|
HC RECOVERY LEVL II EA ADDL 30 MIN
|
Facility
OP
|
$881.00
|
|
| Hospital Charge Code |
907201704
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$159.46 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$470.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$748.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$484.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$660.75
|
| Rate for Payer: Blue Shield of California Commercial |
$547.10
|
| Rate for Payer: Blue Shield of California EPN |
$517.15
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$572.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$748.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$748.85
|
| Rate for Payer: Dignity Health Senior |
$748.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$545.34
|
| Rate for Payer: Heritage Provider Network Senior |
$545.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$424.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.25
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$748.85
|
| Rate for Payer: Vantage Medical Group Senior |
$748.85
|
|
|
HC RECOVERY LEVL IV EA ADDL 30 MIN
|
Facility
OP
|
$1,463.00
|
|
| Hospital Charge Code |
907201708
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Adventist Health Commercial |
$292.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$781.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,005.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,243.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$804.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,097.25
|
| Rate for Payer: Blue Shield of California Commercial |
$908.52
|
| Rate for Payer: Blue Shield of California EPN |
$858.78
|
| Rate for Payer: Cash Price |
$658.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$950.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,243.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,243.55
|
| Rate for Payer: Dignity Health Senior |
$1,243.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$950.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$905.60
|
| Rate for Payer: Heritage Provider Network Senior |
$905.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$705.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.75
|
| Rate for Payer: Multiplan Commercial |
$1,097.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,243.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,243.55
|
|
|
HC RECOVERY LEVL IV EA ADDL 30 MIN
|
Facility
IP
|
$1,463.00
|
|
| Hospital Charge Code |
907201708
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$1,097.25 |
| Rate for Payer: Adventist Health Commercial |
$292.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,005.08
|
| Rate for Payer: Cash Price |
$658.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$990.45
|
| Rate for Payer: Heritage Provider Network Senior |
$990.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.75
|
| Rate for Payer: Multiplan Commercial |
$1,097.25
|
|
|
HC RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
IP
|
$559.00
|
|
|
Service Code
|
CPT 91120
|
| Hospital Charge Code |
906791120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$419.25 |
| Rate for Payer: Adventist Health Commercial |
$111.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.03
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$378.44
|
| Rate for Payer: Heritage Provider Network Senior |
$378.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.75
|
| Rate for Payer: Multiplan Commercial |
$419.25
|
|
|
HC RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
OP
|
$245.00
|
|
|
Service Code
|
CPT 91120
|
| Hospital Charge Code |
906791120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$807.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$168.32
|
| 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 |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$159.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$151.66
|
| Rate for Payer: Heritage Provider Network Senior |
$482.37
|
| Rate for Payer: Humana Medicare |
$392.17
|
| 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 |
$44.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC RED CELL MASS
|
Facility
IP
|
$1,649.00
|
|
|
Service Code
|
CPT 78122
|
| Hospital Charge Code |
909301332
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$298.47 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: Adventist Health Commercial |
$329.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,132.86
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,116.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.25
|
| Rate for Payer: Multiplan Commercial |
$1,236.75
|
|
|
HC RED CELL MASS
|
Facility
OP
|
$1,649.00
|
|
|
Service Code
|
CPT 78122
|
| Hospital Charge Code |
909301332
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$137.78 |
| Max. Negotiated Rate |
$1,283.13 |
| Rate for Payer: Adventist Health Commercial |
$329.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,132.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Blue Shield of California Commercial |
$939.64
|
| Rate for Payer: Blue Shield of California EPN |
$534.35
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,071.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: Dignity Health Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,071.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$675.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,020.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,020.73
|
| Rate for Payer: Humana Medicare |
$675.33
|
| Rate for Payer: IEHP Medi-Cal |
$137.78
|
| Rate for Payer: IEHP Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,283.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$796.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$850.92
|
| Rate for Payer: Multiplan Commercial |
$1,236.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$742.86
|
| Rate for Payer: TriValley Medical Group Senior |
$675.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC RED CELL SUR/HEP SEQ
|
Facility
OP
|
$1,492.00
|
|
|
Service Code
|
CPT 78140
|
| Hospital Charge Code |
909301336
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$134.97 |
| Max. Negotiated Rate |
$1,119.00 |
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$241.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,025.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$804.08
|
| Rate for Payer: Blue Shield of California EPN |
$457.26
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$969.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$969.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$923.55
|
| Rate for Payer: Heritage Provider Network Senior |
$923.55
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: IEHP Medi-Cal |
$134.97
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,119.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC RED CELL SUR/HEP SEQ
|
Facility
IP
|
$1,492.00
|
|
|
Service Code
|
CPT 78140
|
| Hospital Charge Code |
909301336
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$270.05 |
| Max. Negotiated Rate |
$1,119.00 |
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,025.00
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,010.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,010.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.00
|
| Rate for Payer: Multiplan Commercial |
$1,119.00
|
|
|
HC RED CELL SURVIVAL
|
Facility
IP
|
$1,722.00
|
|
|
Service Code
|
CPT 78130
|
| Hospital Charge Code |
909301334
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$311.68 |
| Max. Negotiated Rate |
$1,291.50 |
| Rate for Payer: Adventist Health Commercial |
$344.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,183.01
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,165.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,165.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$430.50
|
| Rate for Payer: Multiplan Commercial |
$1,291.50
|
|
|
HC RED CELL SURVIVAL
|
Facility
OP
|
$1,722.00
|
|
|
Service Code
|
CPT 78130
|
| Hospital Charge Code |
909301334
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$134.97 |
| Max. Negotiated Rate |
$1,291.50 |
| Rate for Payer: Adventist Health Commercial |
$344.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$275.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,183.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$580.50
|
| Rate for Payer: Blue Shield of California EPN |
$330.11
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,119.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,119.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,065.92
|
| Rate for Payer: Heritage Provider Network Senior |
$1,065.92
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: IEHP Medi-Cal |
$134.97
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$430.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,291.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC RED OF PROCIDENTIA UND ANESTH
|
Facility
OP
|
$1,285.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
900501155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$232.58 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$257.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$882.80
|
| 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 |
$3,237.00
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$835.25
|
| 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 |
$869.94
|
| Rate for Payer: Heritage Provider Network Senior |
$869.94
|
| 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 |
$619.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.25
|
| 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 |
$963.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$466.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$429.32
|
| 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 RED OF PROCIDENTIA UND ANESTH
|
Facility
IP
|
$1,285.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
900501155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$232.58 |
| Max. Negotiated Rate |
$963.75 |
| Rate for Payer: Adventist Health Commercial |
$257.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$882.80
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$869.94
|
| Rate for Payer: Heritage Provider Network Senior |
$869.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.25
|
| Rate for Payer: Multiplan Commercial |
$963.75
|
|
|
HC REDUCING SUBSTANCE
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
900910318
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$18.09 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.09
|
| Rate for Payer: Blue Shield of California Commercial |
$16.94
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.39
|
| Rate for Payer: Dignity Health Senior |
$2.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Humana Medicare |
$2.17
|
| Rate for Payer: IEHP Medi-Cal |
$2.76
|
| Rate for Payer: IEHP Medicare Advantage |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.73
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.17
|
| Rate for Payer: TriValley Medical Group Senior |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2.17
|
|
|
HC REDUCING SUBSTANCE
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
900910318
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
IP
|
$1,224.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.54 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: Adventist Health Commercial |
$244.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$840.89
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$828.65
|
| Rate for Payer: Heritage Provider Network Senior |
$828.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Multiplan Commercial |
$918.00
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
OP
|
$1,224.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.54 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$244.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$840.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$795.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$828.65
|
| Rate for Payer: Heritage Provider Network Senior |
$828.65
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$589.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: Multiplan Commercial |
$918.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$444.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$408.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
IP
|
$1,104.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.82 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Adventist Health Commercial |
$220.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$758.45
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$747.41
|
| Rate for Payer: Heritage Provider Network Senior |
$747.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.00
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
OP
|
$1,104.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.33 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Adventist Health Commercial |
$220.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$192.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$758.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$527.84
|
| Rate for Payer: Blue Shield of California Commercial |
$525.60
|
| Rate for Payer: Blue Shield of California EPN |
$298.89
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$717.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$717.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$683.38
|
| Rate for Payer: Heritage Provider Network Senior |
$683.38
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC REFILL/MAIN IMPL PUMP/RESV
|
Facility
IP
|
$638.00
|
|
|
Service Code
|
CPT 95990
|
| Hospital Charge Code |
911801003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$478.50 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.31
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$431.93
|
| Rate for Payer: Heritage Provider Network Senior |
$431.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
|
|
HC REFILL/MAIN IMPL PUMP/RESV
|
Facility
OP
|
$638.00
|
|
|
Service Code
|
CPT 95990
|
| Hospital Charge Code |
911801003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$77.25 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$180.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: Dignity Health Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$423.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$394.92
|
| Rate for Payer: Heritage Provider Network Senior |
$394.92
|
| Rate for Payer: Humana Medicare |
$423.14
|
| Rate for Payer: IEHP Medi-Cal |
$77.25
|
| Rate for Payer: IEHP Medicare Advantage |
$423.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$803.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$499.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$533.16
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$465.45
|
| Rate for Payer: TriValley Medical Group Senior |
$423.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$727.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$610.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
OP
|
$10,169.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$7,626.75 |
| Rate for Payer: Adventist Health Commercial |
$2,033.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,986.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$4,576.05
|
| Rate for Payer: Cash Price |
$4,576.05
|
| Rate for Payer: Cash Price |
$4,576.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,609.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,609.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,884.41
|
| Rate for Payer: Heritage Provider Network Senior |
$6,884.41
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,901.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,840.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,542.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: Multiplan Commercial |
$7,626.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,692.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,397.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
IP
|
$10,169.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,840.59 |
| Max. Negotiated Rate |
$7,626.75 |
| Rate for Payer: Adventist Health Commercial |
$2,033.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,986.10
|
| Rate for Payer: Cash Price |
$4,576.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,884.41
|
| Rate for Payer: Heritage Provider Network Senior |
$6,884.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,840.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,542.25
|
| Rate for Payer: Multiplan Commercial |
$7,626.75
|
|
|
HC REMOVAL LV LEAD PACE OR ICD
|
Facility
OP
|
$7,212.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820316
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,442.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,854.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,954.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| 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 |
$3,245.40
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,687.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,687.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,464.23
|
| Rate for Payer: Heritage Provider Network Senior |
$240.06
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,305.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,803.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$5,409.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| 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 |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC REMOVAL LV LEAD PACE OR ICD
|
Facility
IP
|
$7,212.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820316
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,305.37 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,442.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,954.64
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,305.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,803.00
|
| Rate for Payer: Multiplan Commercial |
$5,409.00
|
|
