|
HC OCA1 81479 SOUMN
|
Facility
OP
|
$1,181.68
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914802
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$109.45 |
| Max. Negotiated Rate |
$1,004.43 |
| Rate for Payer: Adventist Health Commercial |
$236.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$811.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,004.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$649.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$886.26
|
| Rate for Payer: Blue Shield of California Commercial |
$733.82
|
| Rate for Payer: Blue Shield of California EPN |
$693.65
|
| Rate for Payer: Cash Price |
$531.76
|
| Rate for Payer: Cash Price |
$531.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$768.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,004.43
|
| Rate for Payer: Dignity Health Senior |
$1,004.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$768.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$731.46
|
| Rate for Payer: Heritage Provider Network Senior |
$731.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$569.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.42
|
| Rate for Payer: Multiplan Commercial |
$886.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,004.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1,004.43
|
|
|
HC OCA1 81479 SOUMN
|
Facility
IP
|
$1,181.68
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914802
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$213.88 |
| Max. Negotiated Rate |
$886.26 |
| Rate for Payer: Adventist Health Commercial |
$236.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$811.81
|
| Rate for Payer: Cash Price |
$531.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$800.00
|
| Rate for Payer: Heritage Provider Network Senior |
$800.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.42
|
| Rate for Payer: Multiplan Commercial |
$886.26
|
|
|
HC OCCLUSION CATHETER
|
Facility
OP
|
$595.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
909081214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.70 |
| Max. Negotiated Rate |
$915.35 |
| Rate for Payer: Adventist Health Commercial |
$119.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$915.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$505.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$327.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$446.25
|
| Rate for Payer: Blue Shield of California Commercial |
$369.50
|
| Rate for Payer: Blue Shield of California EPN |
$349.26
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$386.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$505.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$505.75
|
| Rate for Payer: Dignity Health Senior |
$505.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$386.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$368.30
|
| Rate for Payer: Heritage Provider Network Senior |
$368.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$286.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.75
|
| Rate for Payer: Multiplan Commercial |
$446.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$505.75
|
| Rate for Payer: Vantage Medical Group Senior |
$505.75
|
|
|
HC OCCLUSION CATHETER
|
Facility
IP
|
$595.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
909081214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.70 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Adventist Health Commercial |
$119.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.76
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$402.82
|
| Rate for Payer: Heritage Provider Network Senior |
$402.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.75
|
| Rate for Payer: Multiplan Commercial |
$446.25
|
|
|
HC OCCLUSIVE DEVICE IN VEIN ART
|
Facility
IP
|
$1,074.00
|
|
|
Service Code
|
CPT G0269
|
| Hospital Charge Code |
906820128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.84
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
|
|
HC OCCLUSIVE DEVICE IN VEIN ART
|
Facility
OP
|
$1,074.00
|
|
|
Service Code
|
CPT G0269
|
| Hospital Charge Code |
906820128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$912.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$590.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$805.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$698.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$912.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$912.90
|
| Rate for Payer: Dignity Health Senior |
$912.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$644.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$664.81
|
| Rate for Payer: Heritage Provider Network Senior |
$664.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$517.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$912.90
|
| Rate for Payer: Vantage Medical Group Senior |
$912.90
|
|
|
HC OCCLUSIVE DEVICE IN VEIN ART
|
Facility
IP
|
$898.00
|
|
|
Service Code
|
CPT G0269
|
| Hospital Charge Code |
906811384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$162.54 |
| Max. Negotiated Rate |
$673.50 |
| Rate for Payer: Adventist Health Commercial |
$179.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$616.93
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$607.95
|
| Rate for Payer: Heritage Provider Network Senior |
$607.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.50
|
| Rate for Payer: Multiplan Commercial |
$673.50
|
|
|
HC OCCLUSIVE DEVICE IN VEIN ART
|
Facility
OP
|
$898.00
|
|
|
Service Code
|
CPT G0269
|
| Hospital Charge Code |
906811384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$162.54 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$179.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$616.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$763.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$493.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$673.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$404.10
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$583.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$763.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.30
|
| Rate for Payer: Dignity Health Senior |
$763.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.86
|
| Rate for Payer: Heritage Provider Network Senior |
$555.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$432.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.50
|
| Rate for Payer: Multiplan Commercial |
$673.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.30
|
| Rate for Payer: Vantage Medical Group Senior |
$763.30
|
|
|
HC OCC THER EVALUATION INITIAL 15MIN
|
Facility
IP
|
$202.00
|
|
| Hospital Charge Code |
901309051
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$36.56 |
| Max. Negotiated Rate |
$151.50 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.77
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$136.75
|
| Rate for Payer: Heritage Provider Network Senior |
$136.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.50
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
|
|
HC OCC THER EVALUATION INITIAL 15MIN
|
Facility
OP
|
$202.00
|
|
| Hospital Charge Code |
901309051
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$36.56 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$107.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$111.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$151.50
|
| 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 |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$131.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$171.70
|
| Rate for Payer: Dignity Health Senior |
$171.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.04
|
| Rate for Payer: Heritage Provider Network Senior |
$125.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$97.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.50
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.70
|
| Rate for Payer: Vantage Medical Group Senior |
$171.70
|
|
|
HC OCC THER EVALUATION INITIAL 30MIN
|
Facility
IP
|
$735.00
|
|
| Hospital Charge Code |
901309050
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$133.04 |
| Max. Negotiated Rate |
$551.25 |
| Rate for Payer: Adventist Health Commercial |
$147.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$504.94
|
| Rate for Payer: Cash Price |
$330.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$497.60
|
| Rate for Payer: Heritage Provider Network Senior |
$497.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.75
|
| Rate for Payer: Multiplan Commercial |
$551.25
|
|
|
HC OCC THER EVALUATION INITIAL 30MIN
|
Facility
OP
|
$735.00
|
|
| Hospital Charge Code |
901309050
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$624.75 |
| Rate for Payer: Adventist Health Commercial |
$147.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$392.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$504.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$624.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$404.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$551.25
|
| 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 |
$330.75
|
| Rate for Payer: Cash Price |
$330.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$477.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$624.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.75
|
| Rate for Payer: Dignity Health Senior |
$624.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$477.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$454.96
|
| Rate for Payer: Heritage Provider Network Senior |
$454.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$354.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.75
|
| Rate for Payer: Multiplan Commercial |
$551.25
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.75
|
| Rate for Payer: Vantage Medical Group Senior |
$624.75
|
|
|
HC OCCULT BLOOD, FECES 1-3 SIMUL
|
Facility
IP
|
$181.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
900501612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$135.75 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$124.35
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.54
|
| Rate for Payer: Heritage Provider Network Senior |
$122.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.25
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
|
|
HC OCCULT BLOOD, FECES 1-3 SIMUL
|
Facility
OP
|
$181.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
900501612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$135.75 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$124.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.02
|
| Rate for Payer: Blue Shield of California Commercial |
$25.38
|
| Rate for Payer: Blue Shield of California EPN |
$19.84
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.82
|
| Rate for Payer: Dignity Health Senior |
$4.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.04
|
| Rate for Payer: Heritage Provider Network Senior |
$112.04
|
| Rate for Payer: Humana Medicare |
$4.38
|
| Rate for Payer: IEHP Medi-Cal |
$4.56
|
| Rate for Payer: IEHP Medicare Advantage |
$4.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.38
|
| Rate for Payer: TriValley Medical Group Senior |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4.38
|
|
|
HC OCCULT BLOOD GASTRIC
|
Facility
OP
|
$7.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900912329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.60
|
| Rate for Payer: Blue Shield of California Commercial |
$25.38
|
| Rate for Payer: Blue Shield of California EPN |
$19.84
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Senior |
$5.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4.33
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: IEHP Medi-Cal |
$5.52
|
| Rate for Payer: IEHP Medicare Advantage |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.32
|
| Rate for Payer: TriValley Medical Group Senior |
$5.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
HC OCCULT BLOOD GASTRIC
|
Facility
IP
|
$122.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900912329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.81
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.59
|
| Rate for Payer: Heritage Provider Network Senior |
$82.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.50
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
|
|
HC OCCULT BLOOD OTHR SOURCE
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900911536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.60
|
| Rate for Payer: Blue Shield of California Commercial |
$25.38
|
| Rate for Payer: Blue Shield of California EPN |
$19.84
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Senior |
$5.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.57
|
| Rate for Payer: Heritage Provider Network Senior |
$5.57
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: IEHP Medi-Cal |
$5.52
|
| Rate for Payer: IEHP Medicare Advantage |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.32
|
| Rate for Payer: TriValley Medical Group Senior |
$5.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
HC OCCULT BLOOD OTHR SOURCE
|
Facility
IP
|
$122.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900911536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.81
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.59
|
| Rate for Payer: Heritage Provider Network Senior |
$82.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.50
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
|
|
HC OPEN FX DISTAL TIBIA/FIBULA
|
Facility
IP
|
$17,413.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
900501606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,151.75 |
| Max. Negotiated Rate |
$13,059.75 |
| Rate for Payer: Adventist Health Commercial |
$3,482.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,962.73
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,788.60
|
| Rate for Payer: Heritage Provider Network Senior |
$11,788.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,151.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,353.25
|
| Rate for Payer: Multiplan Commercial |
$13,059.75
|
|
|
HC OPEN FX DISTAL TIBIA/FIBULA
|
Facility
OP
|
$17,413.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
900501606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$13,407.80 |
| Rate for Payer: Adventist Health Commercial |
$3,482.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,962.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,318.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,788.60
|
| Rate for Payer: Heritage Provider Network Senior |
$11,788.60
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,393.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,151.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,353.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: Multiplan Commercial |
$13,059.75
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,322.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,817.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC OPEN TREAT ELBOW DISLOCATION
|
Facility
OP
|
$26,062.00
|
|
|
Service Code
|
CPT 24615
|
| Hospital Charge Code |
900524615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$19,546.50 |
| Rate for Payer: Adventist Health Commercial |
$5,212.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,904.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$11,727.90
|
| Rate for Payer: Cash Price |
$11,727.90
|
| Rate for Payer: Cash Price |
$11,727.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,940.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,643.97
|
| Rate for Payer: Heritage Provider Network Senior |
$17,643.97
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,561.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,717.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,515.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: Multiplan Commercial |
$19,546.50
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,463.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,707.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC OPEN TREAT ELBOW DISLOCATION
|
Facility
IP
|
$26,062.00
|
|
|
Service Code
|
CPT 24615
|
| Hospital Charge Code |
900524615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,717.22 |
| Max. Negotiated Rate |
$19,546.50 |
| Rate for Payer: Adventist Health Commercial |
$5,212.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,904.59
|
| Rate for Payer: Cash Price |
$11,727.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,643.97
|
| Rate for Payer: Heritage Provider Network Senior |
$17,643.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,717.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,515.50
|
| Rate for Payer: Multiplan Commercial |
$19,546.50
|
|
|
HC OPEN TREAT FINGER FX, EA
|
Facility
OP
|
$5,575.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
900501422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,115.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,830.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$2,508.75
|
| Rate for Payer: Cash Price |
$2,508.75
|
| Rate for Payer: Cash Price |
$2,508.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,623.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,774.28
|
| Rate for Payer: Heritage Provider Network Senior |
$3,774.28
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,687.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,009.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$4,181.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,024.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,862.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC OPEN TREAT FINGER FX, EA
|
Facility
IP
|
$5,575.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
900501422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,009.08 |
| Max. Negotiated Rate |
$4,181.25 |
| Rate for Payer: Adventist Health Commercial |
$1,115.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,830.02
|
| Rate for Payer: Cash Price |
$2,508.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,774.28
|
| Rate for Payer: Heritage Provider Network Senior |
$3,774.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,009.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.75
|
| Rate for Payer: Multiplan Commercial |
$4,181.25
|
|
|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
OP
|
$5,575.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,115.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,830.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$2,508.75
|
| Rate for Payer: Cash Price |
$2,508.75
|
| Rate for Payer: Cash Price |
$2,508.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,623.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,774.28
|
| Rate for Payer: Heritage Provider Network Senior |
$3,774.28
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,687.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,009.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$4,181.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,024.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,862.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
