|
HC SHILEY TRACHEO SOFT XLT PROXIMAL CUFFLESS 5.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$283.19 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.62
|
| Rate for Payer: Heritage Provider Network Senior |
$255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
|
|
HC SHILEY TRACHEO SOFT XLT PROXIMAL CUFFLESS 6.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.19
|
| Rate for Payer: Blue Shield of California Commercial |
$230.32
|
| Rate for Payer: Blue Shield of California EPN |
$184.26
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$245.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Senior |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.72
|
| Rate for Payer: Heritage Provider Network Senior |
$233.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$180.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT PROXIMAL CUFFLESS 6.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$283.19 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.62
|
| Rate for Payer: Heritage Provider Network Senior |
$255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
|
|
HC SHILEY TRACHEO SOFT XLT PROXIMAL CUFFLESS 7.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$283.19 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.62
|
| Rate for Payer: Heritage Provider Network Senior |
$255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
|
|
HC SHILEY TRACHEO SOFT XLT PROXIMAL CUFFLESS 7.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.19
|
| Rate for Payer: Blue Shield of California Commercial |
$230.32
|
| Rate for Payer: Blue Shield of California EPN |
$184.26
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$245.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Senior |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.72
|
| Rate for Payer: Heritage Provider Network Senior |
$233.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$180.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT PROXIMAL CUFFLESS 8.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.19
|
| Rate for Payer: Blue Shield of California Commercial |
$230.32
|
| Rate for Payer: Blue Shield of California EPN |
$184.26
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$245.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Senior |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.72
|
| Rate for Payer: Heritage Provider Network Senior |
$233.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$180.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT PROXIMAL CUFFLESS 8.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$283.19 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.62
|
| Rate for Payer: Heritage Provider Network Senior |
$255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
|
|
HC SHILEY TRACH TUBE
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
900800703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC SHILEY TRACH TUBE
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
900800703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Blue Shield of California Commercial |
$164.70
|
| Rate for Payer: Blue Shield of California EPN |
$131.76
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Senior |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$135.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC SHOULDER ARTHROGRAPHY INJ
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
909000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$107.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$368.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$455.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$402.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$294.80
|
| Rate for Payer: Cash Price |
$294.80
|
| Rate for Payer: Cash Price |
$294.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$348.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$455.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$455.60
|
| Rate for Payer: Dignity Health Senior |
$455.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$331.78
|
| Rate for Payer: Heritage Provider Network Senior |
$331.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$279.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$255.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$375.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$375.20
|
| Rate for Payer: Multiplan Commercial |
$402.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$455.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$455.60
|
| Rate for Payer: Vantage Medical Group Senior |
$455.60
|
|
|
HC SHOULDER ARTHROGRAPHY INJ
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
909000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.02 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Adventist Health Commercial |
$107.20
|
| Rate for Payer: Cash Price |
$294.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$362.87
|
| Rate for Payer: Heritage Provider Network Senior |
$362.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.00
|
| Rate for Payer: Multiplan Commercial |
$402.00
|
|
|
HC SHOULDER COMPLETE UNILAT
|
Facility
|
IP
|
$1,153.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
909001504
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.69 |
| Max. Negotiated Rate |
$864.75 |
| Rate for Payer: Adventist Health Commercial |
$230.60
|
| Rate for Payer: Cash Price |
$634.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$780.58
|
| Rate for Payer: Heritage Provider Network Senior |
$780.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.25
|
| Rate for Payer: Multiplan Commercial |
$864.75
|
|
|
HC SHOULDER COMPLETE UNILAT
|
Facility
|
OP
|
$1,153.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
909001504
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.89 |
| Max. Negotiated Rate |
$864.75 |
| Rate for Payer: Adventist Health Commercial |
$230.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$616.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$792.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.99
|
| Rate for Payer: Blue Shield of California Commercial |
$120.91
|
| Rate for Payer: Blue Shield of California EPN |
$97.23
|
| Rate for Payer: Cash Price |
$634.15
|
| Rate for Payer: Cash Price |
$634.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$749.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$713.71
|
| Rate for Payer: Heritage Provider Network Senior |
$713.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$549.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$864.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC SHOULDER LIMITED
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
909001505
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$431.25 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$307.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$395.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.66
|
| Rate for Payer: Blue Shield of California Commercial |
$97.82
|
| Rate for Payer: Blue Shield of California EPN |
$78.67
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$373.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$373.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$355.93
|
| Rate for Payer: Heritage Provider Network Senior |
$355.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$274.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC SHOULDER LIMITED
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
909001505
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.08 |
| Max. Negotiated Rate |
$431.25 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$389.27
|
| Rate for Payer: Heritage Provider Network Senior |
$389.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.75
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
|
|
HC SHUNT EVALUATION
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
909301415
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$241.96 |
| Max. Negotiated Rate |
$1,183.50 |
| Rate for Payer: Adventist Health Commercial |
$315.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$843.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,084.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Blue Shield of California Commercial |
$720.86
|
| Rate for Payer: Blue Shield of California EPN |
$579.69
|
| Rate for Payer: Cash Price |
$867.90
|
| Rate for Payer: Cash Price |
$867.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,025.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Senior |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,025.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$683.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$976.78
|
| Rate for Payer: Heritage Provider Network Senior |
$976.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$752.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$786.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$861.75
|
| Rate for Payer: Multiplan Commercial |
$1,183.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$752.32
|
| Rate for Payer: TriValley Medical Group Senior |
$683.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$789.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$789.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC SHUNT EVALUATION
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
909301415
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$285.62 |
| Max. Negotiated Rate |
$1,183.50 |
| Rate for Payer: Adventist Health Commercial |
$315.60
|
| Rate for Payer: Cash Price |
$867.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,068.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,068.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.50
|
| Rate for Payer: Multiplan Commercial |
$1,183.50
|
|
|
HC SHUNTOGRAM
|
Facility
|
IP
|
$2,038.00
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
909001355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$368.88 |
| Max. Negotiated Rate |
$1,528.50 |
| Rate for Payer: Adventist Health Commercial |
$407.60
|
| Rate for Payer: Cash Price |
$1,120.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,379.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,379.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.50
|
| Rate for Payer: Multiplan Commercial |
$1,528.50
|
|
|
HC SHUNTOGRAM
|
Facility
|
OP
|
$2,038.00
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
909001355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.22 |
| Max. Negotiated Rate |
$1,528.50 |
| Rate for Payer: Adventist Health Commercial |
$407.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,089.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,400.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.10
|
| Rate for Payer: Blue Shield of California Commercial |
$166.80
|
| Rate for Payer: Blue Shield of California EPN |
$134.13
|
| Rate for Payer: Cash Price |
$1,120.90
|
| Rate for Payer: Cash Price |
$1,120.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,324.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,324.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,261.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,261.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$972.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,528.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SIALOGRAM
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
909001167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.95 |
| Max. Negotiated Rate |
$622.50 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$443.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$570.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$464.23
|
| Rate for Payer: Blue Shield of California Commercial |
$377.47
|
| Rate for Payer: Blue Shield of California EPN |
$303.55
|
| Rate for Payer: Cash Price |
$456.50
|
| Rate for Payer: Cash Price |
$456.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$539.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$539.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$513.77
|
| Rate for Payer: Heritage Provider Network Senior |
$513.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$66.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$395.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$307.13
|
| Rate for Payer: TriValley Medical Group Senior |
$307.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC SIALOGRAM
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
909001167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.23 |
| Max. Negotiated Rate |
$622.50 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Cash Price |
$456.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$561.91
|
| Rate for Payer: Heritage Provider Network Senior |
$561.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.50
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
|
|
HC SIALOGRAPHY DUCT DILATION
|
Facility
|
IP
|
$4,009.00
|
|
|
Service Code
|
CPT 42660
|
| Hospital Charge Code |
909000133
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$725.63 |
| Max. Negotiated Rate |
$3,006.75 |
| Rate for Payer: Adventist Health Commercial |
$801.80
|
| Rate for Payer: Cash Price |
$2,204.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,714.09
|
| Rate for Payer: Heritage Provider Network Senior |
$2,714.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$725.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.25
|
| Rate for Payer: Multiplan Commercial |
$3,006.75
|
|
|
HC SIALOGRAPHY DUCT DILATION
|
Facility
|
OP
|
$4,009.00
|
|
|
Service Code
|
CPT 42660
|
| Hospital Charge Code |
909000133
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$801.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,754.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,204.95
|
| Rate for Payer: Cash Price |
$2,204.95
|
| Rate for Payer: Cash Price |
$2,204.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,605.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Senior |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$647.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,481.57
|
| Rate for Payer: Heritage Provider Network Senior |
$795.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,229.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$725.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$744.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,002.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$815.28
|
| Rate for Payer: Multiplan Commercial |
$3,006.75
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$711.75
|
| Rate for Payer: TriValley Medical Group Senior |
$711.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC SIALOGRAPHY INJECTION
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
909000132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$69.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$239.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$296.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$261.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$191.95
|
| Rate for Payer: Cash Price |
$191.95
|
| Rate for Payer: Cash Price |
$191.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$226.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$296.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$296.65
|
| Rate for Payer: Dignity Health Senior |
$296.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.03
|
| Rate for Payer: Heritage Provider Network Senior |
$216.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$166.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$244.30
|
| Rate for Payer: Multiplan Commercial |
$261.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$296.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$296.65
|
| Rate for Payer: Vantage Medical Group Senior |
$296.65
|
|
|
HC SIALOGRAPHY INJECTION
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
909000132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$261.75 |
| Rate for Payer: Adventist Health Commercial |
$69.80
|
| Rate for Payer: Cash Price |
$191.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.27
|
| Rate for Payer: Heritage Provider Network Senior |
$236.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.25
|
| Rate for Payer: Multiplan Commercial |
$261.75
|
|
