|
HC REMOVAL OF BREAST IMPLANT
|
Facility
OP
|
$11,377.00
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
900501758
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,275.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,816.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$5,119.65
|
| Rate for Payer: Cash Price |
$5,119.65
|
| Rate for Payer: Cash Price |
$5,119.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,395.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: Dignity Health Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,762.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,702.23
|
| Rate for Payer: Heritage Provider Network Senior |
$7,702.23
|
| Rate for Payer: Humana Medicare |
$4,762.51
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,762.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,483.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,059.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,619.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,844.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,000.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,000.76
|
| Rate for Payer: Multiplan Commercial |
$8,532.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,130.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,801.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
HC REMOVAL OF BREAST IMPLANT
|
Facility
IP
|
$11,377.00
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
900501758
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,059.24 |
| Max. Negotiated Rate |
$8,532.75 |
| Rate for Payer: Adventist Health Commercial |
$2,275.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,816.00
|
| Rate for Payer: Cash Price |
$5,119.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,702.23
|
| Rate for Payer: Heritage Provider Network Senior |
$7,702.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,059.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,844.25
|
| Rate for Payer: Multiplan Commercial |
$8,532.75
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
OP
|
$21,487.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906820321
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$41.93 |
| Max. Negotiated Rate |
$18,263.95 |
| Rate for Payer: Adventist Health Commercial |
$4,297.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,761.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18,263.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11,817.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16,115.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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 |
$9,669.15
|
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,966.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,263.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,263.95
|
| Rate for Payer: Dignity Health Senior |
$18,263.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,300.45
|
| Rate for Payer: Heritage Provider Network Senior |
$13,300.45
|
| Rate for Payer: IEHP Medi-Cal |
$41.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,356.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,889.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,371.75
|
| Rate for Payer: Multiplan Commercial |
$16,115.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,263.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18,263.95
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
OP
|
$18,226.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906811997
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$41.93 |
| Max. Negotiated Rate |
$15,492.10 |
| Rate for Payer: Adventist Health Commercial |
$3,645.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,521.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15,492.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,024.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,669.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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 |
$8,201.70
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,846.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,492.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,492.10
|
| Rate for Payer: Dignity Health Senior |
$15,492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,281.89
|
| Rate for Payer: Heritage Provider Network Senior |
$11,281.89
|
| Rate for Payer: IEHP Medi-Cal |
$41.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,784.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,298.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,556.50
|
| Rate for Payer: Multiplan Commercial |
$13,669.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,492.10
|
| Rate for Payer: Vantage Medical Group Senior |
$15,492.10
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
IP
|
$18,226.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906811997
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,298.91 |
| Max. Negotiated Rate |
$13,669.50 |
| Rate for Payer: Adventist Health Commercial |
$3,645.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,521.26
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,339.00
|
| Rate for Payer: Heritage Provider Network Senior |
$12,339.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,298.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,556.50
|
| Rate for Payer: Multiplan Commercial |
$13,669.50
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
IP
|
$21,487.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906820321
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,889.15 |
| Max. Negotiated Rate |
$16,115.25 |
| Rate for Payer: Adventist Health Commercial |
$4,297.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,761.57
|
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,546.70
|
| Rate for Payer: Heritage Provider Network Senior |
$14,546.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,889.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,371.75
|
| Rate for Payer: Multiplan Commercial |
$16,115.25
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
IP
|
$9,896.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,791.18 |
| Max. Negotiated Rate |
$7,422.00 |
| Rate for Payer: Adventist Health Commercial |
$1,979.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,798.55
|
| Rate for Payer: Cash Price |
$4,453.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,699.59
|
| Rate for Payer: Heritage Provider Network Senior |
$6,699.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,791.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,474.00
|
| Rate for Payer: Multiplan Commercial |
$7,422.00
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
OP
|
$9,896.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$7,422.00 |
| Rate for Payer: Adventist Health Commercial |
$1,979.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,798.55
|
| 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 |
$4,547.00
|
| Rate for Payer: Cash Price |
$4,453.20
|
| Rate for Payer: Cash Price |
$4,453.20
|
| Rate for Payer: Cash Price |
$4,453.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,432.40
|
| 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 |
$6,432.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,699.59
|
| Rate for Payer: Heritage Provider Network Senior |
$6,699.59
|
| 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 |
$4,769.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,791.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,474.00
|
| 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 |
$7,422.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,593.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,306.25
|
| 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 REMOVE FIBRIN SHEATH
|
Facility
IP
|
$7,683.00
|
|
|
Service Code
|
CPT 36595
|
| Hospital Charge Code |
909020014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,390.62 |
| Max. Negotiated Rate |
$5,762.25 |
| Rate for Payer: Adventist Health Commercial |
$1,536.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,278.22
|
| Rate for Payer: Cash Price |
$3,457.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,201.39
|
| Rate for Payer: Heritage Provider Network Senior |
$5,201.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,390.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,920.75
|
| Rate for Payer: Multiplan Commercial |
$5,762.25
|
|
|
HC REMOVE FIBRIN SHEATH
|
Facility
OP
|
$7,683.00
|
|
|
Service Code
|
CPT 36595
|
| Hospital Charge Code |
909020014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,135.73 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,536.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,278.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$3,457.35
|
| Rate for Payer: Cash Price |
$3,457.35
|
| Rate for Payer: Cash Price |
$3,457.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,993.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,755.78
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$1,135.73
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,390.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,920.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$5,762.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REMOVE FOREIGN BODY (RENAL)
|
Facility
IP
|
$10,024.00
|
|
|
Service Code
|
CPT 50561
|
| Hospital Charge Code |
909081362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,814.34 |
| Max. Negotiated Rate |
$7,518.00 |
| Rate for Payer: Adventist Health Commercial |
$2,004.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,886.49
|
| Rate for Payer: Cash Price |
$4,510.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,786.25
|
| Rate for Payer: Heritage Provider Network Senior |
$6,786.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,506.00
|
| Rate for Payer: Multiplan Commercial |
$7,518.00
|
|
|
HC REMOVE FOREIGN BODY (RENAL)
|
Facility
OP
|
$10,024.00
|
|
|
Service Code
|
CPT 50561
|
| Hospital Charge Code |
909081362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$658.62 |
| Max. Negotiated Rate |
$12,283.52 |
| Rate for Payer: Adventist Health Commercial |
$2,004.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,886.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,465.01
|
| 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 |
$4,510.80
|
| Rate for Payer: Cash Price |
$4,510.80
|
| Rate for Payer: Cash Price |
$4,510.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,515.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,111.51
|
| Rate for Payer: Dignity Health Senior |
$6,465.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,465.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,204.86
|
| Rate for Payer: Heritage Provider Network Senior |
$7,951.96
|
| Rate for Payer: Humana Medicare |
$6,465.01
|
| Rate for Payer: IEHP Medi-Cal |
$658.62
|
| Rate for Payer: IEHP Medicare Advantage |
$6,465.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,283.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,628.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,506.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,145.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,145.91
|
| Rate for Payer: Multiplan Commercial |
$7,518.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,111.51
|
| Rate for Payer: TriValley Medical Group Senior |
$7,111.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Vantage Medical Group Senior |
$6,465.01
|
|
|
HC REMOVE FOREIGN BODY (URETER
|
Facility
IP
|
$10,024.00
|
|
|
Service Code
|
CPT 50961
|
| Hospital Charge Code |
909081363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,814.34 |
| Max. Negotiated Rate |
$7,518.00 |
| Rate for Payer: Adventist Health Commercial |
$2,004.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,886.49
|
| Rate for Payer: Cash Price |
$4,510.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,786.25
|
| Rate for Payer: Heritage Provider Network Senior |
$6,786.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,506.00
|
| Rate for Payer: Multiplan Commercial |
$7,518.00
|
|
|
HC REMOVE FOREIGN BODY (URETER
|
Facility
OP
|
$10,024.00
|
|
|
Service Code
|
CPT 50961
|
| Hospital Charge Code |
909081363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$778.83 |
| Max. Negotiated Rate |
$12,283.52 |
| Rate for Payer: Adventist Health Commercial |
$2,004.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,886.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,465.01
|
| 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 |
$4,510.80
|
| Rate for Payer: Cash Price |
$4,510.80
|
| Rate for Payer: Cash Price |
$4,510.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,515.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,111.51
|
| Rate for Payer: Dignity Health Senior |
$6,465.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,465.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,204.86
|
| Rate for Payer: Heritage Provider Network Senior |
$7,951.96
|
| Rate for Payer: Humana Medicare |
$6,465.01
|
| Rate for Payer: IEHP Medi-Cal |
$778.83
|
| Rate for Payer: IEHP Medicare Advantage |
$6,465.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,283.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,628.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,506.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,145.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,145.91
|
| Rate for Payer: Multiplan Commercial |
$7,518.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,111.51
|
| Rate for Payer: TriValley Medical Group Senior |
$7,111.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Vantage Medical Group Senior |
$6,465.01
|
|
|
HC REMOVE LAMINA/FACETS LUMBAR
|
Facility
OP
|
$21,671.00
|
|
|
Service Code
|
CPT 63012
|
| Hospital Charge Code |
900100965
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$325.24 |
| Max. Negotiated Rate |
$16,983.21 |
| Rate for Payer: Adventist Health Commercial |
$4,334.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,887.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$9,751.95
|
| Rate for Payer: Cash Price |
$9,751.95
|
| Rate for Payer: Cash Price |
$9,751.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,086.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,002.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,414.35
|
| Rate for Payer: Heritage Provider Network Senior |
$10,994.39
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: IEHP Medi-Cal |
$325.24
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,983.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,922.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,417.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: Multiplan Commercial |
$16,253.25
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,832.38
|
| Rate for Payer: TriValley Medical Group Senior |
$9,832.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC REMOVE LAMINA/FACETS LUMBAR
|
Facility
IP
|
$21,671.00
|
|
|
Service Code
|
CPT 63012
|
| Hospital Charge Code |
900100965
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,922.45 |
| Max. Negotiated Rate |
$16,253.25 |
| Rate for Payer: Adventist Health Commercial |
$4,334.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,887.98
|
| Rate for Payer: Cash Price |
$9,751.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,671.27
|
| Rate for Payer: Heritage Provider Network Senior |
$14,671.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,922.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,417.75
|
| Rate for Payer: Multiplan Commercial |
$16,253.25
|
|
|
HC REMOVE OBSTRUCT GAST/JEJ/CEC T
|
Facility
OP
|
$4,384.00
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
909020008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$793.50 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$876.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,011.81
|
| 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 |
$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 |
$1,972.80
|
| Rate for Payer: Cash Price |
$1,972.80
|
| Rate for Payer: Cash Price |
$1,972.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,849.60
|
| 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 |
$2,713.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$1,060.52
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$793.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,096.00
|
| 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 |
$3,288.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,245.85
|
| Rate for Payer: TriValley Medical Group Senior |
$1,245.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| 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 REMOVE OBSTRUCT GAST/JEJ/CEC T
|
Facility
IP
|
$4,384.00
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
909020008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$793.50 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Adventist Health Commercial |
$876.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,011.81
|
| Rate for Payer: Cash Price |
$1,972.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,967.97
|
| Rate for Payer: Heritage Provider Network Senior |
$2,967.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$793.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,096.00
|
| Rate for Payer: Multiplan Commercial |
$3,288.00
|
|
|
HC REMOVE PERICATH OBSTRUCTION
|
Facility
IP
|
$2,951.00
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
909020013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$534.13 |
| Max. Negotiated Rate |
$2,213.25 |
| Rate for Payer: Adventist Health Commercial |
$590.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,027.34
|
| Rate for Payer: Cash Price |
$1,327.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,997.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,997.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$737.75
|
| Rate for Payer: Multiplan Commercial |
$2,213.25
|
|
|
HC REMOVE PERICATH OBSTRUCTION
|
Facility
OP
|
$2,951.00
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
909020013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.00 |
| Max. Negotiated Rate |
$2,508.35 |
| Rate for Payer: Adventist Health Commercial |
$590.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$319.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,027.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,508.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,623.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,213.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.90
|
| Rate for Payer: Blue Shield of California Commercial |
$373.36
|
| Rate for Payer: Blue Shield of California EPN |
$212.32
|
| Rate for Payer: Cash Price |
$1,327.95
|
| Rate for Payer: Cash Price |
$1,327.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,918.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,508.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,508.35
|
| Rate for Payer: Dignity Health Senior |
$2,508.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,918.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,826.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,826.67
|
| Rate for Payer: IEHP Medi-Cal |
$155.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,422.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$737.75
|
| Rate for Payer: Multiplan Commercial |
$2,213.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,508.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,508.35
|
|
|
HC REMOVE PERM CANNULA/CATHETER
|
Facility
OP
|
$8,792.00
|
|
|
Service Code
|
CPT 49422
|
| Hospital Charge Code |
909001458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.76 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,758.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,040.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$3,956.40
|
| Rate for Payer: Cash Price |
$3,956.40
|
| Rate for Payer: Cash Price |
$3,956.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,714.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,442.25
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$490.76
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,591.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,198.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$6,594.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REMOVE PERM CANNULA/CATHETER
|
Facility
IP
|
$8,792.00
|
|
|
Service Code
|
CPT 49422
|
| Hospital Charge Code |
909001458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,591.35 |
| Max. Negotiated Rate |
$6,594.00 |
| Rate for Payer: Adventist Health Commercial |
$1,758.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,040.10
|
| Rate for Payer: Cash Price |
$3,956.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,952.18
|
| Rate for Payer: Heritage Provider Network Senior |
$5,952.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,591.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,198.00
|
| Rate for Payer: Multiplan Commercial |
$6,594.00
|
|
|
HC REMOVE RENAL TUBE W/FLUORO
|
Facility
IP
|
$7,812.00
|
|
|
Service Code
|
CPT 50389
|
| Hospital Charge Code |
909081853
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,413.97 |
| Max. Negotiated Rate |
$5,859.00 |
| Rate for Payer: Adventist Health Commercial |
$1,562.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,366.84
|
| Rate for Payer: Cash Price |
$3,515.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,288.72
|
| Rate for Payer: Heritage Provider Network Senior |
$5,288.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,413.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,953.00
|
| Rate for Payer: Multiplan Commercial |
$5,859.00
|
|
|
HC REMOVE RENAL TUBE W/FLUORO
|
Facility
OP
|
$7,812.00
|
|
|
Service Code
|
CPT 50389
|
| Hospital Charge Code |
909081853
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$709.14 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,562.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,366.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$853.50
|
| 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 |
$3,515.40
|
| Rate for Payer: Cash Price |
$3,515.40
|
| Rate for Payer: Cash Price |
$3,515.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,077.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$938.85
|
| Rate for Payer: Dignity Health Senior |
$853.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$853.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,835.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,049.80
|
| Rate for Payer: Humana Medicare |
$853.50
|
| Rate for Payer: IEHP Medi-Cal |
$709.14
|
| Rate for Payer: IEHP Medicare Advantage |
$853.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,621.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,413.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,007.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,953.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.41
|
| Rate for Payer: Multiplan Commercial |
$5,859.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$938.85
|
| Rate for Payer: TriValley Medical Group Senior |
$938.85
|
| 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 |
$1,280.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Vantage Medical Group Senior |
$853.50
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
OP
|
$4,318.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
909080021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$211.99 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$863.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,966.47
|
| 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 |
$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 |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,806.70
|
| 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 |
$2,672.84
|
| Rate for Payer: Heritage Provider Network Senior |
$965.43
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: IEHP Medi-Cal |
$211.99
|
| Rate for Payer: IEHP Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$781.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.50
|
| 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 |
$3,238.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.39
|
| Rate for Payer: TriValley Medical Group Senior |
$863.39
|
| 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 |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
