|
HC PULM STRESS TEST COMPLEX
|
Facility
OP
|
$3,286.00
|
|
|
Service Code
|
CPT 94621
|
| Hospital Charge Code |
900801021
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$155.39 |
| Max. Negotiated Rate |
$2,464.50 |
| Rate for Payer: Adventist Health Commercial |
$657.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$226.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,257.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Blue Shield of California Commercial |
$333.66
|
| Rate for Payer: Blue Shield of California EPN |
$189.74
|
| Rate for Payer: Cash Price |
$1,478.70
|
| Rate for Payer: Cash Price |
$1,478.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,135.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,135.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,034.03
|
| Rate for Payer: Heritage Provider Network Senior |
$2,034.03
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: IEHP Medi-Cal |
$155.39
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$745.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$594.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$821.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$2,464.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$431.39
|
| Rate for Payer: TriValley Medical Group Senior |
$392.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC PULM STRESS TEST SIMPLE
|
Facility
OP
|
$1,997.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
900801020
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$27.39 |
| Max. Negotiated Rate |
$1,497.75 |
| Rate for Payer: Adventist Health Commercial |
$399.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,371.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Blue Shield of California Commercial |
$62.21
|
| Rate for Payer: Blue Shield of California EPN |
$35.38
|
| Rate for Payer: Cash Price |
$898.65
|
| Rate for Payer: Cash Price |
$898.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,298.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,298.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,236.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,236.14
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medi-Cal |
$46.99
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$1,497.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.56
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC PULM STRESS TEST SIMPLE
|
Facility
IP
|
$1,997.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
900801020
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$361.46 |
| Max. Negotiated Rate |
$1,497.75 |
| Rate for Payer: Adventist Health Commercial |
$399.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,371.94
|
| Rate for Payer: Cash Price |
$898.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,351.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,351.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.25
|
| Rate for Payer: Multiplan Commercial |
$1,497.75
|
|
|
HC PULSE OXIMETRY MULT DETER
|
Facility
IP
|
$500.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
900800106
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$343.50
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$338.50
|
| Rate for Payer: Heritage Provider Network Senior |
$338.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
|
|
HC PULSE OXIMETRY MULT DETER
|
Facility
OP
|
$500.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
900800106
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$343.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$375.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22.14
|
| Rate for Payer: Blue Shield of California EPN |
$12.59
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$325.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$425.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.00
|
| Rate for Payer: Dignity Health Senior |
$425.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$309.50
|
| Rate for Payer: Heritage Provider Network Senior |
$309.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$241.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.00
|
| Rate for Payer: Vantage Medical Group Senior |
$425.00
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$168.75
|
| Rate for Payer: Blue Shield of California Commercial |
$10.67
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: Dignity Health Senior |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.28
|
| Rate for Payer: Heritage Provider Network Senior |
$139.28
|
| Rate for Payer: IEHP Medi-Cal |
$8.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$108.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
IP
|
$225.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$168.75 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.32
|
| Rate for Payer: Heritage Provider Network Senior |
$152.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
IP
|
$225.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$168.75 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.32
|
| Rate for Payer: Heritage Provider Network Senior |
$152.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$168.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: Dignity Health Senior |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.32
|
| Rate for Payer: Heritage Provider Network Senior |
$152.32
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$108.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$81.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$75.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC PUNCH BX SKIN EA SEP/ADD LSN
|
Facility
OP
|
$244.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
900511105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$134.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$183.00
|
| 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 |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$158.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$207.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.40
|
| Rate for Payer: Dignity Health Senior |
$207.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$151.04
|
| Rate for Payer: Heritage Provider Network Senior |
$151.04
|
| Rate for Payer: IEHP Medi-Cal |
$86.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$117.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| 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 |
$207.40
|
| Rate for Payer: Vantage Medical Group Senior |
$207.40
|
|
|
HC PUNCH BX SKIN EA SEP/ADD LSN
|
Facility
IP
|
$244.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
900511105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.63
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.19
|
| Rate for Payer: Heritage Provider Network Senior |
$165.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
|
|
HC PUNCH BX SKIN SINGLE LESION
|
Facility
OP
|
$487.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
900511104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.15 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$334.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$316.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$301.45
|
| Rate for Payer: Heritage Provider Network Senior |
$612.79
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: IEHP Medi-Cal |
$174.81
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$946.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$548.02
|
| Rate for Payer: TriValley Medical Group Senior |
$548.02
|
| 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 Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC PUNCH BX SKIN SINGLE LESION
|
Facility
IP
|
$487.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
900511104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.15 |
| Max. Negotiated Rate |
$365.25 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$334.57
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.70
|
| Rate for Payer: Heritage Provider Network Senior |
$329.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.75
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
OP
|
$1,094.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
906820028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.18 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$218.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$751.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$711.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$677.19
|
| Rate for Payer: Heritage Provider Network Senior |
$612.79
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: IEHP Medi-Cal |
$73.18
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$946.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$548.02
|
| Rate for Payer: TriValley Medical Group Senior |
$548.02
|
| 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 Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
IP
|
$580.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.66
|
| Rate for Payer: Heritage Provider Network Senior |
$392.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
OP
|
$580.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.18 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$377.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$359.02
|
| Rate for Payer: Heritage Provider Network Senior |
$612.79
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: IEHP Medi-Cal |
$73.18
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$946.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$548.02
|
| Rate for Payer: TriValley Medical Group Senior |
$548.02
|
| 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 Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
OP
|
$580.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$377.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.66
|
| Rate for Payer: Heritage Provider Network Senior |
$392.66
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$279.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$210.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$193.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
IP
|
$580.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.66
|
| Rate for Payer: Heritage Provider Network Senior |
$392.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
IP
|
$1,094.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
906820028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$198.01 |
| Max. Negotiated Rate |
$820.50 |
| Rate for Payer: Adventist Health Commercial |
$218.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$751.58
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$740.64
|
| Rate for Payer: Heritage Provider Network Senior |
$740.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.50
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
IP
|
$1,928.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$348.97 |
| Max. Negotiated Rate |
$1,446.00 |
| Rate for Payer: Adventist Health Commercial |
$385.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,324.54
|
| Rate for Payer: Cash Price |
$867.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,305.26
|
| Rate for Payer: Heritage Provider Network Senior |
$1,305.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.00
|
| Rate for Payer: Multiplan Commercial |
$1,446.00
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
IP
|
$1,928.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.97 |
| Max. Negotiated Rate |
$1,446.00 |
| Rate for Payer: Adventist Health Commercial |
$385.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,324.54
|
| Rate for Payer: Cash Price |
$867.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,305.26
|
| Rate for Payer: Heritage Provider Network Senior |
$1,305.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.00
|
| Rate for Payer: Multiplan Commercial |
$1,446.00
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
OP
|
$1,928.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$348.97 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$385.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,324.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$867.60
|
| Rate for Payer: Cash Price |
$867.60
|
| Rate for Payer: Cash Price |
$867.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,253.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,253.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,305.26
|
| Rate for Payer: Heritage Provider Network Senior |
$1,305.26
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$929.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,446.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$700.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$644.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
OP
|
$1,928.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.86 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$385.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,324.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$867.60
|
| Rate for Payer: Cash Price |
$867.60
|
| Rate for Payer: Cash Price |
$867.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,253.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,193.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,062.77
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: IEHP Medi-Cal |
$203.86
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,641.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,446.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$950.44
|
| Rate for Payer: TriValley Medical Group Senior |
$950.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC PVA PARTICLES
|
Facility
IP
|
$1,127.00
|
|
| Hospital Charge Code |
909081806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$225.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$540.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$774.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$507.15
|
| Rate for Payer: Cash Price |
$507.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$518.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$608.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$762.98
|
| Rate for Payer: Heritage Provider Network Senior |
$762.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$563.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$563.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$563.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.75
|
| Rate for Payer: Multiplan Commercial |
$845.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$410.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$376.53
|
|
|
HC PVA PARTICLES
|
Facility
OP
|
$1,127.00
|
|
| Hospital Charge Code |
909081806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$225.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$540.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$774.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$957.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$619.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$845.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$699.87
|
| Rate for Payer: Blue Shield of California EPN |
$661.55
|
| Rate for Payer: Cash Price |
$507.15
|
| Rate for Payer: Cash Price |
$507.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$518.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$957.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$957.95
|
| Rate for Payer: Dignity Health Senior |
$957.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$721.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$521.80
|
| Rate for Payer: Heritage Provider Network Senior |
$521.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$563.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$563.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$563.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.75
|
| Rate for Payer: Multiplan Commercial |
$845.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$410.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$376.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$957.95
|
| Rate for Payer: Vantage Medical Group Senior |
$957.95
|
|
