|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
IP
|
$1,211.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.19 |
| Max. Negotiated Rate |
$908.25 |
| Rate for Payer: Adventist Health Commercial |
$242.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$831.96
|
| Rate for Payer: Cash Price |
$544.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$819.85
|
| Rate for Payer: Heritage Provider Network Senior |
$819.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.75
|
| Rate for Payer: Multiplan Commercial |
$908.25
|
|
|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
OP
|
$1,211.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$128.36 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$242.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$831.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$752.03
|
| Rate for Payer: Blue Shield of California EPN |
$710.86
|
| Rate for Payer: Cash Price |
$544.95
|
| Rate for Payer: Cash Price |
$544.95
|
| Rate for Payer: Cash Price |
$544.95
|
| Rate for Payer: Cash Price |
$544.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$787.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.61
|
| Rate for Payer: Heritage Provider Network Senior |
$749.61
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: IEHP Medi-Cal |
$128.36
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,641.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$908.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$950.44
|
| Rate for Payer: TriValley Medical Group Senior |
$864.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
IP
|
$1,211.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$219.19 |
| Max. Negotiated Rate |
$908.25 |
| Rate for Payer: Adventist Health Commercial |
$242.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$831.96
|
| Rate for Payer: Cash Price |
$544.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$819.85
|
| Rate for Payer: Heritage Provider Network Senior |
$819.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.75
|
| Rate for Payer: Multiplan Commercial |
$908.25
|
|
|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
OP
|
$1,211.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.36 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$242.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$831.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| 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 |
$544.95
|
| Rate for Payer: Cash Price |
$544.95
|
| Rate for Payer: Cash Price |
$544.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$787.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$726.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.61
|
| Rate for Payer: Heritage Provider Network Senior |
$1,062.77
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: IEHP Medi-Cal |
$128.36
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,641.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$908.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$950.44
|
| Rate for Payer: TriValley Medical Group Senior |
$950.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC SPINAL PUNCTURE DRAIN FLUID
|
Facility
IP
|
$1,211.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
900501458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$219.19 |
| Max. Negotiated Rate |
$908.25 |
| Rate for Payer: Adventist Health Commercial |
$242.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$831.96
|
| Rate for Payer: Cash Price |
$544.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$819.85
|
| Rate for Payer: Heritage Provider Network Senior |
$819.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.75
|
| Rate for Payer: Multiplan Commercial |
$908.25
|
|
|
HC SPINE 2-3 VIEWS
|
Facility
IP
|
$699.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
909001302
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.52 |
| Max. Negotiated Rate |
$524.25 |
| Rate for Payer: Adventist Health Commercial |
$139.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$480.21
|
| Rate for Payer: Cash Price |
$314.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$473.22
|
| Rate for Payer: Heritage Provider Network Senior |
$473.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.75
|
| Rate for Payer: Multiplan Commercial |
$524.25
|
|
|
HC SPINE 2-3 VIEWS
|
Facility
OP
|
$699.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
909001302
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.53 |
| Max. Negotiated Rate |
$524.25 |
| Rate for Payer: Adventist Health Commercial |
$139.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$480.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.15
|
| Rate for Payer: Blue Shield of California Commercial |
$123.26
|
| Rate for Payer: Blue Shield of California EPN |
$70.09
|
| Rate for Payer: Cash Price |
$314.55
|
| Rate for Payer: Cash Price |
$314.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$454.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$432.68
|
| Rate for Payer: Heritage Provider Network Senior |
$432.68
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$40.53
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$524.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| 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 |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC SPINE MINIMUM 4 VIEWS
|
Facility
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
909001301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$852.75 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$82.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$781.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.09
|
| Rate for Payer: Blue Shield of California Commercial |
$182.95
|
| Rate for Payer: Blue Shield of California EPN |
$104.04
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$739.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$739.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$703.80
|
| Rate for Payer: Heritage Provider Network Senior |
$703.80
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$62.40
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$852.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| 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 |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC SPINE MINIMUM 4 VIEWS
|
Facility
IP
|
$1,137.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
909001301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$852.75 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$781.12
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$769.75
|
| Rate for Payer: Heritage Provider Network Senior |
$769.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.25
|
| Rate for Payer: Multiplan Commercial |
$852.75
|
|
|
HC SPINE SCAN
|
Facility
IP
|
$958.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
906601401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$718.50 |
| Rate for Payer: Adventist Health Commercial |
$191.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$658.15
|
| Rate for Payer: Cash Price |
$431.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.57
|
| Rate for Payer: Heritage Provider Network Senior |
$648.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.50
|
| Rate for Payer: Multiplan Commercial |
$718.50
|
|
|
HC SPINE SCAN
|
Facility
OP
|
$958.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
906601401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.33 |
| Max. Negotiated Rate |
$718.50 |
| Rate for Payer: Adventist Health Commercial |
$191.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$175.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$658.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$291.67
|
| Rate for Payer: Blue Shield of California EPN |
$165.86
|
| Rate for Payer: Cash Price |
$431.10
|
| Rate for Payer: Cash Price |
$431.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$622.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$593.00
|
| Rate for Payer: Heritage Provider Network Senior |
$593.00
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$126.33
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$718.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC SPINE SINGLE VIEW
|
Facility
IP
|
$494.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
909001325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.41 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Adventist Health Commercial |
$98.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$339.38
|
| Rate for Payer: Cash Price |
$222.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.44
|
| Rate for Payer: Heritage Provider Network Senior |
$334.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.50
|
| Rate for Payer: Multiplan Commercial |
$370.50
|
|
|
HC SPINE SINGLE VIEW
|
Facility
OP
|
$494.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
909001325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Adventist Health Commercial |
$98.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$339.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.77
|
| Rate for Payer: Blue Shield of California Commercial |
$83.23
|
| Rate for Payer: Blue Shield of California EPN |
$47.33
|
| Rate for Payer: Cash Price |
$222.30
|
| Rate for Payer: Cash Price |
$222.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$321.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$321.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.79
|
| Rate for Payer: Heritage Provider Network Senior |
$305.79
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$26.99
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$370.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| 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 |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC SPIROMETRY STUDIES
|
Facility
OP
|
$520.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
900801001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$38.38 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$357.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Blue Shield of California Commercial |
$124.38
|
| Rate for Payer: Blue Shield of California EPN |
$70.73
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$338.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$321.88
|
| Rate for Payer: Heritage Provider Network Senior |
$321.88
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: IEHP Medi-Cal |
$38.38
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC SPIROMETRY STUDIES
|
Facility
IP
|
$520.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
900801001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$94.12 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$357.24
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$352.04
|
| Rate for Payer: Heritage Provider Network Senior |
$352.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
|
|
HC SPLINT FINGER BASEBALL 4.25 MD
|
Facility
IP
|
$8.19
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698379
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.14 |
| Rate for Payer: Adventist Health Commercial |
$1.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.63
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.54
|
| Rate for Payer: Heritage Provider Network Senior |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$6.14
|
|
|
HC SPLINT FINGER BASEBALL 4.25 MD
|
Facility
OP
|
$8.19
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698379
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$13.04 |
| Rate for Payer: Adventist Health Commercial |
$1.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.14
|
| Rate for Payer: Blue Shield of California Commercial |
$5.09
|
| Rate for Payer: Blue Shield of California EPN |
$4.81
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.96
|
| Rate for Payer: Dignity Health Senior |
$6.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.07
|
| Rate for Payer: Heritage Provider Network Senior |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$6.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Vantage Medical Group Senior |
$6.96
|
|
|
HC SPLINT FINGER BASEBALL 5 LG
|
Facility
IP
|
$8.19
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698380
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.14 |
| Rate for Payer: Adventist Health Commercial |
$1.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.63
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.54
|
| Rate for Payer: Heritage Provider Network Senior |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$6.14
|
|
|
HC SPLINT FINGER BASEBALL 5 LG
|
Facility
OP
|
$8.19
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698380
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$13.04 |
| Rate for Payer: Adventist Health Commercial |
$1.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.14
|
| Rate for Payer: Blue Shield of California Commercial |
$5.09
|
| Rate for Payer: Blue Shield of California EPN |
$4.81
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.96
|
| Rate for Payer: Dignity Health Senior |
$6.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.07
|
| Rate for Payer: Heritage Provider Network Senior |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$6.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Vantage Medical Group Senior |
$6.96
|
|
|
HC SPLINT FINGER BASEBALL SM
|
Facility
IP
|
$8.19
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698378
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.14 |
| Rate for Payer: Adventist Health Commercial |
$1.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.63
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.54
|
| Rate for Payer: Heritage Provider Network Senior |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$6.14
|
|
|
HC SPLINT FINGER BASEBALL SM
|
Facility
OP
|
$8.19
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698378
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$13.04 |
| Rate for Payer: Adventist Health Commercial |
$1.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.14
|
| Rate for Payer: Blue Shield of California Commercial |
$5.09
|
| Rate for Payer: Blue Shield of California EPN |
$4.81
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.96
|
| Rate for Payer: Dignity Health Senior |
$6.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.07
|
| Rate for Payer: Heritage Provider Network Senior |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$6.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.96
|
| Rate for Payer: Vantage Medical Group Senior |
$6.96
|
|
|
HC SPLINT FINGER FROG 2.25X2.75"
|
Facility
IP
|
$8.58
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698377
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.89
|
| Rate for Payer: Cash Price |
$3.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.81
|
| Rate for Payer: Heritage Provider Network Senior |
$5.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.14
|
| Rate for Payer: Multiplan Commercial |
$6.44
|
|
|
HC SPLINT FINGER FROG 2.25X2.75"
|
Facility
OP
|
$8.58
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
901698377
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$13.04 |
| Rate for Payer: Adventist Health Commercial |
$1.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.44
|
| Rate for Payer: Blue Shield of California Commercial |
$5.33
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Cash Price |
$3.86
|
| Rate for Payer: Cash Price |
$3.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.29
|
| Rate for Payer: Dignity Health Senior |
$7.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.31
|
| Rate for Payer: Heritage Provider Network Senior |
$5.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.14
|
| Rate for Payer: Multiplan Commercial |
$6.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.29
|
| Rate for Payer: Vantage Medical Group Senior |
$7.29
|
|
|
HC SPLINT SLING ARM MED
|
Facility
IP
|
$21.06
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698389
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$4.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$9.48
|
| Rate for Payer: Cash Price |
$9.48
|
| Rate for Payer: Cash Price |
$9.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.26
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.26
|
| Rate for Payer: Multiplan Commercial |
$15.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.04
|
|
|
HC SPLINT SLING ARM MED
|
Facility
OP
|
$21.06
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698389
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$4.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13.08
|
| Rate for Payer: Blue Shield of California EPN |
$12.36
|
| Rate for Payer: Cash Price |
$9.48
|
| Rate for Payer: Cash Price |
$9.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.90
|
| Rate for Payer: Dignity Health Senior |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.75
|
| Rate for Payer: Heritage Provider Network Senior |
$9.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.26
|
| Rate for Payer: Multiplan Commercial |
$15.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.90
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
