: Cash Price |
$141.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.70
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$151.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC NDL SET 18G 15CM 10MM THROW
|
Facility
IP
|
$314.94
|
|
| Hospital Charge Code |
909081711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.20 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Cash Price |
$141.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
|
|
HC NDL SET 18G 9CM 10MM THROW
|
Facility
OP
|
$314.94
|
|
| Hospital Charge Code |
909081715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$267.70 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$236.20
|
| Rate for Payer: Blue Shield of California Commercial |
$195.58
|
| Rate for Payer: Blue Shield of California EPN |
$184.87
|
| Rate for Payer: Cash Price |
$141.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.70
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$151.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC NDL SET 18G 9CM 10MM THROW
|
Facility
IP
|
$314.94
|
|
| Hospital Charge Code |
909081715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.20 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Cash Price |
$141.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
|
|
HC NDL SET 20G 20CM 20MM THROW
|
Facility
IP
|
$314.94
|
|
| Hospital Charge Code |
909081717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.20 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Cash Price |
$141.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
|
|
HC NDL SET 20G 20CM 20MM THROW
|
Facility
OP
|
$314.94
|
|
| Hospital Charge Code |
909081717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$267.70 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$236.20
|
| Rate for Payer: Blue Shield of California Commercial |
$195.58
|
| Rate for Payer: Blue Shield of California EPN |
$184.87
|
| Rate for Payer: Cash Price |
$141.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.70
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$151.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC NDL SET 20G 9CM 20MM THROW
|
Facility
IP
|
$314.94
|
|
| Hospital Charge Code |
909081732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$236.20 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: Cash Price |
$141.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.21
|
| Rate for Payer: Heritage Provider Network Senior |
$213.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
|
|
HC NDL SET 20G 9CM 20MM THROW
|
Facility
OP
|
$314.94
|
|
| Hospital Charge Code |
909081732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$267.70 |
| Rate for Payer: Adventist Health Commercial |
$62.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$267.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$173.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$236.20
|
| Rate for Payer: Blue Shield of California Commercial |
$195.58
|
| Rate for Payer: Blue Shield of California EPN |
$184.87
|
| Rate for Payer: Cash Price |
$141.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.70
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.95
|
| Rate for Payer: Heritage Provider Network Senior |
$194.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$151.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.74
|
| Rate for Payer: Multiplan Commercial |
$236.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.70
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC NECK SOFT TISSUE
|
Facility
IP
|
$414.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
909001201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.93 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$284.42
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$280.28
|
| Rate for Payer: Heritage Provider Network Senior |
$280.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
|
|
HC NECK SOFT TISSUE
|
Facility
OP
|
$414.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
909001201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$284.42
|
| 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 |
$101.77
|
| Rate for Payer: Blue Shield of California Commercial |
$83.23
|
| Rate for Payer: Blue Shield of California EPN |
$47.33
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$269.10
|
| 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 |
$269.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$256.27
|
| Rate for Payer: Heritage Provider Network Senior |
$256.27
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$26.99
|
| 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 |
$74.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.50
|
| 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 |
$310.50
|
| 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 NEFF SET
|
Facility
IP
|
$452.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.81 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$310.52
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$306.00
|
| Rate for Payer: Heritage Provider Network Senior |
$306.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
|
|
HC NEFF SET
|
Facility
OP
|
$452.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.81 |
| Max. Negotiated Rate |
$384.20 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$310.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$248.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$280.69
|
| Rate for Payer: Blue Shield of California EPN |
$265.32
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$293.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$384.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$384.20
|
| Rate for Payer: Dignity Health Senior |
$384.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$279.79
|
| Rate for Payer: Heritage Provider Network Senior |
$279.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$217.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$384.20
|
| Rate for Payer: Vantage Medical Group Senior |
$384.20
|
|
|
HC NEGATIVE URINE COMBO PANEL 61
|
Facility
OP
|
$185.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912450
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.56
|
| Rate for Payer: Blue Shield of California Commercial |
$63.11
|
| Rate for Payer: Blue Shield of California EPN |
$49.34
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: IEHP Medi-Cal |
$10.37
|
| Rate for Payer: IEHP Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NEGATIVE URINE COMBO PANEL 61
|
Facility
IP
|
$223.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912450
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$167.25 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$153.20
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$150.97
|
| Rate for Payer: Heritage Provider Network Senior |
$150.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.75
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
|
|
HC NEG PRESS WOUND THERAPY MECH GT 50 SQ CM
|
Facility
OP
|
$614.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
900101508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.13 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$122.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$510.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$421.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Blue Shield of California Commercial |
$381.29
|
| Rate for Payer: Blue Shield of California EPN |
$360.42
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$399.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$380.07
|
| Rate for Payer: Heritage Provider Network Senior |
$380.07
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$946.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$460.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$548.02
|
| Rate for Payer: TriValley Medical Group Senior |
$548.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC NEG PRESS WOUND THERAPY MECH GT 50 SQ CM
|
Facility
IP
|
$614.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
900101508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.13 |
| Max. Negotiated Rate |
$460.50 |
| Rate for Payer: Adventist Health Commercial |
$122.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$421.82
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$415.68
|
| Rate for Payer: Heritage Provider Network Senior |
$415.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.50
|
| Rate for Payer: Multiplan Commercial |
$460.50
|
|
|
HC NEG PRESS WOUND THERAPY MECH LT 50 SQ CM
|
Facility
OP
|
$614.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
900101534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.13 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$122.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$387.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$421.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Blue Shield of California Commercial |
$381.29
|
| Rate for Payer: Blue Shield of California EPN |
$360.42
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$399.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$380.07
|
| Rate for Payer: Heritage Provider Network Senior |
$380.07
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$946.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$460.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$548.02
|
| Rate for Payer: TriValley Medical Group Senior |
$548.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC NEG PRESS WOUND THERAPY MECH LT 50 SQ CM
|
Facility
IP
|
$614.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
900101534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.13 |
| Max. Negotiated Rate |
$460.50 |
| Rate for Payer: Adventist Health Commercial |
$122.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$421.82
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$415.68
|
| Rate for Payer: Heritage Provider Network Senior |
$415.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.50
|
| Rate for Payer: Multiplan Commercial |
$460.50
|
|
