HC PROBE NASOLACRIMAL DUCT W/ANES
|
Facility
OP
|
$4,568.00
|
|
Service Code
|
CPT 68811
|
Hospital Charge Code |
900501656
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$826.81 |
Max. Negotiated Rate |
$4,379.50 |
Rate for Payer: Adventist Health Commercial |
$913.60
|
Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,138.22
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
Rate for Payer: Cash Price |
$2,055.60
|
Rate for Payer: Cash Price |
$2,055.60
|
Rate for Payer: Cash Price |
$2,055.60
|
Rate for Payer: Cigna of CA HMO/PPO |
$2,969.20
|
Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
Rate for Payer: Dignity Health Senior |
$2,919.67
|
Rate for Payer: EPIC Health Plan Commercial |
$2,969.20
|
Rate for Payer: EPIC Health Plan Medicare |
$2,919.67
|
Rate for Payer: Heritage Provider Network Commercial |
$3,092.54
|
Rate for Payer: Heritage Provider Network Senior |
$3,092.54
|
Rate for Payer: Humana Medicare |
$2,919.67
|
Rate for Payer: IEHP Medi-Cal |
$936.00
|
Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$2,201.78
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$826.81
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,445.21
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1,142.00
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
Rate for Payer: Molina Healthcare of CA Medicare |
$3,678.78
|
Rate for Payer: Multiplan Commercial |
$3,426.00
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,658.64
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,526.17
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
HC PROBE NASOLACRIMAL DUCT W/ANES
|
Facility
IP
|
$4,568.00
|
|
Service Code
|
CPT 68811
|
Hospital Charge Code |
900501656
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$826.81 |
Max. Negotiated Rate |
$3,426.00 |
Rate for Payer: Adventist Health Commercial |
$913.60
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,138.22
|
Rate for Payer: Cash Price |
$2,055.60
|
Rate for Payer: Heritage Provider Network Commercial |
$3,092.54
|
Rate for Payer: Heritage Provider Network Senior |
$3,092.54
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$826.81
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1,142.00
|
Rate for Payer: Multiplan Commercial |
$3,426.00
|
|
HC PROBE NASOLACRIMAL DUCT W/TUBE
|
Facility
IP
|
$4,818.00
|
|
Service Code
|
CPT 68815
|
Hospital Charge Code |
900501677
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$872.06 |
Max. Negotiated Rate |
$3,613.50 |
Rate for Payer: Adventist Health Commercial |
$963.60
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,309.97
|
Rate for Payer: Cash Price |
$2,168.10
|
Rate for Payer: Heritage Provider Network Commercial |
$3,261.79
|
Rate for Payer: Heritage Provider Network Senior |
$3,261.79
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$872.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.50
|
Rate for Payer: Multiplan Commercial |
$3,613.50
|
|
HC PROBE NASOLACRIMAL DUCT W/TUBE
|
Facility
OP
|
$4,818.00
|
|
Service Code
|
CPT 68815
|
Hospital Charge Code |
900501677
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$872.06 |
Max. Negotiated Rate |
$4,547.00 |
Rate for Payer: Adventist Health Commercial |
$963.60
|
Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,309.97
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
Rate for Payer: Cash Price |
$2,168.10
|
Rate for Payer: Cash Price |
$2,168.10
|
Rate for Payer: Cash Price |
$2,168.10
|
Rate for Payer: Cigna of CA HMO/PPO |
$3,131.70
|
Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
Rate for Payer: Dignity Health Senior |
$2,919.67
|
Rate for Payer: EPIC Health Plan Commercial |
$3,131.70
|
Rate for Payer: EPIC Health Plan Medicare |
$2,919.67
|
Rate for Payer: Heritage Provider Network Commercial |
$3,261.79
|
Rate for Payer: Heritage Provider Network Senior |
$3,261.79
|
Rate for Payer: Humana Medicare |
$2,919.67
|
Rate for Payer: IEHP Medi-Cal |
$936.00
|
Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$2,322.28
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$872.06
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,445.21
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.50
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
Rate for Payer: Molina Healthcare of CA Medicare |
$3,678.78
|
Rate for Payer: Multiplan Commercial |
$3,613.50
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,749.42
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,609.69
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
HC PROB NASOLACRIMAL DUCT
|
Facility
IP
|
$2,080.00
|
|
Service Code
|
CPT 68810
|
Hospital Charge Code |
900501582
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$376.48 |
Max. Negotiated Rate |
$1,560.00 |
Rate for Payer: Adventist Health Commercial |
$416.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,428.96
|
Rate for Payer: Cash Price |
$936.00
|
Rate for Payer: Heritage Provider Network Commercial |
$1,408.16
|
Rate for Payer: Heritage Provider Network Senior |
$1,408.16
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$376.48
|
Rate for Payer: LLUH Dept of Risk Management WC |
$520.00
|
Rate for Payer: Multiplan Commercial |
$1,560.00
|
|
HC PROB NASOLACRIMAL DUCT
|
Facility
OP
|
$2,080.00
|
|
Service Code
|
CPT 68810
|
Hospital Charge Code |
900501582
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$363.98 |
Max. Negotiated Rate |
$3,237.00 |
Rate for Payer: Adventist Health Commercial |
$416.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,428.96
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$545.97
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$400.38
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$363.98
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
Rate for Payer: Cash Price |
$936.00
|
Rate for Payer: Cash Price |
$936.00
|
Rate for Payer: Cash Price |
$936.00
|
Rate for Payer: Cigna of CA HMO/PPO |
$1,352.00
|
Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
Rate for Payer: Dignity Health Senior |
$363.98
|
Rate for Payer: EPIC Health Plan Commercial |
$1,352.00
|
Rate for Payer: EPIC Health Plan Medicare |
$363.98
|
Rate for Payer: Heritage Provider Network Commercial |
$1,408.16
|
Rate for Payer: Heritage Provider Network Senior |
$1,408.16
|
Rate for Payer: Humana Medicare |
$363.98
|
Rate for Payer: IEHP Medi-Cal |
$936.00
|
Rate for Payer: IEHP Medicare Advantage |
$363.98
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$1,002.56
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$376.48
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.50
|
Rate for Payer: LLUH Dept of Risk Management WC |
$520.00
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
Rate for Payer: Molina Healthcare of CA Medicare |
$458.61
|
Rate for Payer: Multiplan Commercial |
$1,560.00
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$755.25
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$694.93
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
HC PROB-NATRIURETIC PEPTIDE
|
Facility
OP
|
$95.00
|
|
Service Code
|
CPT 83880
|
Hospital Charge Code |
900912306
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$17.20 |
Max. Negotiated Rate |
$284.18 |
Rate for Payer: Adventist Health Commercial |
$19.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$98.75
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.26
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$58.89
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$43.19
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$39.26
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.18
|
Rate for Payer: Blue Shield of California Commercial |
$265.13
|
Rate for Payer: Blue Shield of California EPN |
$207.27
|
Rate for Payer: Cash Price |
$42.75
|
Rate for Payer: Cash Price |
$42.75
|
Rate for Payer: Cigna of CA HMO/PPO |
$61.75
|
Rate for Payer: Dignity Health Commercial/Exchange |
$58.89
|
Rate for Payer: Dignity Health Medi-Cal |
$43.19
|
Rate for Payer: Dignity Health Senior |
$39.26
|
Rate for Payer: EPIC Health Plan Commercial |
$61.75
|
Rate for Payer: EPIC Health Plan Medicare |
$39.26
|
Rate for Payer: Heritage Provider Network Commercial |
$58.80
|
Rate for Payer: Heritage Provider Network Senior |
$58.80
|
Rate for Payer: Humana Medicare |
$39.26
|
Rate for Payer: IEHP Medi-Cal |
$47.03
|
Rate for Payer: IEHP Medicare Advantage |
$39.26
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$74.59
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.33
|
Rate for Payer: LLUH Dept of Risk Management WC |
$23.75
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.47
|
Rate for Payer: Molina Healthcare of CA Medicare |
$49.47
|
Rate for Payer: Multiplan Commercial |
$71.25
|
Rate for Payer: TriValley Medical Group Commercial |
$39.26
|
Rate for Payer: TriValley Medical Group Senior |
$39.26
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$42.40
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.40
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.89
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$43.19
|
Rate for Payer: Vantage Medical Group Senior |
$39.26
|
|
HC PROB-NATRIURETIC PEPTIDE
|
Facility
IP
|
$592.00
|
|
Service Code
|
CPT 83880
|
Hospital Charge Code |
900912306
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$107.15 |
Max. Negotiated Rate |
$444.00 |
Rate for Payer: Adventist Health Commercial |
$118.40
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$406.70
|
Rate for Payer: Cash Price |
$266.40
|
Rate for Payer: Heritage Provider Network Commercial |
$400.78
|
Rate for Payer: Heritage Provider Network Senior |
$400.78
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.15
|
Rate for Payer: LLUH Dept of Risk Management WC |
$148.00
|
Rate for Payer: Multiplan Commercial |
$444.00
|
|
HC PROCALCITONIN
|
Facility
IP
|
$260.00
|
|
Service Code
|
CPT 84145
|
Hospital Charge Code |
900912171
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$47.06 |
Max. Negotiated Rate |
$195.00 |
Rate for Payer: Adventist Health Commercial |
$52.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$178.62
|
Rate for Payer: Cash Price |
$117.00
|
Rate for Payer: Heritage Provider Network Commercial |
$176.02
|
Rate for Payer: Heritage Provider Network Senior |
$176.02
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.06
|
Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
Rate for Payer: Multiplan Commercial |
$195.00
|
|
HC PROCALCITONIN
|
Facility
OP
|
$102.00
|
|
Service Code
|
CPT 84145
|
Hospital Charge Code |
900912171
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$18.46 |
Max. Negotiated Rate |
$155.18 |
Rate for Payer: Adventist Health Commercial |
$20.40
|
Rate for Payer: Aetna of CA Gatekeeper |
$77.93
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.07
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.83
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.94
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.22
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.30
|
Rate for Payer: Blue Shield of California Commercial |
$155.18
|
Rate for Payer: Blue Shield of California EPN |
$121.31
|
Rate for Payer: Cash Price |
$45.90
|
Rate for Payer: Cash Price |
$45.90
|
Rate for Payer: Cigna of CA HMO/PPO |
$66.30
|
Rate for Payer: Dignity Health Commercial/Exchange |
$40.83
|
Rate for Payer: Dignity Health Medi-Cal |
$29.94
|
Rate for Payer: Dignity Health Senior |
$27.22
|
Rate for Payer: EPIC Health Plan Commercial |
$66.30
|
Rate for Payer: EPIC Health Plan Medicare |
$27.22
|
Rate for Payer: Heritage Provider Network Commercial |
$63.14
|
Rate for Payer: Heritage Provider Network Senior |
$63.14
|
Rate for Payer: Humana Medicare |
$27.22
|
Rate for Payer: IEHP Medi-Cal |
$34.65
|
Rate for Payer: IEHP Medicare Advantage |
$27.22
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$51.72
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.46
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.30
|
Rate for Payer: Molina Healthcare of CA Medicare |
$34.30
|
Rate for Payer: Multiplan Commercial |
$76.50
|
Rate for Payer: TriValley Medical Group Commercial |
$27.22
|
Rate for Payer: TriValley Medical Group Senior |
$27.22
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.40
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.40
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.83
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$29.94
|
Rate for Payer: Vantage Medical Group Senior |
$27.22
|
|
HC PROC BILIARY TRACT
|
Facility
OP
|
$9,381.00
|
|
Service Code
|
CPT 47999
|
Hospital Charge Code |
907247999
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$936.00 |
Max. Negotiated Rate |
$9,616.00 |
Rate for Payer: Adventist Health Commercial |
$1,876.20
|
Rate for Payer: Aetna of CA Gatekeeper |
$5,014.14
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,444.75
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
Rate for Payer: Cash Price |
$4,221.45
|
Rate for Payer: Cash Price |
$4,221.45
|
Rate for Payer: Cash Price |
$4,221.45
|
Rate for Payer: Cigna of CA HMO/PPO |
$6,097.65
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
Rate for Payer: Dignity Health Senior |
$1,132.59
|
Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
Rate for Payer: Heritage Provider Network Commercial |
$6,350.94
|
Rate for Payer: Heritage Provider Network Senior |
$6,350.94
|
Rate for Payer: Humana Medicare |
$1,132.59
|
Rate for Payer: IEHP Medi-Cal |
$936.00
|
Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$4,521.64
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,697.96
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
Rate for Payer: LLUH Dept of Risk Management WC |
$2,345.25
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
Rate for Payer: Multiplan Commercial |
$7,035.75
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,406.24
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,134.19
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
HC PROC BILIARY TRACT
|
Facility
IP
|
$9,381.00
|
|
Service Code
|
CPT 47999
|
Hospital Charge Code |
907247999
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$1,697.96 |
Max. Negotiated Rate |
$7,035.75 |
Rate for Payer: Adventist Health Commercial |
$1,876.20
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,444.75
|
Rate for Payer: Cash Price |
$4,221.45
|
Rate for Payer: Heritage Provider Network Commercial |
$6,350.94
|
Rate for Payer: Heritage Provider Network Senior |
$6,350.94
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,697.96
|
Rate for Payer: LLUH Dept of Risk Management WC |
$2,345.25
|
Rate for Payer: Multiplan Commercial |
$7,035.75
|
|
HC PROC DENTOALVEOLAR STRUCTR
|
Facility
OP
|
$1,134.00
|
|
Service Code
|
CPT 41899
|
Hospital Charge Code |
900501221
|
Hospital Revenue Code
|
720
|
Min. Negotiated Rate |
$205.25 |
Max. Negotiated Rate |
$9,616.00 |
Rate for Payer: Adventist Health Commercial |
$226.80
|
Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$779.06
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
Rate for Payer: Blue Shield of California Commercial |
$704.21
|
Rate for Payer: Blue Shield of California EPN |
$665.66
|
Rate for Payer: Cash Price |
$510.30
|
Rate for Payer: Cash Price |
$510.30
|
Rate for Payer: Cash Price |
$510.30
|
Rate for Payer: Cash Price |
$510.30
|
Rate for Payer: Cigna of CA HMO/PPO |
$737.10
|
Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
Rate for Payer: Dignity Health Senior |
$305.19
|
Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
Rate for Payer: EPIC Health Plan Medicare |
$305.19
|
Rate for Payer: Heritage Provider Network Commercial |
$701.95
|
Rate for Payer: Heritage Provider Network Senior |
$701.95
|
Rate for Payer: Humana Medicare |
$305.19
|
Rate for Payer: IEHP Medicare Advantage |
$305.19
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$579.86
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.25
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$283.50
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
Rate for Payer: Molina Healthcare of CA Medicare |
$384.54
|
Rate for Payer: Multiplan Commercial |
$850.50
|
Rate for Payer: TriValley Medical Group Commercial |
$335.71
|
Rate for Payer: TriValley Medical Group Senior |
$305.19
|
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 |
$457.78
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
HC PROC DENTOALVEOLAR STRUCTR
|
Facility
IP
|
$1,134.00
|
|
Service Code
|
CPT 41899
|
Hospital Charge Code |
900501221
|
Hospital Revenue Code
|
720
|
Min. Negotiated Rate |
$205.25 |
Max. Negotiated Rate |
$850.50 |
Rate for Payer: Adventist Health Commercial |
$226.80
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$779.06
|
Rate for Payer: Cash Price |
$510.30
|
Rate for Payer: Heritage Provider Network Commercial |
$767.72
|
Rate for Payer: Heritage Provider Network Senior |
$767.72
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.25
|
Rate for Payer: LLUH Dept of Risk Management WC |
$283.50
|
Rate for Payer: Multiplan Commercial |
$850.50
|
|
HC PROC DENTOALVEOLAR STRUCTR
|
Facility
OP
|
$1,134.00
|
|
Service Code
|
CPT 41899
|
Hospital Charge Code |
900501221
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$205.25 |
Max. Negotiated Rate |
$9,616.00 |
Rate for Payer: Adventist Health Commercial |
$226.80
|
Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$779.06
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
Rate for Payer: Cash Price |
$510.30
|
Rate for Payer: Cash Price |
$510.30
|
Rate for Payer: Cash Price |
$510.30
|
Rate for Payer: Cigna of CA HMO/PPO |
$737.10
|
Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
Rate for Payer: Dignity Health Senior |
$305.19
|
Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
Rate for Payer: EPIC Health Plan Medicare |
$305.19
|
Rate for Payer: Heritage Provider Network Commercial |
$767.72
|
Rate for Payer: Heritage Provider Network Senior |
$767.72
|
Rate for Payer: Humana Medicare |
$305.19
|
Rate for Payer: IEHP Medi-Cal |
$936.00
|
Rate for Payer: IEHP Medicare Advantage |
$305.19
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$546.59
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.25
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$283.50
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
Rate for Payer: Molina Healthcare of CA Medicare |
$384.54
|
Rate for Payer: Multiplan Commercial |
$850.50
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$411.76
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.87
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
HC PROC DENTOALVEOLAR STRUCTR
|
Facility
IP
|
$1,134.00
|
|
Service Code
|
CPT 41899
|
Hospital Charge Code |
900501221
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$205.25 |
Max. Negotiated Rate |
$850.50 |
Rate for Payer: Adventist Health Commercial |
$226.80
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$779.06
|
Rate for Payer: Cash Price |
$510.30
|
Rate for Payer: Heritage Provider Network Commercial |
$767.72
|
Rate for Payer: Heritage Provider Network Senior |
$767.72
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.25
|
Rate for Payer: LLUH Dept of Risk Management WC |
$283.50
|
Rate for Payer: Multiplan Commercial |
$850.50
|
|
HC PROCEDURE ANUS
|
Facility
IP
|
$1,730.00
|
|
Service Code
|
CPT 46999
|
Hospital Charge Code |
900501653
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$313.13 |
Max. Negotiated Rate |
$1,297.50 |
Rate for Payer: Adventist Health Commercial |
$346.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,188.51
|
Rate for Payer: Cash Price |
$778.50
|
Rate for Payer: Heritage Provider Network Commercial |
$1,171.21
|
Rate for Payer: Heritage Provider Network Senior |
$1,171.21
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.13
|
Rate for Payer: LLUH Dept of Risk Management WC |
$432.50
|
Rate for Payer: Multiplan Commercial |
$1,297.50
|
|
HC PROCEDURE ANUS
|
Facility
OP
|
$1,730.00
|
|
Service Code
|
CPT 46999
|
Hospital Charge Code |
900501653
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$313.13 |
Max. Negotiated Rate |
$9,616.00 |
Rate for Payer: Adventist Health Commercial |
$346.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,188.51
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,712.90
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,256.12
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
Rate for Payer: Cash Price |
$778.50
|
Rate for Payer: Cash Price |
$778.50
|
Rate for Payer: Cash Price |
$778.50
|
Rate for Payer: Cigna of CA HMO/PPO |
$1,124.50
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
Rate for Payer: Dignity Health Senior |
$1,141.93
|
Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
Rate for Payer: Heritage Provider Network Commercial |
$1,171.21
|
Rate for Payer: Heritage Provider Network Senior |
$1,171.21
|
Rate for Payer: Humana Medicare |
$1,141.93
|
Rate for Payer: IEHP Medi-Cal |
$936.00
|
Rate for Payer: IEHP Medicare Advantage |
$1,141.93
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$833.86
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.13
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
Rate for Payer: LLUH Dept of Risk Management WC |
$432.50
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
Rate for Payer: Multiplan Commercial |
$1,297.50
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$628.16
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$577.99
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
HC PROCEDURE CARDIAC SURG
|
Facility
IP
|
$1,254.00
|
|
Service Code
|
CPT 33999
|
Hospital Charge Code |
900501696
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$226.97 |
Max. Negotiated Rate |
$940.50 |
Rate for Payer: Adventist Health Commercial |
$250.80
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$861.50
|
Rate for Payer: Cash Price |
$564.30
|
Rate for Payer: Heritage Provider Network Commercial |
$848.96
|
Rate for Payer: Heritage Provider Network Senior |
$848.96
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.97
|
Rate for Payer: LLUH Dept of Risk Management WC |
$313.50
|
Rate for Payer: Multiplan Commercial |
$940.50
|
|
HC PROCEDURE CARDIAC SURG
|
Facility
OP
|
$1,254.00
|
|
Service Code
|
CPT 33999
|
Hospital Charge Code |
900501696
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$226.97 |
Max. Negotiated Rate |
$9,616.00 |
Rate for Payer: Adventist Health Commercial |
$250.80
|
Rate for Payer: Aetna of CA Gatekeeper |
$670.26
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$861.50
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.90
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
Rate for Payer: Cash Price |
$564.30
|
Rate for Payer: Cash Price |
$564.30
|
Rate for Payer: Cash Price |
$564.30
|
Rate for Payer: Cigna of CA HMO/PPO |
$815.10
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
Rate for Payer: Dignity Health Senior |
$784.90
|
Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
Rate for Payer: Heritage Provider Network Commercial |
$848.96
|
Rate for Payer: Heritage Provider Network Senior |
$848.96
|
Rate for Payer: Humana Medicare |
$784.90
|
Rate for Payer: IEHP Medi-Cal |
$936.00
|
Rate for Payer: IEHP Medicare Advantage |
$784.90
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$604.43
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.97
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
Rate for Payer: LLUH Dept of Risk Management WC |
$313.50
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
Rate for Payer: Multiplan Commercial |
$940.50
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$455.33
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$418.96
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
HC PROCEDURE NOSE
|
Facility
OP
|
$798.00
|
|
Service Code
|
CPT 30999
|
Hospital Charge Code |
900501667
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$144.44 |
Max. Negotiated Rate |
$9,616.00 |
Rate for Payer: Adventist Health Commercial |
$159.60
|
Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$548.23
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
Rate for Payer: Cash Price |
$359.10
|
Rate for Payer: Cash Price |
$359.10
|
Rate for Payer: Cash Price |
$359.10
|
Rate for Payer: Cigna of CA HMO/PPO |
$518.70
|
Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
Rate for Payer: Dignity Health Senior |
$305.19
|
Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
Rate for Payer: EPIC Health Plan Medicare |
$305.19
|
Rate for Payer: Heritage Provider Network Commercial |
$540.25
|
Rate for Payer: Heritage Provider Network Senior |
$540.25
|
Rate for Payer: Humana Medicare |
$305.19
|
Rate for Payer: IEHP Medi-Cal |
$936.00
|
Rate for Payer: IEHP Medicare Advantage |
$305.19
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$384.64
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.44
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$199.50
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
Rate for Payer: Molina Healthcare of CA Medicare |
$384.54
|
Rate for Payer: Multiplan Commercial |
$598.50
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$289.75
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$266.61
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
HC PROCEDURE NOSE
|
Facility
IP
|
$798.00
|
|
Service Code
|
CPT 30999
|
Hospital Charge Code |
900501667
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$144.44 |
Max. Negotiated Rate |
$598.50 |
Rate for Payer: Adventist Health Commercial |
$159.60
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$548.23
|
Rate for Payer: Cash Price |
$359.10
|
Rate for Payer: Heritage Provider Network Commercial |
$540.25
|
Rate for Payer: Heritage Provider Network Senior |
$540.25
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.44
|
Rate for Payer: LLUH Dept of Risk Management WC |
$199.50
|
Rate for Payer: Multiplan Commercial |
$598.50
|
|
HC PROC PHARYNX ADENOIDS
|
Facility
OP
|
$994.00
|
|
Service Code
|
CPT 42999
|
Hospital Charge Code |
900501360
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$179.91 |
Max. Negotiated Rate |
$9,616.00 |
Rate for Payer: Adventist Health Commercial |
$198.80
|
Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$682.88
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
Rate for Payer: Cash Price |
$447.30
|
Rate for Payer: Cash Price |
$447.30
|
Rate for Payer: Cash Price |
$447.30
|
Rate for Payer: Cigna of CA HMO/PPO |
$646.10
|
Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
Rate for Payer: Dignity Health Senior |
$305.19
|
Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
Rate for Payer: EPIC Health Plan Medicare |
$305.19
|
Rate for Payer: Heritage Provider Network Commercial |
$672.94
|
Rate for Payer: Heritage Provider Network Senior |
$672.94
|
Rate for Payer: Humana Medicare |
$305.19
|
Rate for Payer: IEHP Medi-Cal |
$936.00
|
Rate for Payer: IEHP Medicare Advantage |
$305.19
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$479.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.91
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$248.50
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
Rate for Payer: Molina Healthcare of CA Medicare |
$384.54
|
Rate for Payer: Multiplan Commercial |
$745.50
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$360.92
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$332.10
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
HC PROC PHARYNX ADENOIDS
|
Facility
IP
|
$994.00
|
|
Service Code
|
CPT 42999
|
Hospital Charge Code |
900501360
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$179.91 |
Max. Negotiated Rate |
$745.50 |
Rate for Payer: Adventist Health Commercial |
$198.80
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$682.88
|
Rate for Payer: Cash Price |
$447.30
|
Rate for Payer: Heritage Provider Network Commercial |
$672.94
|
Rate for Payer: Heritage Provider Network Senior |
$672.94
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.91
|
Rate for Payer: LLUH Dept of Risk Management WC |
$248.50
|
Rate for Payer: Multiplan Commercial |
$745.50
|
|
HC PROC RECTUM
|
Facility
OP
|
$2,201.00
|
|
Service Code
|
CPT 45999
|
Hospital Charge Code |
900501387
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$398.38 |
Max. Negotiated Rate |
$9,616.00 |
Rate for Payer: Adventist Health Commercial |
$440.20
|
Rate for Payer: Aetna of CA Gatekeeper |
$1,176.43
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,512.09
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,712.90
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,256.12
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
Rate for Payer: Cash Price |
$990.45
|
Rate for Payer: Cash Price |
$990.45
|
Rate for Payer: Cash Price |
$990.45
|
Rate for Payer: Cigna of CA HMO/PPO |
$1,430.65
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
Rate for Payer: Dignity Health Senior |
$1,141.93
|
Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
Rate for Payer: Heritage Provider Network Commercial |
$1,490.08
|
Rate for Payer: Heritage Provider Network Senior |
$1,490.08
|
Rate for Payer: Humana Medicare |
$1,141.93
|
Rate for Payer: IEHP Medi-Cal |
$936.00
|
Rate for Payer: IEHP Medicare Advantage |
$1,141.93
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$1,060.88
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.38
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
Rate for Payer: LLUH Dept of Risk Management WC |
$550.25
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
Rate for Payer: Multiplan Commercial |
$1,650.75
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$799.18
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$735.35
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|