|
HC SPLINT SLING ARM SMALL
|
Facility
IP
|
$18.88
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698383
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$3.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.78
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$14.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.31
|
|
|
HC SPLINT SLING ARM SMALL
|
Facility
OP
|
$18.88
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698383
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$3.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11.72
|
| Rate for Payer: Blue Shield of California EPN |
$11.08
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.05
|
| Rate for Payer: Dignity Health Senior |
$16.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.74
|
| Rate for Payer: Heritage Provider Network Senior |
$8.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$14.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Vantage Medical Group Senior |
$16.05
|
|
|
HC SPNL PNCTR LMBR DX W/FLUOR/CT
|
Facility
OP
|
$1,739.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
909002328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$314.76 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$347.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,194.69
|
| 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 |
$782.55
|
| Rate for Payer: Cash Price |
$782.55
|
| Rate for Payer: Cash Price |
$782.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,130.35
|
| 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 |
$1,043.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,076.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1,062.77
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: IEHP Medi-Cal |
$371.48
|
| 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 |
$314.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.75
|
| 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 |
$1,304.25
|
| 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 SPNL PNCTR LMBR DX W/FLUOR/CT
|
Facility
IP
|
$1,739.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
909002328
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$314.76 |
| Max. Negotiated Rate |
$1,304.25 |
| Rate for Payer: Adventist Health Commercial |
$347.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,194.69
|
| Rate for Payer: Cash Price |
$782.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,177.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,177.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.75
|
| Rate for Payer: Multiplan Commercial |
$1,304.25
|
|
|
HC SPUTUM COLLECTION
|
Facility
OP
|
$366.00
|
|
|
Service Code
|
CPT 89220
|
| Hospital Charge Code |
900800385
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$405.48 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$251.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$237.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$226.55
|
| Rate for Payer: Heritage Provider Network Senior |
$226.55
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: IEHP Medi-Cal |
$16.11
|
| Rate for Payer: IEHP Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC SPUTUM COLLECTION
|
Facility
IP
|
$366.00
|
|
|
Service Code
|
CPT 89220
|
| Hospital Charge Code |
900800385
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$66.25 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$251.44
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.78
|
| Rate for Payer: Heritage Provider Network Senior |
$247.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.50
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
|
|
HC SSA AB
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913521
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$140.09 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.47
|
| Rate for Payer: Blue Shield of California Commercial |
$140.09
|
| Rate for Payer: Blue Shield of California EPN |
$109.51
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: IEHP Medi-Cal |
$22.76
|
| Rate for Payer: IEHP Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.59
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SSA AB
|
Facility
IP
|
$162.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913521
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.29
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.67
|
| Rate for Payer: Heritage Provider Network Senior |
$109.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
|
|
HC SSB AB
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913522
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$140.09 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.47
|
| Rate for Payer: Blue Shield of California Commercial |
$140.09
|
| Rate for Payer: Blue Shield of California EPN |
$109.51
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: IEHP Medi-Cal |
$22.76
|
| Rate for Payer: IEHP Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.59
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SSB AB
|
Facility
IP
|
$162.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913522
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.29
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.67
|
| Rate for Payer: Heritage Provider Network Senior |
$109.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
|
|
HC STDZD COG PERF TESTING PER HOUR
|
Facility
OP
|
$262.00
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
905606125
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$47.42 |
| Max. Negotiated Rate |
$448.00 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$215.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$222.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$144.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$196.50
|
| Rate for Payer: Blue Shield of California Commercial |
$162.70
|
| Rate for Payer: Blue Shield of California EPN |
$153.79
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$170.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$222.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$222.70
|
| Rate for Payer: Dignity Health Senior |
$222.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.18
|
| Rate for Payer: Heritage Provider Network Senior |
$162.18
|
| Rate for Payer: IEHP Medi-Cal |
$142.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$126.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.50
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$375.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$222.70
|
| Rate for Payer: Vantage Medical Group Senior |
$222.70
|
|
|
HC STDZD COG PERF TESTING PER HOUR
|
Facility
IP
|
$262.00
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
905606125
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$47.42 |
| Max. Negotiated Rate |
$196.50 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.99
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$177.37
|
| Rate for Payer: Heritage Provider Network Senior |
$177.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.50
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
|
|
HC STEERABLE GW
|
Facility
IP
|
$398.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$298.50 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$273.43
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.45
|
| Rate for Payer: Heritage Provider Network Senior |
$269.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.50
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
|
|
HC STEERABLE GW
|
Facility
OP
|
$398.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$338.30 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$273.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$218.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$298.50
|
| Rate for Payer: Blue Shield of California Commercial |
$247.16
|
| Rate for Payer: Blue Shield of California EPN |
$233.63
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$258.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$338.30
|
| Rate for Payer: Dignity Health Senior |
$338.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$246.36
|
| Rate for Payer: Heritage Provider Network Senior |
$246.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$191.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.50
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$338.30
|
| Rate for Payer: Vantage Medical Group Senior |
$338.30
|
|
|
HC STENT BILIARY SMART CORIDS 2-6
|
Facility
IP
|
$2,880.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$576.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,382.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,978.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,324.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,555.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,949.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,949.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,440.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,440.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,440.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.00
|
| Rate for Payer: Multiplan Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,050.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$962.21
|
|
|
HC STENT BILIARY SMART CORIDS 2-6
|
Facility
OP
|
$2,880.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$576.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,382.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,978.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,448.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,584.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,160.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,788.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,690.56
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,324.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,448.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,448.00
|
| Rate for Payer: Dignity Health Senior |
$2,448.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,843.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,333.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1,333.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,440.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,440.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,440.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.00
|
| Rate for Payer: Multiplan Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,050.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$962.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,448.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,448.00
|
|
|
HC STENT CAROTID UNCVRD
|
Facility
OP
|
$6,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$1,365.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,688.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,801.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,753.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,118.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,238.32
|
| Rate for Payer: Blue Shield of California EPN |
$4,006.28
|
| Rate for Payer: Cash Price |
$3,071.25
|
| Rate for Payer: Cash Price |
$3,071.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,139.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,801.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,801.25
|
| Rate for Payer: Dignity Health Senior |
$5,801.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,368.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,159.98
|
| Rate for Payer: Heritage Provider Network Senior |
$3,159.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,412.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,412.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,412.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,706.25
|
| Rate for Payer: Multiplan Commercial |
$5,118.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,488.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,280.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,801.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,801.25
|
|
|
HC STENT CAROTID UNCVRD
|
Facility
IP
|
$6,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,365.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,688.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$3,071.25
|
| Rate for Payer: Cash Price |
$3,071.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,139.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,685.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,620.52
|
| Rate for Payer: Heritage Provider Network Senior |
$4,620.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,412.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,412.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,412.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,706.25
|
| Rate for Payer: Multiplan Commercial |
$5,118.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,488.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,280.23
|
|
|
HC STENT, CCA W EPD
|
Facility
IP
|
$27,193.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
909080026
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,921.93 |
| Max. Negotiated Rate |
$20,394.75 |
| Rate for Payer: Adventist Health Commercial |
$5,438.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,681.59
|
| Rate for Payer: Cash Price |
$12,236.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,409.66
|
| Rate for Payer: Heritage Provider Network Senior |
$18,409.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,921.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,798.25
|
| Rate for Payer: Multiplan Commercial |
$20,394.75
|
|
|
HC STENT, CCA W EPD
|
Facility
OP
|
$17,826.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
906820166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$955.39 |
| Max. Negotiated Rate |
$15,152.10 |
| Rate for Payer: Adventist Health Commercial |
$3,565.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,246.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15,152.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,804.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,369.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$8,021.70
|
| Rate for Payer: Cash Price |
$8,021.70
|
| Rate for Payer: Cash Price |
$8,021.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,586.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,152.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,152.10
|
| Rate for Payer: Dignity Health Senior |
$15,152.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,034.29
|
| Rate for Payer: Heritage Provider Network Senior |
$11,034.29
|
| Rate for Payer: IEHP Medi-Cal |
$955.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,592.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,226.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,456.50
|
| Rate for Payer: Multiplan Commercial |
$13,369.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,152.10
|
| Rate for Payer: Vantage Medical Group Senior |
$15,152.10
|
|
|
HC STENT, CCA W EPD
|
Facility
IP
|
$17,826.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
906820166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,226.51 |
| Max. Negotiated Rate |
$13,369.50 |
| Rate for Payer: Adventist Health Commercial |
$3,565.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,246.46
|
| Rate for Payer: Cash Price |
$8,021.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,068.20
|
| Rate for Payer: Heritage Provider Network Senior |
$12,068.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,226.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,456.50
|
| Rate for Payer: Multiplan Commercial |
$13,369.50
|
|
|
HC STENT, CCA W EPD
|
Facility
OP
|
$27,193.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
909080026
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$955.39 |
| Max. Negotiated Rate |
$23,114.05 |
| Rate for Payer: Adventist Health Commercial |
$5,438.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,681.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23,114.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14,956.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20,394.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$12,236.85
|
| Rate for Payer: Cash Price |
$12,236.85
|
| Rate for Payer: Cash Price |
$12,236.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,675.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,114.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,114.05
|
| Rate for Payer: Dignity Health Senior |
$23,114.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,832.47
|
| Rate for Payer: Heritage Provider Network Senior |
$16,832.47
|
| Rate for Payer: IEHP Medi-Cal |
$955.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,107.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,921.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,798.25
|
| Rate for Payer: Multiplan Commercial |
$20,394.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,114.05
|
| Rate for Payer: Vantage Medical Group Senior |
$23,114.05
|
|
|
HC STENT CCA W/O EPD
|
Facility
IP
|
$31,781.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
909080027
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,752.36 |
| Max. Negotiated Rate |
$23,835.75 |
| Rate for Payer: Adventist Health Commercial |
$6,356.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,833.55
|
| Rate for Payer: Cash Price |
$14,301.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,515.74
|
| Rate for Payer: Heritage Provider Network Senior |
$21,515.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,752.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,945.25
|
| Rate for Payer: Multiplan Commercial |
$23,835.75
|
|
|
HC STENT CCA W/O EPD
|
Facility
OP
|
$31,781.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
909080027
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$183.53 |
| Max. Negotiated Rate |
$27,013.85 |
| Rate for Payer: Adventist Health Commercial |
$6,356.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,833.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27,013.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17,479.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23,835.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$14,301.45
|
| Rate for Payer: Cash Price |
$14,301.45
|
| Rate for Payer: Cash Price |
$14,301.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20,657.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27,013.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,013.85
|
| Rate for Payer: Dignity Health Senior |
$27,013.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,672.44
|
| Rate for Payer: Heritage Provider Network Senior |
$19,672.44
|
| Rate for Payer: IEHP Medi-Cal |
$183.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,318.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,752.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,945.25
|
| Rate for Payer: Multiplan Commercial |
$23,835.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,013.85
|
| Rate for Payer: Vantage Medical Group Senior |
$27,013.85
|
|
|
HC STENT CCA W/O EPD
|
Facility
IP
|
$20,831.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
906820167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,770.41 |
| Max. Negotiated Rate |
$15,623.25 |
| Rate for Payer: Adventist Health Commercial |
$4,166.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,310.90
|
| Rate for Payer: Cash Price |
$9,373.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,102.59
|
| Rate for Payer: Heritage Provider Network Senior |
$14,102.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,770.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,207.75
|
| Rate for Payer: Multiplan Commercial |
$15,623.25
|
|
