|
HC ROOM TRAUMA ICU ISOLATION 1:1
|
Facility
IP
|
$25,608.00
|
|
| Hospital Charge Code |
992314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$19,206.00 |
| Rate for Payer: Adventist Health Commercial |
$5,121.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,592.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,487.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,570.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,629.00
|
| Rate for Payer: Cash Price |
$11,523.60
|
| Rate for Payer: Cash Price |
$11,523.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,635.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,402.00
|
| Rate for Payer: Multiplan Commercial |
$19,206.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
IP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,056.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,512.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,012.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,188.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,490.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,490.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,100.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,100.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,100.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.25
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$802.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$735.35
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
OP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,056.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,512.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,210.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,650.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,366.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,291.99
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,012.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.85
|
| Rate for Payer: Dignity Health Senior |
$1,870.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,408.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,019.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,019.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,100.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,100.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,100.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.25
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$802.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$735.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.85
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
IP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$401.25 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$367.54
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$362.20
|
| Rate for Payer: Heritage Provider Network Senior |
$362.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.75
|
| Rate for Payer: Multiplan Commercial |
$401.25
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
OP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$454.75 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$367.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$294.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$401.25
|
| Rate for Payer: Blue Shield of California Commercial |
$332.24
|
| Rate for Payer: Blue Shield of California EPN |
$314.04
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$347.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$454.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$454.75
|
| Rate for Payer: Dignity Health Senior |
$454.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$331.16
|
| Rate for Payer: Heritage Provider Network Senior |
$331.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$257.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.75
|
| Rate for Payer: Multiplan Commercial |
$401.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$454.75
|
| Rate for Payer: Vantage Medical Group Senior |
$454.75
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
OP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.12 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$999.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$964.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,193.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$772.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,053.00
|
| Rate for Payer: Blue Shield of California Commercial |
$871.88
|
| Rate for Payer: Blue Shield of California EPN |
$824.15
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$912.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,193.40
|
| Rate for Payer: Dignity Health Senior |
$1,193.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$912.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$869.08
|
| Rate for Payer: Heritage Provider Network Senior |
$869.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$676.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,193.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,193.40
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
IP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.12 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$964.55
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$950.51
|
| Rate for Payer: Heritage Provider Network Senior |
$950.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
|
|
HC ROTOVIRUS AG
|
Facility
IP
|
$176.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.91
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.15
|
| Rate for Payer: Heritage Provider Network Senior |
$119.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
|
|
HC ROTOVIRUS AG
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$75.23 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.23
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Humana Medicare |
$11.98
|
| Rate for Payer: IEHP Medi-Cal |
$13.82
|
| Rate for Payer: IEHP Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC ROUTINE URINALYSIS
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
900910167
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$25.58 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.58
|
| Rate for Payer: Blue Shield of California Commercial |
$24.76
|
| Rate for Payer: Blue Shield of California EPN |
$19.36
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.49
|
| Rate for Payer: Dignity Health Senior |
$3.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Humana Medicare |
$3.17
|
| Rate for Payer: IEHP Medi-Cal |
$4.32
|
| Rate for Payer: IEHP Medicare Advantage |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.99
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.17
|
| Rate for Payer: TriValley Medical Group Senior |
$3.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
HC ROUTINE URINALYSIS
|
Facility
IP
|
$138.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
900910167
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.81
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
IP
|
$997.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$180.46 |
| Max. Negotiated Rate |
$747.75 |
| Rate for Payer: Adventist Health Commercial |
$199.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$684.94
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$674.97
|
| Rate for Payer: Heritage Provider Network Senior |
$674.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.25
|
| Rate for Payer: Multiplan Commercial |
$747.75
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
OP
|
$997.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$180.46 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$199.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$684.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$648.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: Dignity Health Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$674.97
|
| Rate for Payer: Heritage Provider Network Senior |
$674.97
|
| Rate for Payer: Humana Medicare |
$308.79
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$480.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$364.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.08
|
| Rate for Payer: Multiplan Commercial |
$747.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$362.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$333.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
IP
|
$997.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$180.46 |
| Max. Negotiated Rate |
$747.75 |
| Rate for Payer: Adventist Health Commercial |
$199.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$684.94
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$674.97
|
| Rate for Payer: Heritage Provider Network Senior |
$674.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.25
|
| Rate for Payer: Multiplan Commercial |
$747.75
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
OP
|
$997.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$180.46 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$199.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$684.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.79
|
| 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 |
$448.65
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$648.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: Dignity Health Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$617.14
|
| Rate for Payer: Heritage Provider Network Senior |
$379.81
|
| Rate for Payer: Humana Medicare |
$308.79
|
| Rate for Payer: IEHP Medi-Cal |
$320.02
|
| Rate for Payer: IEHP Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$586.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$364.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.08
|
| Rate for Payer: Multiplan Commercial |
$747.75
|
| 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 |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC RPL GTUBE REQ REV GSTRST TRC
|
Facility
OP
|
$607.00
|
|
|
Service Code
|
CPT 43763
|
| Hospital Charge Code |
906043763
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$94.08 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$121.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$417.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.79
|
| 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 |
$273.15
|
| Rate for Payer: Cash Price |
$273.15
|
| Rate for Payer: Cash Price |
$273.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$394.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: Dignity Health Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.73
|
| Rate for Payer: Heritage Provider Network Senior |
$379.81
|
| Rate for Payer: Humana Medicare |
$308.79
|
| Rate for Payer: IEHP Medi-Cal |
$94.08
|
| Rate for Payer: IEHP Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$586.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$364.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.08
|
| Rate for Payer: Multiplan Commercial |
$455.25
|
| 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 |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC RPL GTUBE REQ REV GSTRST TRC
|
Facility
IP
|
$607.00
|
|
|
Service Code
|
CPT 43763
|
| Hospital Charge Code |
906043763
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$109.87 |
| Max. Negotiated Rate |
$455.25 |
| Rate for Payer: Adventist Health Commercial |
$121.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$417.01
|
| Rate for Payer: Cash Price |
$273.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.94
|
| Rate for Payer: Heritage Provider Network Senior |
$410.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.75
|
| Rate for Payer: Multiplan Commercial |
$455.25
|
|
|
HC RPR
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913675
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.27
|
| Rate for Payer: Heritage Provider Network Senior |
$39.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
|
|
HC RPR
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913675
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$108.36 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.36
|
| Rate for Payer: Blue Shield of California Commercial |
$101.12
|
| Rate for Payer: Blue Shield of California EPN |
$79.05
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$17.27
|
| Rate for Payer: IEHP Medi-Cal |
$15.97
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.76
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC RPR DETACHED RETINA
|
Facility
OP
|
$5,699.00
|
|
|
Service Code
|
CPT 67101
|
| Hospital Charge Code |
900501630
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$7,436.00 |
| Rate for Payer: Adventist Health Commercial |
$1,139.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,915.21
|
| 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 |
$7,436.00
|
| Rate for Payer: Cash Price |
$2,564.55
|
| Rate for Payer: Cash Price |
$2,564.55
|
| Rate for Payer: Cash Price |
$2,564.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,704.35
|
| 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 |
$3,704.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,858.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,858.22
|
| 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 |
$2,746.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,031.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,424.75
|
| 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 |
$4,274.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,069.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,904.04
|
| 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 RPR DETACHED RETINA
|
Facility
IP
|
$5,699.00
|
|
|
Service Code
|
CPT 67101
|
| Hospital Charge Code |
900501630
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,031.52 |
| Max. Negotiated Rate |
$4,274.25 |
| Rate for Payer: Adventist Health Commercial |
$1,139.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,915.21
|
| Rate for Payer: Cash Price |
$2,564.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,858.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,858.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,031.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,424.75
|
| Rate for Payer: Multiplan Commercial |
$4,274.25
|
|
|
HC RPR INIT INGN HRNA 5YR GT RDCBL
|
Facility
IP
|
$8,474.00
|
|
|
Service Code
|
CPT 49505
|
| Hospital Charge Code |
900501800
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,533.79 |
| Max. Negotiated Rate |
$6,355.50 |
| Rate for Payer: Adventist Health Commercial |
$1,694.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,821.64
|
| Rate for Payer: Cash Price |
$3,813.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,736.90
|
| Rate for Payer: Heritage Provider Network Senior |
$5,736.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,533.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.50
|
| Rate for Payer: Multiplan Commercial |
$6,355.50
|
|
|
HC RPR INIT INGN HRNA 5YR GT RDCBL
|
Facility
OP
|
$8,474.00
|
|
|
Service Code
|
CPT 49505
|
| Hospital Charge Code |
900501800
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,694.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,821.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$3,813.30
|
| Rate for Payer: Cash Price |
$3,813.30
|
| Rate for Payer: Cash Price |
$3,813.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,508.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: Dignity Health Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,322.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,736.90
|
| Rate for Payer: Heritage Provider Network Senior |
$5,736.90
|
| Rate for Payer: Humana Medicare |
$4,322.62
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,084.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,533.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,100.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,446.50
|
| Rate for Payer: Multiplan Commercial |
$6,355.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,076.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,831.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC RPR LIP FLL THCK UP TO HLF VER
|
Facility
IP
|
$1,662.00
|
|
|
Service Code
|
CPT 40652
|
| Hospital Charge Code |
900540652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.82 |
| Max. Negotiated Rate |
$1,246.50 |
| Rate for Payer: Adventist Health Commercial |
$332.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,141.79
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,125.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,125.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.50
|
| Rate for Payer: Multiplan Commercial |
$1,246.50
|
|
|
HC RPR LIP FLL THCK UP TO HLF VER
|
Facility
OP
|
$1,662.00
|
|
|
Service Code
|
CPT 40652
|
| Hospital Charge Code |
900540652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.82 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$332.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,141.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,080.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: Dignity Health Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,125.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,125.17
|
| Rate for Payer: Humana Medicare |
$687.44
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$801.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$811.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$866.17
|
| Rate for Payer: Multiplan Commercial |
$1,246.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$603.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$555.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
