|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
IP
|
$2,522.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$456.48 |
| Max. Negotiated Rate |
$1,891.50 |
| Rate for Payer: Adventist Health Commercial |
$504.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,732.61
|
| Rate for Payer: Cash Price |
$1,134.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,707.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,707.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.50
|
| Rate for Payer: Multiplan Commercial |
$1,891.50
|
|
|
HC TRACHEOSTOMY, EMERG
|
Facility
IP
|
$6,527.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
900501122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,181.39 |
| Max. Negotiated Rate |
$4,895.25 |
| Rate for Payer: Adventist Health Commercial |
$1,305.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,484.05
|
| Rate for Payer: Cash Price |
$2,937.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,418.78
|
| Rate for Payer: Heritage Provider Network Senior |
$4,418.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,181.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,631.75
|
| Rate for Payer: Multiplan Commercial |
$4,895.25
|
|
|
HC TRACHEOSTOMY, EMERG
|
Facility
OP
|
$6,527.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
900501122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,305.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,484.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$2,937.15
|
| Rate for Payer: Cash Price |
$2,937.15
|
| Rate for Payer: Cash Price |
$2,937.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,242.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: Dignity Health Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,418.78
|
| Rate for Payer: Heritage Provider Network Senior |
$4,418.78
|
| Rate for Payer: Humana Medicare |
$1,905.44
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,146.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,181.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,631.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,400.85
|
| Rate for Payer: Multiplan Commercial |
$4,895.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,369.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,180.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
IP
|
$6,527.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,181.39 |
| Max. Negotiated Rate |
$4,895.25 |
| Rate for Payer: Adventist Health Commercial |
$1,305.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,484.05
|
| Rate for Payer: Cash Price |
$2,937.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,418.78
|
| Rate for Payer: Heritage Provider Network Senior |
$4,418.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,181.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,631.75
|
| Rate for Payer: Multiplan Commercial |
$4,895.25
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
OP
|
$6,527.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,305.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,484.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$2,937.15
|
| Rate for Payer: Cash Price |
$2,937.15
|
| Rate for Payer: Cash Price |
$2,937.15
|
| Rate for Payer: Cash Price |
$2,937.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,242.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: Dignity Health Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,040.21
|
| Rate for Payer: Heritage Provider Network Senior |
$4,040.21
|
| Rate for Payer: Humana Medicare |
$4,022.69
|
| Rate for Payer: IEHP Medi-Cal |
$313.62
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,643.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,181.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,746.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,631.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,068.59
|
| Rate for Payer: Multiplan Commercial |
$4,895.25
|
| 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 |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC TRACH PUNCTURE/CLEAR WINDPIPE
|
Facility
IP
|
$9,575.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
900501421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,733.08 |
| Max. Negotiated Rate |
$7,181.25 |
| Rate for Payer: Adventist Health Commercial |
$1,915.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,578.02
|
| Rate for Payer: Cash Price |
$4,308.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,482.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6,482.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,733.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,393.75
|
| Rate for Payer: Multiplan Commercial |
$7,181.25
|
|
|
HC TRACH PUNCTURE/CLEAR WINDPIPE
|
Facility
OP
|
$9,575.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
900501421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,915.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,578.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$4,308.75
|
| Rate for Payer: Cash Price |
$4,308.75
|
| Rate for Payer: Cash Price |
$4,308.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,223.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: Dignity Health Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,482.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6,482.28
|
| Rate for Payer: Humana Medicare |
$4,022.69
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,615.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,733.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,746.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,393.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,068.59
|
| Rate for Payer: Multiplan Commercial |
$7,181.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,476.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,199.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC TRACH TUBE CHANGE
|
Facility
OP
|
$901.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.08 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$180.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$405.45
|
| Rate for Payer: Cash Price |
$405.45
|
| Rate for Payer: Cash Price |
$405.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$585.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: Dignity Health Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$305.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.98
|
| Rate for Payer: Heritage Provider Network Senior |
$609.98
|
| Rate for Payer: Humana Medicare |
$305.19
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$434.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$675.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$327.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$301.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC TRACH TUBE CHANGE
|
Facility
IP
|
$901.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$163.08 |
| Max. Negotiated Rate |
$675.75 |
| Rate for Payer: Adventist Health Commercial |
$180.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.99
|
| Rate for Payer: Cash Price |
$405.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.98
|
| Rate for Payer: Heritage Provider Network Senior |
$609.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.25
|
| Rate for Payer: Multiplan Commercial |
$675.75
|
|
|
HC TRACH TUBE CHANGE
|
Facility
IP
|
$901.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.08 |
| Max. Negotiated Rate |
$675.75 |
| Rate for Payer: Adventist Health Commercial |
$180.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.99
|
| Rate for Payer: Cash Price |
$405.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.98
|
| Rate for Payer: Heritage Provider Network Senior |
$609.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.25
|
| Rate for Payer: Multiplan Commercial |
$675.75
|
|
|
HC TRACH TUBE CHANGE
|
Facility
OP
|
$901.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.93 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$180.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$405.45
|
| Rate for Payer: Cash Price |
$405.45
|
| Rate for Payer: Cash Price |
$405.45
|
| Rate for Payer: Cash Price |
$405.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$585.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: Dignity Health Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$305.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.72
|
| Rate for Payer: Heritage Provider Network Senior |
$557.72
|
| Rate for Payer: Humana Medicare |
$305.19
|
| Rate for Payer: IEHP Medi-Cal |
$92.93
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$579.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$675.75
|
| 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 |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC TRACKER CATH
|
Facility
OP
|
$930.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$790.50 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$638.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$511.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$697.50
|
| Rate for Payer: Blue Shield of California Commercial |
$577.53
|
| Rate for Payer: Blue Shield of California EPN |
$545.91
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$604.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$790.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$790.50
|
| Rate for Payer: Dignity Health Senior |
$790.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$604.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$575.67
|
| Rate for Payer: Heritage Provider Network Senior |
$575.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$448.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.50
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$790.50
|
| Rate for Payer: Vantage Medical Group Senior |
$790.50
|
|
|
HC TRACKER CATH
|
Facility
IP
|
$930.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.33 |
| Max. Negotiated Rate |
$697.50 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$638.91
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$629.61
|
| Rate for Payer: Heritage Provider Network Senior |
$629.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.50
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
|
|
HC TRACKER - GUIDEWIRE
|
Facility
IP
|
$606.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.69 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Adventist Health Commercial |
$121.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$416.32
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.26
|
| Rate for Payer: Heritage Provider Network Senior |
$410.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.50
|
| Rate for Payer: Multiplan Commercial |
$454.50
|
|
|
HC TRACKER - GUIDEWIRE
|
Facility
OP
|
$606.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.69 |
| Max. Negotiated Rate |
$515.10 |
| Rate for Payer: Adventist Health Commercial |
$121.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$416.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$515.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$333.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$454.50
|
| Rate for Payer: Blue Shield of California Commercial |
$376.33
|
| Rate for Payer: Blue Shield of California EPN |
$355.72
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$393.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$515.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$515.10
|
| Rate for Payer: Dignity Health Senior |
$515.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.11
|
| Rate for Payer: Heritage Provider Network Senior |
$375.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$292.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.50
|
| Rate for Payer: Multiplan Commercial |
$454.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$515.10
|
| Rate for Payer: Vantage Medical Group Senior |
$515.10
|
|
|
HC TRACKER INFUSION KIT
|
Facility
OP
|
$1,148.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$975.80 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$788.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$975.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$631.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$861.00
|
| Rate for Payer: Blue Shield of California Commercial |
$712.91
|
| Rate for Payer: Blue Shield of California EPN |
$673.88
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$746.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$975.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$975.80
|
| Rate for Payer: Dignity Health Senior |
$975.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$746.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$710.61
|
| Rate for Payer: Heritage Provider Network Senior |
$710.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$553.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.00
|
| Rate for Payer: Multiplan Commercial |
$861.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$975.80
|
| Rate for Payer: Vantage Medical Group Senior |
$975.80
|
|
|
HC TRACKER INFUSION KIT
|
Facility
IP
|
$1,148.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.79 |
| Max. Negotiated Rate |
$861.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$788.68
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$777.20
|
| Rate for Payer: Heritage Provider Network Senior |
$777.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.00
|
| Rate for Payer: Multiplan Commercial |
$861.00
|
|
|
HC TRACTION MANUAL 30 MIN OT
|
Facility
IP
|
$228.00
|
|
|
Service Code
|
CPT 97122
|
| Hospital Charge Code |
905104144
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$156.64
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$154.36
|
| Rate for Payer: Heritage Provider Network Senior |
$154.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$171.00
|
|
|
HC TRACTION MANUAL 30 MIN OT
|
Facility
OP
|
$228.00
|
|
|
Service Code
|
CPT 97122
|
| Hospital Charge Code |
905104144
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$121.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$156.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$125.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$171.00
|
| 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 |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$148.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.80
|
| Rate for Payer: Dignity Health Senior |
$193.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.13
|
| Rate for Payer: Heritage Provider Network Senior |
$141.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$109.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$171.00
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.80
|
| Rate for Payer: Vantage Medical Group Senior |
$193.80
|
|
|
HC TRACTION MANUAL 30 MIN PT
|
Facility
OP
|
$228.00
|
|
|
Service Code
|
CPT 97122
|
| Hospital Charge Code |
905103144
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$121.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$156.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$125.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$171.00
|
| 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 |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$148.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.80
|
| Rate for Payer: Dignity Health Senior |
$193.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.13
|
| Rate for Payer: Heritage Provider Network Senior |
$141.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$109.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$171.00
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.80
|
| Rate for Payer: Vantage Medical Group Senior |
$193.80
|
|
|
HC TRACTION MANUAL 30 MIN PT
|
Facility
IP
|
$228.00
|
|
|
Service Code
|
CPT 97122
|
| Hospital Charge Code |
905103144
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$156.64
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$154.36
|
| Rate for Payer: Heritage Provider Network Senior |
$154.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$171.00
|
|
|
HC TRACTION MECHANICAL
|
Facility
OP
|
$138.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
905103103
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$75.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$103.50
|
| 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 |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.30
|
| Rate for Payer: Dignity Health Senior |
$117.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.42
|
| Rate for Payer: Heritage Provider Network Senior |
$85.42
|
| Rate for Payer: IEHP Medi-Cal |
$20.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.30
|
| Rate for Payer: Vantage Medical Group Senior |
$117.30
|
|
|
HC TRACTION MECHANICAL
|
Facility
IP
|
$138.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900417012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.81
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
|
HC TRACTION MECHANICAL
|
Facility
OP
|
$138.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
900417012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$75.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$103.50
|
| 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 |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.30
|
| Rate for Payer: Dignity Health Senior |
$117.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.42
|
| Rate for Payer: Heritage Provider Network Senior |
$85.42
|
| Rate for Payer: IEHP Medi-Cal |
$20.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.30
|
| Rate for Payer: Vantage Medical Group Senior |
$117.30
|
|
|
HC TRACTION MECHANICAL
|
Facility
IP
|
$138.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
905103103
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.81
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
