|
HC RETICULOCYTE COUNT, AUTO
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
900910088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.55
|
| Rate for Payer: Blue Shield of California Commercial |
$43.60
|
| Rate for Payer: Blue Shield of California EPN |
$34.09
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: Dignity Health Senior |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.00
|
| Rate for Payer: Heritage Provider Network Senior |
$13.00
|
| Rate for Payer: Humana Medicare |
$5.57
|
| Rate for Payer: IEHP Medi-Cal |
$7.19
|
| Rate for Payer: IEHP Medicare Advantage |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.02
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Senior |
$5.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
|
|
HC RETICULOCYTE COUNT, AUTO
|
Facility
IP
|
$110.00
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
900910088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC RETICULOCYTE COUNT, MANUAL
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT 85044
|
| Hospital Charge Code |
900910063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$36.01 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.01
|
| Rate for Payer: Blue Shield of California Commercial |
$33.60
|
| Rate for Payer: Blue Shield of California EPN |
$26.26
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Senior |
$4.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| Rate for Payer: Humana Medicare |
$4.31
|
| Rate for Payer: IEHP Medi-Cal |
$4.12
|
| Rate for Payer: IEHP Medicare Advantage |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.31
|
| Rate for Payer: TriValley Medical Group Senior |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
|
|
HC RETICULOCYTE COUNT, MANUAL
|
Facility
IP
|
$131.00
|
|
|
Service Code
|
CPT 85044
|
| Hospital Charge Code |
900910063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$98.25 |
| Rate for Payer: Adventist Health Commercial |
$26.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.00
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.69
|
| Rate for Payer: Heritage Provider Network Senior |
$88.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.75
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
|
|
HC RETROBULBAR INJECTION
|
Facility
OP
|
$917.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.89 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$629.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$596.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: Dignity Health Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$596.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$363.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.81
|
| Rate for Payer: Heritage Provider Network Senior |
$620.81
|
| Rate for Payer: Humana Medicare |
$363.98
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$363.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$441.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$458.61
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$332.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$306.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC RETROBULBAR INJECTION
|
Facility
IP
|
$917.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$687.75 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$629.98
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.81
|
| Rate for Payer: Heritage Provider Network Senior |
$620.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.25
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
|
|
HC RETROGRADE DBL BLLN ENTSCPY
|
Facility
OP
|
$7,186.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,437.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,936.78
|
| 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: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$3,233.70
|
| Rate for Payer: Cash Price |
$3,233.70
|
| Rate for Payer: Cash Price |
$3,233.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,670.90
|
| 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 |
$4,448.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| 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 |
$1,300.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,796.50
|
| 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 |
$5,389.50
|
| 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 |
$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 RETROGRADE DBL BLLN ENTSCPY
|
Facility
IP
|
$7,186.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,300.67 |
| Max. Negotiated Rate |
$5,389.50 |
| Rate for Payer: Adventist Health Commercial |
$1,437.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,936.78
|
| Rate for Payer: Cash Price |
$3,233.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,864.92
|
| Rate for Payer: Heritage Provider Network Senior |
$4,864.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,300.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,796.50
|
| Rate for Payer: Multiplan Commercial |
$5,389.50
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
IP
|
$7,186.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,300.67 |
| Max. Negotiated Rate |
$5,389.50 |
| Rate for Payer: Adventist Health Commercial |
$1,437.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,936.78
|
| Rate for Payer: Cash Price |
$3,233.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,864.92
|
| Rate for Payer: Heritage Provider Network Senior |
$4,864.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,300.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,796.50
|
| Rate for Payer: Multiplan Commercial |
$5,389.50
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
OP
|
$7,186.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,437.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,936.78
|
| 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: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$3,233.70
|
| Rate for Payer: Cash Price |
$3,233.70
|
| Rate for Payer: Cash Price |
$3,233.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,670.90
|
| 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 |
$4,448.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| 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 |
$1,300.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,796.50
|
| 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 |
$5,389.50
|
| 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 |
$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 RETROGRAD URETHROGRAM
|
Facility
IP
|
$1,157.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$209.42 |
| Max. Negotiated Rate |
$867.75 |
| Rate for Payer: Adventist Health Commercial |
$231.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$794.86
|
| Rate for Payer: Cash Price |
$520.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$783.29
|
| Rate for Payer: Heritage Provider Network Senior |
$783.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$867.75
|
|
|
HC RETROGRAD URETHROGRAM
|
Facility
OP
|
$1,157.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.77 |
| Max. Negotiated Rate |
$867.75 |
| Rate for Payer: Adventist Health Commercial |
$231.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$391.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$794.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.97
|
| Rate for Payer: Blue Shield of California Commercial |
$297.54
|
| Rate for Payer: Blue Shield of California EPN |
$169.20
|
| Rate for Payer: Cash Price |
$520.65
|
| Rate for Payer: Cash Price |
$520.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$752.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$752.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$716.18
|
| Rate for Payer: Heritage Provider Network Senior |
$716.18
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$64.77
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$867.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.16
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC RETRO PYELOGRAM
|
Facility
IP
|
$1,536.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.02 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,055.23
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,039.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,039.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
|
|
HC RETRO PYELOGRAM
|
Facility
OP
|
$1,536.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.02 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$391.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,055.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$551.06
|
| Rate for Payer: Blue Shield of California Commercial |
$533.43
|
| Rate for Payer: Blue Shield of California EPN |
$303.35
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$998.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: Dignity Health Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$998.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$950.78
|
| Rate for Payer: Heritage Provider Network Senior |
$950.78
|
| Rate for Payer: Humana Medicare |
$480.50
|
| Rate for Payer: IEHP Medi-Cal |
$88.02
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$605.43
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$480.50
|
| Rate for Payer: TriValley Medical Group Senior |
$480.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC REVERSE KNUCKLE BENDER
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309138
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$95.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$136.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.05
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$72.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$66.15
|
|
|
HC REVERSE KNUCKLE BENDER
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309138
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$95.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$136.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$108.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$148.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$122.96
|
| Rate for Payer: Blue Shield of California EPN |
$116.23
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$168.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$168.30
|
| Rate for Payer: Dignity Health Senior |
$168.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.67
|
| Rate for Payer: Heritage Provider Network Senior |
$91.67
|
| Rate for Payer: IEHP Medi-Cal |
$102.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$72.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$66.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Vantage Medical Group Senior |
$168.30
|
|
|
HC REV INCL RPLCMT SPNL NEURO ELEC
|
Facility
OP
|
$22,736.00
|
|
|
Service Code
|
CPT 63663
|
| Hospital Charge Code |
900100645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.79 |
| Max. Negotiated Rate |
$17,052.00 |
| Rate for Payer: Adventist Health Commercial |
$4,547.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,619.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,817.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,399.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,545.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$10,231.20
|
| Rate for Payer: Cash Price |
$10,231.20
|
| Rate for Payer: Cash Price |
$10,231.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,778.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,817.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,399.57
|
| Rate for Payer: Dignity Health Senior |
$8,545.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,641.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,545.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,073.58
|
| Rate for Payer: Heritage Provider Network Senior |
$10,510.42
|
| Rate for Payer: Humana Medicare |
$8,545.06
|
| Rate for Payer: IEHP Medi-Cal |
$217.79
|
| Rate for Payer: IEHP Medicare Advantage |
$8,545.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,235.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,115.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,083.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,684.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,766.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,766.78
|
| Rate for Payer: Multiplan Commercial |
$17,052.00
|
| Rate for Payer: Multiplan WC |
$11,682.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,399.57
|
| Rate for Payer: TriValley Medical Group Senior |
$9,399.57
|
| 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 |
$12,817.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,399.57
|
| Rate for Payer: Vantage Medical Group Senior |
$8,545.06
|
|
|
HC REV INCL RPLCMT SPNL NEURO ELEC
|
Facility
IP
|
$22,736.00
|
|
|
Service Code
|
CPT 63663
|
| Hospital Charge Code |
900100645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,115.22 |
| Max. Negotiated Rate |
$17,052.00 |
| Rate for Payer: Adventist Health Commercial |
$4,547.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,619.63
|
| Rate for Payer: Cash Price |
$10,231.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,392.27
|
| Rate for Payer: Heritage Provider Network Senior |
$15,392.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,115.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,684.00
|
| Rate for Payer: Multiplan Commercial |
$17,052.00
|
|
|
HC REVISE REMOVE NEURORECEIVER
|
Facility
IP
|
$10,949.00
|
|
|
Service Code
|
CPT 63688
|
| Hospital Charge Code |
909000688
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,981.77 |
| Max. Negotiated Rate |
$8,211.75 |
| Rate for Payer: Adventist Health Commercial |
$2,189.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,521.96
|
| Rate for Payer: Cash Price |
$4,927.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,412.47
|
| Rate for Payer: Heritage Provider Network Senior |
$7,412.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,981.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,737.25
|
| Rate for Payer: Multiplan Commercial |
$8,211.75
|
|
|
HC REVISE REMOVE NEURORECEIVER
|
Facility
OP
|
$10,949.00
|
|
|
Service Code
|
CPT 63688
|
| Hospital Charge Code |
909000688
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.18 |
| Max. Negotiated Rate |
$9,520.00 |
| Rate for Payer: Adventist Health Commercial |
$2,189.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,521.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,376.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,676.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,251.23
|
| 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 |
$4,927.05
|
| Rate for Payer: Cash Price |
$4,927.05
|
| Rate for Payer: Cash Price |
$4,927.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,116.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,376.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,676.35
|
| Rate for Payer: Dignity Health Senior |
$4,251.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,569.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,251.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,777.43
|
| Rate for Payer: Heritage Provider Network Senior |
$5,229.01
|
| Rate for Payer: Humana Medicare |
$4,251.23
|
| Rate for Payer: IEHP Medi-Cal |
$472.18
|
| Rate for Payer: IEHP Medicare Advantage |
$4,251.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,077.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,981.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,016.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,737.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,356.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,356.55
|
| Rate for Payer: Multiplan Commercial |
$8,211.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,676.35
|
| Rate for Payer: TriValley Medical Group Senior |
$4,676.35
|
| 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 |
$6,376.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,676.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,251.23
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
OP
|
$37,916.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$389.78 |
| Max. Negotiated Rate |
$28,437.00 |
| Rate for Payer: Adventist Health Commercial |
$7,583.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,995.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,048.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| 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 |
$17,062.20
|
| Rate for Payer: Cash Price |
$17,062.20
|
| Rate for Payer: Cash Price |
$17,062.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24,645.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,470.00
|
| Rate for Payer: Heritage Provider Network Senior |
$8,783.86
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: IEHP Medi-Cal |
$389.78
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,862.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,479.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$28,437.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,855.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7,855.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
IP
|
$37,916.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,862.80 |
| Max. Negotiated Rate |
$28,437.00 |
| Rate for Payer: Adventist Health Commercial |
$7,583.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,048.29
|
| Rate for Payer: Cash Price |
$17,062.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,669.13
|
| Rate for Payer: Heritage Provider Network Senior |
$25,669.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,862.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,479.00
|
| Rate for Payer: Multiplan Commercial |
$28,437.00
|
|
|
HC REVISION OF EYELID
|
Facility
IP
|
$3,204.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$579.92 |
| Max. Negotiated Rate |
$2,403.00 |
| Rate for Payer: Adventist Health Commercial |
$640.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,201.15
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,169.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,169.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$579.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.00
|
| Rate for Payer: Multiplan Commercial |
$2,403.00
|
|
|
HC REVISION OF EYELID
|
Facility
OP
|
$3,204.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$363.98 |
| Max. Negotiated Rate |
$2,403.00 |
| Rate for Payer: Adventist Health Commercial |
$640.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,712.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,201.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,082.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: Dignity Health Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,082.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$363.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,169.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,169.11
|
| Rate for Payer: Humana Medicare |
$363.98
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$363.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,544.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$579.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$458.61
|
| Rate for Payer: Multiplan Commercial |
$2,403.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,163.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,070.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC RF ABL NRV NRVTG SJ W/IG
|
Facility
OP
|
$4,786.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$712.59 |
| Max. Negotiated Rate |
$7,096.00 |
| Rate for Payer: Adventist Health Commercial |
$957.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,287.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$2,153.70
|
| Rate for Payer: Cash Price |
$2,153.70
|
| Rate for Payer: Cash Price |
$2,153.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,110.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: Dignity Health Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,871.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,412.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,962.53
|
| Rate for Payer: Heritage Provider Network Senior |
$2,967.23
|
| Rate for Payer: Humana Medicare |
$2,412.38
|
| Rate for Payer: IEHP Medi-Cal |
$712.59
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,583.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$866.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,196.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,039.60
|
| Rate for Payer: Multiplan Commercial |
$3,589.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,653.62
|
| Rate for Payer: TriValley Medical Group Senior |
$2,653.62
|
| 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 |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
