|
HC NEG PRES WOUND THRPY GT 50 SQ CM
|
Facility
IP
|
$337.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
903501029
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$252.75 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$231.52
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$228.15
|
| Rate for Payer: Heritage Provider Network Senior |
$228.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.25
|
| Rate for Payer: Multiplan Commercial |
$252.75
|
|
|
HC NEG PRES WOUND THRPY GT 50 SQ CM
|
Facility
OP
|
$337.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
903501029
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$65.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$231.52
|
| 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 |
$209.28
|
| Rate for Payer: Blue Shield of California EPN |
$197.82
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$219.05
|
| 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 |
$208.60
|
| Rate for Payer: Heritage Provider Network Senior |
$208.60
|
| 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 |
$61.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.25
|
| 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 |
$252.75
|
| 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 PRES WOUND THRPY LT 50 SQ CM
|
Facility
IP
|
$398.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$298.50 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$273.43
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.45
|
| Rate for Payer: Heritage Provider Network Senior |
$269.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.50
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
IP
|
$398.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$298.50 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$273.43
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.45
|
| Rate for Payer: Heritage Provider Network Senior |
$269.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.50
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
OP
|
$398.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$59.74 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$59.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$273.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Blue Shield of California Commercial |
$247.16
|
| Rate for Payer: Blue Shield of California EPN |
$233.63
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$258.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$246.36
|
| Rate for Payer: Heritage Provider Network Senior |
$246.36
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$275.15
|
| Rate for Payer: TriValley Medical Group Senior |
$250.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$501.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$422.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
OP
|
$398.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.74 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$59.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$273.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Blue Shield of California Commercial |
$247.16
|
| Rate for Payer: Blue Shield of California EPN |
$233.63
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$258.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$246.36
|
| Rate for Payer: Heritage Provider Network Senior |
$246.36
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$275.15
|
| Rate for Payer: TriValley Medical Group Senior |
$275.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC NEONATAL RESUSCITATION
|
Facility
IP
|
$4,684.00
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
900800498
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$847.80 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$936.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,217.91
|
| Rate for Payer: Cash Price |
$2,107.80
|
| Rate for Payer: Cash Price |
$2,107.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$847.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.00
|
| Rate for Payer: Multiplan Commercial |
$3,513.00
|
|
|
HC NEONATAL RESUSCITATION
|
Facility
OP
|
$4,684.00
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
900800498
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$190.32 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$936.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$281.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,217.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$813.16
|
| 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 |
$2,107.80
|
| Rate for Payer: Cash Price |
$2,107.80
|
| Rate for Payer: Cash Price |
$2,107.80
|
| Rate for Payer: Cash Price |
$2,107.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,044.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: Dignity Health Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,044.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$813.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,899.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,000.19
|
| Rate for Payer: Humana Medicare |
$813.16
|
| Rate for Payer: IEHP Medi-Cal |
$190.32
|
| Rate for Payer: IEHP Medicare Advantage |
$813.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,545.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$847.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$959.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,024.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,024.58
|
| Rate for Payer: Multiplan Commercial |
$3,513.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$894.48
|
| Rate for Payer: TriValley Medical Group Senior |
$813.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC NEPHROSTOMY CATH KIT
|
Facility
IP
|
$312.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$214.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$143.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.22
|
| Rate for Payer: Heritage Provider Network Senior |
$211.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$156.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$156.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$113.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$104.24
|
|
|
HC NEPHROSTOMY CATH KIT
|
Facility
OP
|
$312.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$214.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$171.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$234.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$193.75
|
| Rate for Payer: Blue Shield of California EPN |
$183.14
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$143.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$265.20
|
| Rate for Payer: Dignity Health Senior |
$265.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.46
|
| Rate for Payer: Heritage Provider Network Senior |
$144.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$156.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$156.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$113.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$104.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$265.20
|
| Rate for Payer: Vantage Medical Group Senior |
$265.20
|
|
|
HC NEPHROSTOMY TRACT DILITATN
|
Facility
IP
|
$10,844.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
909001936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,962.76 |
| Max. Negotiated Rate |
$8,133.00 |
| Rate for Payer: Adventist Health Commercial |
$2,168.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,449.83
|
| Rate for Payer: Cash Price |
$4,879.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,341.39
|
| Rate for Payer: Heritage Provider Network Senior |
$7,341.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,962.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,711.00
|
| Rate for Payer: Multiplan Commercial |
$8,133.00
|
|
|
HC NEPHROSTOMY TRACT DILITATN
|
Facility
OP
|
$10,844.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
909001936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$8,133.00 |
| Rate for Payer: Adventist Health Commercial |
$2,168.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$186.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,449.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$754.15
|
| Rate for Payer: Blue Shield of California Commercial |
$645.50
|
| Rate for Payer: Blue Shield of California EPN |
$367.08
|
| Rate for Payer: Cash Price |
$4,879.80
|
| Rate for Payer: Cash Price |
$4,879.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,048.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: Dignity Health Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,048.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,712.44
|
| Rate for Payer: Heritage Provider Network Senior |
$6,712.44
|
| Rate for Payer: Humana Medicare |
$2,544.87
|
| Rate for Payer: IEHP Medi-Cal |
$129.50
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,835.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,962.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,711.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,206.54
|
| Rate for Payer: Multiplan Commercial |
$8,133.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,544.87
|
| Rate for Payer: TriValley Medical Group Senior |
$2,544.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,957.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,957.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
OP
|
$5,263.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,615.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,420.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: Dignity Health Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,563.05
|
| Rate for Payer: Heritage Provider Network Senior |
$3,563.05
|
| Rate for Payer: Humana Medicare |
$2,544.87
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,536.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$952.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,206.54
|
| Rate for Payer: Multiplan Commercial |
$3,947.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,911.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,758.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
IP
|
$5,263.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$952.60 |
| Max. Negotiated Rate |
$3,947.25 |
| Rate for Payer: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,615.68
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,563.05
|
| Rate for Payer: Heritage Provider Network Senior |
$3,563.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$952.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.75
|
| Rate for Payer: Multiplan Commercial |
$3,947.25
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN
|
Facility
OP
|
$1,165.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
905601804
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$87.67 |
| Max. Negotiated Rate |
$873.75 |
| Rate for Payer: Adventist Health Commercial |
$233.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$193.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$800.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$757.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$721.14
|
| Rate for Payer: Heritage Provider Network Senior |
$721.14
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: IEHP Medi-Cal |
$87.67
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$745.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$873.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN
|
Facility
IP
|
$1,165.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
905601804
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$210.86 |
| Max. Negotiated Rate |
$873.75 |
| Rate for Payer: Adventist Health Commercial |
$233.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$800.36
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.70
|
| Rate for Payer: Heritage Provider Network Senior |
$788.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.25
|
| Rate for Payer: Multiplan Commercial |
$873.75
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN MCAL
|
Facility
IP
|
$1,165.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
907000032
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$210.86 |
| Max. Negotiated Rate |
$873.75 |
| Rate for Payer: Adventist Health Commercial |
$233.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$800.36
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.70
|
| Rate for Payer: Heritage Provider Network Senior |
$788.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.25
|
| Rate for Payer: Multiplan Commercial |
$873.75
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN MCAL
|
Facility
OP
|
$1,165.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
907000032
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$87.67 |
| Max. Negotiated Rate |
$873.75 |
| Rate for Payer: Adventist Health Commercial |
$233.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$193.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$800.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$757.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$721.14
|
| Rate for Payer: Heritage Provider Network Senior |
$721.14
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: IEHP Medi-Cal |
$87.67
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$745.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$873.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC NEUROINTERVENTIONAL CATH J&J
|
Facility
IP
|
$138.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.81
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
|
HC NEUROINTERVENTIONAL CATH J&J
|
Facility
OP
|
$138.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$75.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$103.50
|
| Rate for Payer: Blue Shield of California Commercial |
$85.70
|
| Rate for Payer: Blue Shield of California EPN |
$81.01
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.30
|
| Rate for Payer: Dignity Health Senior |
$117.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.42
|
| Rate for Payer: Heritage Provider Network Senior |
$85.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.30
|
| Rate for Payer: Vantage Medical Group Senior |
$117.30
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
OP
|
$4,271.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$184.11 |
| Max. Negotiated Rate |
$4,706.95 |
| Rate for Payer: Adventist Health Commercial |
$854.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,934.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,921.95
|
| Rate for Payer: Cash Price |
$1,921.95
|
| Rate for Payer: Cash Price |
$1,921.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,776.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,562.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,643.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.76
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: IEHP Medi-Cal |
$184.11
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,163.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$773.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,067.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$3,203.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,252.71
|
| Rate for Payer: TriValley Medical Group Senior |
$1,252.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
IP
|
$4,507.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$815.77 |
| Max. Negotiated Rate |
$3,380.25 |
| Rate for Payer: Adventist Health Commercial |
$901.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,096.31
|
| Rate for Payer: Cash Price |
$2,028.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,051.24
|
| Rate for Payer: Heritage Provider Network Senior |
$3,051.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$815.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,126.75
|
| Rate for Payer: Multiplan Commercial |
$3,380.25
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
OP
|
$4,271.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$184.11 |
| Max. Negotiated Rate |
$4,706.95 |
| Rate for Payer: Adventist Health Commercial |
$854.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,934.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,921.95
|
| Rate for Payer: Cash Price |
$1,921.95
|
| Rate for Payer: Cash Price |
$1,921.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,776.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,562.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,643.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.76
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: IEHP Medi-Cal |
$184.11
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,163.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$773.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,067.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$3,203.25
|
| 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 |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
IP
|
$4,507.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$815.77 |
| Max. Negotiated Rate |
$3,380.25 |
| Rate for Payer: Adventist Health Commercial |
$901.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,096.31
|
| Rate for Payer: Cash Price |
$2,028.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,051.24
|
| Rate for Payer: Heritage Provider Network Senior |
$3,051.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$815.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,126.75
|
| Rate for Payer: Multiplan Commercial |
$3,380.25
|
|
|
HC NEUROMUSC RE-ED 15 MIN OT
|
Facility
IP
|
$167.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905104141
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$125.25 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.73
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.06
|
| Rate for Payer: Heritage Provider Network Senior |
$113.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.75
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
|
