|
HC OT INIT EVAL MODERATE
|
Facility
IP
|
$554.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
908697166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$100.27 |
| Max. Negotiated Rate |
$415.50 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$380.60
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.06
|
| Rate for Payer: Heritage Provider Network Senior |
$375.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.50
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
OP
|
$554.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
901397166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$470.90 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$380.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$470.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$304.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$415.50
|
| 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 |
$249.30
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$360.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.90
|
| Rate for Payer: Dignity Health Senior |
$470.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$342.93
|
| Rate for Payer: Heritage Provider Network Senior |
$342.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$267.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.50
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
| 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 |
$470.90
|
| Rate for Payer: Vantage Medical Group Senior |
$470.90
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
OP
|
$554.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
908697166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$470.90 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$380.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$470.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$304.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$415.50
|
| 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 |
$249.30
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$360.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.90
|
| Rate for Payer: Dignity Health Senior |
$470.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$342.93
|
| Rate for Payer: Heritage Provider Network Senior |
$342.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$267.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.50
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
| 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 |
$470.90
|
| Rate for Payer: Vantage Medical Group Senior |
$470.90
|
|
|
HC OT INIT EVAL MODERATE
|
Facility
IP
|
$554.00
|
|
|
Service Code
|
CPT 97166
|
| Hospital Charge Code |
901397166
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$100.27 |
| Max. Negotiated Rate |
$415.50 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$380.60
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.06
|
| Rate for Payer: Heritage Provider Network Senior |
$375.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.50
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
|
|
HC OTOLARYNGOLOGIC EXAM GEN ANEST
|
Facility
OP
|
$674.00
|
|
|
Service Code
|
CPT 92502
|
| Hospital Charge Code |
900501620
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.99 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$134.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$223.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$438.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: Dignity Health Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.30
|
| Rate for Payer: Heritage Provider Network Senior |
$456.30
|
| Rate for Payer: Humana Medicare |
$687.44
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$324.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$811.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$866.17
|
| Rate for Payer: Multiplan Commercial |
$505.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$244.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$225.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC OTOLARYNGOLOGIC EXAM GEN ANEST
|
Facility
IP
|
$674.00
|
|
|
Service Code
|
CPT 92502
|
| Hospital Charge Code |
900501620
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.99 |
| Max. Negotiated Rate |
$505.50 |
| Rate for Payer: Adventist Health Commercial |
$134.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.04
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.30
|
| Rate for Payer: Heritage Provider Network Senior |
$456.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.50
|
| Rate for Payer: Multiplan Commercial |
$505.50
|
|
|
HC OT PRELIMINARY EVALUATION
|
Facility
OP
|
$274.00
|
|
| Hospital Charge Code |
905104349
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$54.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$146.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$188.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$232.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$205.50
|
| 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 |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$178.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.90
|
| Rate for Payer: Dignity Health Senior |
$232.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$169.61
|
| Rate for Payer: Heritage Provider Network Senior |
$169.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$132.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.50
|
| Rate for Payer: Multiplan Commercial |
$205.50
|
| 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 |
$232.90
|
| Rate for Payer: Vantage Medical Group Senior |
$232.90
|
|
|
HC OT PRELIMINARY EVALUATION
|
Facility
IP
|
$274.00
|
|
| Hospital Charge Code |
905104349
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$205.50 |
| Rate for Payer: Adventist Health Commercial |
$54.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$188.24
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$185.50
|
| Rate for Payer: Heritage Provider Network Senior |
$185.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.50
|
| Rate for Payer: Multiplan Commercial |
$205.50
|
|
|
HC OT RE-EVALUATION
|
Facility
OP
|
$395.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
905104008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$79.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$271.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$335.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$217.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$296.25
|
| 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 |
$177.75
|
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$256.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$335.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.75
|
| Rate for Payer: Dignity Health Senior |
$335.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$244.50
|
| Rate for Payer: Heritage Provider Network Senior |
$244.50
|
| Rate for Payer: IEHP Medi-Cal |
$136.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$190.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.75
|
| Rate for Payer: Multiplan Commercial |
$296.25
|
| 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 |
$335.75
|
| Rate for Payer: Vantage Medical Group Senior |
$335.75
|
|
|
HC OT RE-EVALUATION
|
Facility
IP
|
$395.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
905104008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$296.25 |
| Rate for Payer: Adventist Health Commercial |
$79.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$271.36
|
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$267.42
|
| Rate for Payer: Heritage Provider Network Senior |
$267.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.75
|
| Rate for Payer: Multiplan Commercial |
$296.25
|
|
|
HC OUTBACK CATHETER
|
Facility
OP
|
$5,075.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,015.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$1,015.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,436.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,486.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,313.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,791.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,806.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,151.58
|
| Rate for Payer: Blue Shield of California EPN |
$2,979.02
|
| Rate for Payer: Cash Price |
$2,283.75
|
| Rate for Payer: Cash Price |
$2,283.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,334.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,313.75
|
| Rate for Payer: Dignity Health Senior |
$4,313.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,248.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,349.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,349.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,537.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,537.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,537.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,268.75
|
| Rate for Payer: Multiplan Commercial |
$3,806.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,850.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,695.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,313.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,313.75
|
|
|
HC OUTBACK CATHETER
|
Facility
IP
|
$5,075.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,015.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,015.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,436.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,486.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,283.75
|
| Rate for Payer: Cash Price |
$2,283.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,334.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,740.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,435.78
|
| Rate for Payer: Heritage Provider Network Senior |
$3,435.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,537.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,537.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,537.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,268.75
|
| Rate for Payer: Multiplan Commercial |
$3,806.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,850.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,695.56
|
|
|
HC OVA & PARASITES, PRESERVED
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
900911726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.15
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.11
|
| Rate for Payer: Heritage Provider Network Senior |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
|
|
HC OVA & PARASITES, PRESERVED
|
Facility
OP
|
$54.00
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
900911726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.10
|
| Rate for Payer: Blue Shield of California Commercial |
$69.48
|
| Rate for Payer: Blue Shield of California EPN |
$54.32
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.79
|
| Rate for Payer: Dignity Health Senior |
$8.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.43
|
| Rate for Payer: Heritage Provider Network Senior |
$33.43
|
| Rate for Payer: Humana Medicare |
$8.90
|
| Rate for Payer: IEHP Medi-Cal |
$11.20
|
| Rate for Payer: IEHP Medicare Advantage |
$8.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.21
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.90
|
| Rate for Payer: TriValley Medical Group Senior |
$8.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Vantage Medical Group Senior |
$8.90
|
|
|
HC OXYGEN PER HOUR
|
Facility
OP
|
$29.00
|
|
| Hospital Charge Code |
900802001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$24.65 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.75
|
| Rate for Payer: Blue Shield of California Commercial |
$18.01
|
| Rate for Payer: Blue Shield of California EPN |
$17.02
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Senior |
$24.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.95
|
| Rate for Payer: Heritage Provider Network Senior |
$17.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$24.65
|
|
|
HC OXYGEN PER HOUR
|
Facility
IP
|
$30.00
|
|
| Hospital Charge Code |
900800650
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC OXYGEN PER HOUR
|
Facility
IP
|
$29.00
|
|
| Hospital Charge Code |
900802001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.63
|
| Rate for Payer: Heritage Provider Network Senior |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
|
|
HC OXYGEN PER HOUR
|
Facility
OP
|
$30.00
|
|
| Hospital Charge Code |
900800650
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Blue Shield of California Commercial |
$18.63
|
| Rate for Payer: Blue Shield of California EPN |
$17.61
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Senior |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC OXYGEN PER HOUR PACU
|
Facility
OP
|
$49.00
|
|
| Hospital Charge Code |
900100043
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$41.65 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$36.75
|
| Rate for Payer: Blue Shield of California Commercial |
$30.43
|
| Rate for Payer: Blue Shield of California EPN |
$28.76
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.65
|
| Rate for Payer: Dignity Health Senior |
$41.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.33
|
| Rate for Payer: Heritage Provider Network Senior |
$30.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.65
|
| Rate for Payer: Vantage Medical Group Senior |
$41.65
|
|
|
HC OXYGEN PER HOUR PACU
|
Facility
IP
|
$49.00
|
|
| Hospital Charge Code |
900100043
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.66
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.17
|
| Rate for Payer: Heritage Provider Network Senior |
$33.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
|
|
HC P32 CHROMIC PHOSPHATE PER MCI
|
Facility
IP
|
$29,723.00
|
|
|
Service Code
|
CPT A9564
|
| Hospital Charge Code |
909301556
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$5,379.86 |
| Max. Negotiated Rate |
$22,292.25 |
| Rate for Payer: Adventist Health Commercial |
$5,944.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,419.70
|
| Rate for Payer: Cash Price |
$13,375.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,122.47
|
| Rate for Payer: Heritage Provider Network Senior |
$20,122.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,379.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,430.75
|
| Rate for Payer: Multiplan Commercial |
$22,292.25
|
|
|
HC P32 CHROMIC PHOSPHATE PER MCI
|
Facility
OP
|
$29,723.00
|
|
|
Service Code
|
CPT A9564
|
| Hospital Charge Code |
909301556
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$703.66 |
| Max. Negotiated Rate |
$25,264.55 |
| Rate for Payer: Adventist Health Commercial |
$5,944.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$703.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,419.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25,264.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16,347.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22,292.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,539.39
|
| Rate for Payer: Blue Shield of California Commercial |
$18,457.98
|
| Rate for Payer: Blue Shield of California EPN |
$17,447.40
|
| Rate for Payer: Cash Price |
$13,375.35
|
| Rate for Payer: Cash Price |
$13,375.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,319.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,264.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,264.55
|
| Rate for Payer: Dignity Health Senior |
$25,264.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,319.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,398.54
|
| Rate for Payer: Heritage Provider Network Senior |
$18,398.54
|
| Rate for Payer: IEHP Medi-Cal |
$819.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14,326.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,379.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,430.75
|
| Rate for Payer: Multiplan Commercial |
$22,292.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$25,264.55
|
|
|
HC P32 SODIUM PHOSPHATE PER MCI
|
Facility
OP
|
$5,150.00
|
|
|
Service Code
|
CPT A9563
|
| Hospital Charge Code |
909301555
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$152.05 |
| Max. Negotiated Rate |
$4,377.50 |
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$738.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,538.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,377.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,832.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,862.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.05
|
| Rate for Payer: Blue Shield of California Commercial |
$3,198.15
|
| Rate for Payer: Blue Shield of California EPN |
$3,023.05
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,347.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,377.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,377.50
|
| Rate for Payer: Dignity Health Senior |
$4,377.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,296.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,187.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,187.85
|
| Rate for Payer: IEHP Medi-Cal |
$153.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,482.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$932.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,287.50
|
| Rate for Payer: Multiplan Commercial |
$3,862.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,877.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,720.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,377.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,377.50
|
|
|
HC P32 SODIUM PHOSPHATE PER MCI
|
Facility
IP
|
$5,150.00
|
|
|
Service Code
|
CPT A9563
|
| Hospital Charge Code |
909301555
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$932.15 |
| Max. Negotiated Rate |
$3,862.50 |
| Rate for Payer: Adventist Health Commercial |
$1,030.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,538.05
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,781.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,486.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,486.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$932.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,287.50
|
| Rate for Payer: Multiplan Commercial |
$3,862.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,877.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,720.62
|
|
|
HC PACE B/S VITALIO DR K273
|
Facility
IP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813736
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,868.82 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$2,065.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,956.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,093.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$4,646.25
|
| Rate for Payer: Cash Price |
$4,646.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,749.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,575.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,990.02
|
| Rate for Payer: Heritage Provider Network Senior |
$6,990.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,868.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,581.25
|
| Rate for Payer: Multiplan Commercial |
$7,743.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,764.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,449.58
|
|
