|
HC TRIMMING NONDYSTROPHIC NAILS
|
Facility
IP
|
$179.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
900501406
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.97
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.18
|
| Rate for Payer: Heritage Provider Network Senior |
$121.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.75
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
|
|
HC TRIM SKIN LESION MORE THAN 4
|
Facility
OP
|
$314.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
900101494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.82 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$62.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$215.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Blue Shield of California Commercial |
$194.99
|
| Rate for Payer: Blue Shield of California EPN |
$184.32
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.37
|
| Rate for Payer: Heritage Provider Network Senior |
$194.37
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: IEHP Medi-Cal |
$41.82
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$235.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$275.15
|
| Rate for Payer: TriValley Medical Group Senior |
$275.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC TRIM SKIN LESION MORE THAN 4
|
Facility
IP
|
$314.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
900101494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.83 |
| Max. Negotiated Rate |
$235.50 |
| Rate for Payer: Adventist Health Commercial |
$62.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$215.72
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$212.58
|
| Rate for Payer: Heritage Provider Network Senior |
$212.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.50
|
| Rate for Payer: Multiplan Commercial |
$235.50
|
|
|
HC TRLUML BLLN ANGIO ADDL ART
|
Facility
IP
|
$10,526.00
|
|
|
Service Code
|
CPT 37247
|
| Hospital Charge Code |
909037247
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,905.21 |
| Max. Negotiated Rate |
$7,894.50 |
| Rate for Payer: Adventist Health Commercial |
$2,105.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,231.36
|
| Rate for Payer: Cash Price |
$4,736.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,126.10
|
| Rate for Payer: Heritage Provider Network Senior |
$7,126.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,905.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,631.50
|
| Rate for Payer: Multiplan Commercial |
$7,894.50
|
|
|
HC TRLUML BLLN ANGIO ADDL ART
|
Facility
OP
|
$10,526.00
|
|
|
Service Code
|
CPT 37247
|
| Hospital Charge Code |
909037247
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,105.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,231.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8,947.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,789.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,894.50
|
| 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 |
$4,736.70
|
| Rate for Payer: Cash Price |
$4,736.70
|
| Rate for Payer: Cash Price |
$4,736.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,841.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,947.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,947.10
|
| Rate for Payer: Dignity Health Senior |
$8,947.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,515.59
|
| Rate for Payer: Heritage Provider Network Senior |
$6,515.59
|
| Rate for Payer: IEHP Medi-Cal |
$1,231.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,073.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,905.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,631.50
|
| Rate for Payer: Multiplan Commercial |
$7,894.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,947.10
|
| Rate for Payer: Vantage Medical Group Senior |
$8,947.10
|
|
|
HC TRLUML BLLN ANGIO ADDL ART
|
Facility
OP
|
$13,062.00
|
|
|
Service Code
|
CPT 37247
|
| Hospital Charge Code |
906820285
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,612.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,973.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11,102.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,184.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,796.50
|
| 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 |
$5,877.90
|
| Rate for Payer: Cash Price |
$5,877.90
|
| Rate for Payer: Cash Price |
$5,877.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,490.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,102.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,102.70
|
| Rate for Payer: Dignity Health Senior |
$11,102.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,085.38
|
| Rate for Payer: Heritage Provider Network Senior |
$8,085.38
|
| Rate for Payer: IEHP Medi-Cal |
$1,231.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,295.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,364.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,265.50
|
| Rate for Payer: Multiplan Commercial |
$9,796.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,102.70
|
| Rate for Payer: Vantage Medical Group Senior |
$11,102.70
|
|
|
HC TRLUML BLLN ANGIO ADDL ART
|
Facility
IP
|
$13,062.00
|
|
|
Service Code
|
CPT 37247
|
| Hospital Charge Code |
906820285
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,364.22 |
| Max. Negotiated Rate |
$9,796.50 |
| Rate for Payer: Adventist Health Commercial |
$2,612.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,973.59
|
| Rate for Payer: Cash Price |
$5,877.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,842.97
|
| Rate for Payer: Heritage Provider Network Senior |
$8,842.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,364.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,265.50
|
| Rate for Payer: Multiplan Commercial |
$9,796.50
|
|
|
HC TRLUML BLLN ANGIO ADDL VEIN
|
Facility
OP
|
$9,166.00
|
|
|
Service Code
|
CPT 37249
|
| Hospital Charge Code |
909037249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,833.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,297.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,791.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,041.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,874.50
|
| 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 |
$4,124.70
|
| Rate for Payer: Cash Price |
$4,124.70
|
| Rate for Payer: Cash Price |
$4,124.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,957.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,791.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,791.10
|
| Rate for Payer: Dignity Health Senior |
$7,791.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,673.75
|
| Rate for Payer: Heritage Provider Network Senior |
$5,673.75
|
| Rate for Payer: IEHP Medi-Cal |
$900.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,418.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,659.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,291.50
|
| Rate for Payer: Multiplan Commercial |
$6,874.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,791.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7,791.10
|
|
|
HC TRLUML BLLN ANGIO ADDL VEIN
|
Facility
IP
|
$12,759.00
|
|
|
Service Code
|
CPT 37249
|
| Hospital Charge Code |
906820287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,309.38 |
| Max. Negotiated Rate |
$9,569.25 |
| Rate for Payer: Adventist Health Commercial |
$2,551.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,765.43
|
| Rate for Payer: Cash Price |
$5,741.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,637.84
|
| Rate for Payer: Heritage Provider Network Senior |
$8,637.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,309.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,189.75
|
| Rate for Payer: Multiplan Commercial |
$9,569.25
|
|
|
HC TRLUML BLLN ANGIO ADDL VEIN
|
Facility
IP
|
$9,166.00
|
|
|
Service Code
|
CPT 37249
|
| Hospital Charge Code |
909037249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,659.05 |
| Max. Negotiated Rate |
$6,874.50 |
| Rate for Payer: Adventist Health Commercial |
$1,833.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,297.04
|
| Rate for Payer: Cash Price |
$4,124.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,205.38
|
| Rate for Payer: Heritage Provider Network Senior |
$6,205.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,659.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,291.50
|
| Rate for Payer: Multiplan Commercial |
$6,874.50
|
|
|
HC TRLUML BLLN ANGIO ADDL VEIN
|
Facility
OP
|
$12,759.00
|
|
|
Service Code
|
CPT 37249
|
| Hospital Charge Code |
906820287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,551.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,765.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,845.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,017.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,569.25
|
| 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 |
$5,741.55
|
| Rate for Payer: Cash Price |
$5,741.55
|
| Rate for Payer: Cash Price |
$5,741.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,293.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,845.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,845.15
|
| Rate for Payer: Dignity Health Senior |
$10,845.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,897.82
|
| Rate for Payer: Heritage Provider Network Senior |
$7,897.82
|
| Rate for Payer: IEHP Medi-Cal |
$900.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,149.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,309.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,189.75
|
| Rate for Payer: Multiplan Commercial |
$9,569.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,845.15
|
| Rate for Payer: Vantage Medical Group Senior |
$10,845.15
|
|
|
HC TRLUML BLLN ANGIO INIT ART
|
Facility
OP
|
$21,052.00
|
|
|
Service Code
|
CPT 37246
|
| Hospital Charge Code |
909037246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,022.94 |
| Max. Negotiated Rate |
$15,789.00 |
| Rate for Payer: Adventist Health Commercial |
$4,210.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,462.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| 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 |
$9,473.40
|
| Rate for Payer: Cash Price |
$9,473.40
|
| Rate for Payer: Cash Price |
$9,473.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,683.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,031.19
|
| Rate for Payer: Heritage Provider Network Senior |
$8,783.86
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: IEHP Medi-Cal |
$3,058.43
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,810.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,263.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$15,789.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,855.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7,855.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC TRLUML BLLN ANGIO INIT ART
|
Facility
IP
|
$29,780.00
|
|
|
Service Code
|
CPT 37246
|
| Hospital Charge Code |
906820284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,390.18 |
| Max. Negotiated Rate |
$22,335.00 |
| Rate for Payer: Adventist Health Commercial |
$5,956.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,458.86
|
| Rate for Payer: Cash Price |
$13,401.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,161.06
|
| Rate for Payer: Heritage Provider Network Senior |
$20,161.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,390.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,445.00
|
| Rate for Payer: Multiplan Commercial |
$22,335.00
|
|
|
HC TRLUML BLLN ANGIO INIT ART
|
Facility
IP
|
$21,052.00
|
|
|
Service Code
|
CPT 37246
|
| Hospital Charge Code |
909037246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,810.41 |
| Max. Negotiated Rate |
$15,789.00 |
| Rate for Payer: Adventist Health Commercial |
$4,210.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,462.72
|
| Rate for Payer: Cash Price |
$9,473.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,252.20
|
| Rate for Payer: Heritage Provider Network Senior |
$14,252.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,810.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,263.00
|
| Rate for Payer: Multiplan Commercial |
$15,789.00
|
|
|
HC TRLUML BLLN ANGIO INIT ART
|
Facility
OP
|
$29,780.00
|
|
|
Service Code
|
CPT 37246
|
| Hospital Charge Code |
906820284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,022.94 |
| Max. Negotiated Rate |
$22,335.00 |
| Rate for Payer: Adventist Health Commercial |
$5,956.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,458.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| 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 |
$13,401.00
|
| Rate for Payer: Cash Price |
$13,401.00
|
| Rate for Payer: Cash Price |
$13,401.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,357.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,433.82
|
| Rate for Payer: Heritage Provider Network Senior |
$8,783.86
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: IEHP Medi-Cal |
$3,058.43
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,390.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,445.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$22,335.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,855.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7,855.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC TRLUML BLLN ANGIO INIT VEIN
|
Facility
IP
|
$25,518.00
|
|
|
Service Code
|
CPT 37248
|
| Hospital Charge Code |
906820286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,618.76 |
| Max. Negotiated Rate |
$19,138.50 |
| Rate for Payer: Adventist Health Commercial |
$5,103.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,530.87
|
| Rate for Payer: Cash Price |
$11,483.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,275.69
|
| Rate for Payer: Heritage Provider Network Senior |
$17,275.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,618.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,379.50
|
| Rate for Payer: Multiplan Commercial |
$19,138.50
|
|
|
HC TRLUML BLLN ANGIO INIT VEIN
|
Facility
OP
|
$18,331.00
|
|
|
Service Code
|
CPT 37248
|
| Hospital Charge Code |
909037248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,108.84 |
| Max. Negotiated Rate |
$13,748.25 |
| Rate for Payer: Adventist Health Commercial |
$3,666.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,593.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| 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 |
$8,248.95
|
| Rate for Payer: Cash Price |
$8,248.95
|
| Rate for Payer: Cash Price |
$8,248.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,915.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,346.89
|
| Rate for Payer: Heritage Provider Network Senior |
$8,783.86
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: IEHP Medi-Cal |
$2,108.84
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,317.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,582.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$13,748.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,855.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7,855.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC TRLUML BLLN ANGIO INIT VEIN
|
Facility
OP
|
$25,518.00
|
|
|
Service Code
|
CPT 37248
|
| Hospital Charge Code |
906820286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,108.84 |
| Max. Negotiated Rate |
$19,138.50 |
| Rate for Payer: Adventist Health Commercial |
$5,103.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,530.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| 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 |
$11,483.10
|
| Rate for Payer: Cash Price |
$11,483.10
|
| Rate for Payer: Cash Price |
$11,483.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,586.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,795.64
|
| Rate for Payer: Heritage Provider Network Senior |
$8,783.86
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: IEHP Medi-Cal |
$2,108.84
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,618.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,379.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$19,138.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,855.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7,855.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC TRLUML BLLN ANGIO INIT VEIN
|
Facility
IP
|
$18,331.00
|
|
|
Service Code
|
CPT 37248
|
| Hospital Charge Code |
909037248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,317.91 |
| Max. Negotiated Rate |
$13,748.25 |
| Rate for Payer: Adventist Health Commercial |
$3,666.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,593.40
|
| Rate for Payer: Cash Price |
$8,248.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,410.09
|
| Rate for Payer: Heritage Provider Network Senior |
$12,410.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,317.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,582.75
|
| Rate for Payer: Multiplan Commercial |
$13,748.25
|
|
|
HC TRMNT SPEECH/LANG/DYSPHAGIA GRP
|
Facility
IP
|
$609.00
|
|
|
Service Code
|
CPT 92508
|
| Hospital Charge Code |
905601501
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$110.23 |
| Max. Negotiated Rate |
$456.75 |
| Rate for Payer: Adventist Health Commercial |
$121.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$418.38
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$412.29
|
| Rate for Payer: Heritage Provider Network Senior |
$412.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.25
|
| Rate for Payer: Multiplan Commercial |
$456.75
|
|
|
HC TRMNT SPEECH/LANG/DYSPHAGIA GRP
|
Facility
OP
|
$609.00
|
|
|
Service Code
|
CPT 92508
|
| Hospital Charge Code |
905601501
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$517.65 |
| Rate for Payer: Adventist Health Commercial |
$121.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$418.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$517.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$334.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$456.75
|
| 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 |
$274.05
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$395.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$517.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$517.65
|
| Rate for Payer: Dignity Health Senior |
$517.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$395.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.97
|
| Rate for Payer: Heritage Provider Network Senior |
$376.97
|
| Rate for Payer: IEHP Medi-Cal |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$293.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.25
|
| Rate for Payer: Multiplan Commercial |
$456.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| 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 |
$517.65
|
| Rate for Payer: Vantage Medical Group Senior |
$517.65
|
|
|
HC TRMNT SPEECH/LANG/DYSPHAGIA GRP MCAL
|
Facility
IP
|
$169.00
|
|
|
Service Code
|
CPT X4302
|
| Hospital Charge Code |
907000038
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.10
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.41
|
| Rate for Payer: Heritage Provider Network Senior |
$114.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.25
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
|
|
HC TRMNT SPEECH/LANG/DYSPHAGIA GRP MCAL
|
Facility
OP
|
$169.00
|
|
|
Service Code
|
CPT X4302
|
| Hospital Charge Code |
907000038
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$143.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$92.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$126.75
|
| 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 |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$143.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.65
|
| Rate for Payer: Dignity Health Senior |
$143.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.61
|
| Rate for Payer: Heritage Provider Network Senior |
$104.61
|
| Rate for Payer: IEHP Medi-Cal |
$41.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.25
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| 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 |
$143.65
|
| Rate for Payer: Vantage Medical Group Senior |
$143.65
|
|
|
HC TRMNT SPEECH/LANG/VOICE INDIV MCAL
|
Facility
OP
|
$860.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000041
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$46.36 |
| Max. Negotiated Rate |
$731.00 |
| Rate for Payer: Adventist Health Commercial |
$172.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$160.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$590.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$731.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$473.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$645.00
|
| 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 |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$559.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$731.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$731.00
|
| Rate for Payer: Dignity Health Senior |
$731.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$559.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.34
|
| Rate for Payer: Heritage Provider Network Senior |
$532.34
|
| Rate for Payer: IEHP Medi-Cal |
$46.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$414.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.00
|
| Rate for Payer: Multiplan Commercial |
$645.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| 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 |
$731.00
|
| Rate for Payer: Vantage Medical Group Senior |
$731.00
|
|
|
HC TRMNT SPEECH/LANG/VOICE INDIV MCAL
|
Facility
IP
|
$860.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000041
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$155.66 |
| Max. Negotiated Rate |
$645.00 |
| Rate for Payer: Adventist Health Commercial |
$172.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$590.82
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$582.22
|
| Rate for Payer: Heritage Provider Network Senior |
$582.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.00
|
| Rate for Payer: Multiplan Commercial |
$645.00
|
|
