|
HC TROPONIN - I
|
Facility
IP
|
$917.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900910994
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$687.75 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$629.98
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.81
|
| Rate for Payer: Heritage Provider Network Senior |
$620.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.25
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
|
|
HC TROPONIN - I
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900910994
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$159.70 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.70
|
| Rate for Payer: Blue Shield of California Commercial |
$76.86
|
| Rate for Payer: Blue Shield of California EPN |
$60.09
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.72
|
| Rate for Payer: Dignity Health Senior |
$12.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Humana Medicare |
$12.47
|
| Rate for Payer: IEHP Medi-Cal |
$13.21
|
| Rate for Payer: IEHP Medicare Advantage |
$12.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.71
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.47
|
| Rate for Payer: TriValley Medical Group Senior |
$12.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Vantage Medical Group Senior |
$12.47
|
|
|
HC TROPONIN-T
|
Facility
IP
|
$285.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900912119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.58 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Adventist Health Commercial |
$57.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$195.80
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$192.94
|
| Rate for Payer: Heritage Provider Network Senior |
$192.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.25
|
| Rate for Payer: Multiplan Commercial |
$213.75
|
|
|
HC TROPONIN-T
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900912119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$159.70 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.70
|
| Rate for Payer: Blue Shield of California Commercial |
$76.86
|
| Rate for Payer: Blue Shield of California EPN |
$60.09
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.72
|
| Rate for Payer: Dignity Health Senior |
$12.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.95
|
| Rate for Payer: Heritage Provider Network Senior |
$17.95
|
| Rate for Payer: Humana Medicare |
$12.47
|
| Rate for Payer: IEHP Medi-Cal |
$13.21
|
| Rate for Payer: IEHP Medicare Advantage |
$12.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.71
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.47
|
| Rate for Payer: TriValley Medical Group Senior |
$12.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Vantage Medical Group Senior |
$12.47
|
|
|
HC TRSNCATH INS/REPL LEADLESS PCR
|
Facility
OP
|
$56,678.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
906820022
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$651.64 |
| Max. Negotiated Rate |
$46,256.43 |
| Rate for Payer: Adventist Health Commercial |
$11,335.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38,937.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24,345.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$25,505.10
|
| Rate for Payer: Cash Price |
$25,505.10
|
| Rate for Payer: Cash Price |
$25,505.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36,840.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,780.04
|
| Rate for Payer: Dignity Health Senior |
$24,345.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,345.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,083.68
|
| Rate for Payer: Heritage Provider Network Senior |
$29,944.95
|
| Rate for Payer: Humana Medicare |
$24,345.49
|
| Rate for Payer: IEHP Medi-Cal |
$651.64
|
| Rate for Payer: IEHP Medicare Advantage |
$24,345.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,256.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,258.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,727.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,169.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,675.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,675.32
|
| Rate for Payer: Multiplan Commercial |
$42,508.50
|
| Rate for Payer: Multiplan WC |
$33,283.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,780.04
|
| Rate for Payer: TriValley Medical Group Senior |
$26,780.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,042.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,173.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: Vantage Medical Group Senior |
$24,345.49
|
|
|
HC TRSNCATH INS/REPL LEADLESS PCR
|
Facility
IP
|
$56,678.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
906811498
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,258.72 |
| Max. Negotiated Rate |
$42,508.50 |
| Rate for Payer: Adventist Health Commercial |
$11,335.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38,937.79
|
| Rate for Payer: Cash Price |
$25,505.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$38,371.01
|
| Rate for Payer: Heritage Provider Network Senior |
$38,371.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,258.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,169.50
|
| Rate for Payer: Multiplan Commercial |
$42,508.50
|
|
|
HC TRSNCATH INS/REPL LEADLESS PCR
|
Facility
IP
|
$56,678.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
906820022
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,258.72 |
| Max. Negotiated Rate |
$42,508.50 |
| Rate for Payer: Adventist Health Commercial |
$11,335.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38,937.79
|
| Rate for Payer: Cash Price |
$25,505.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$38,371.01
|
| Rate for Payer: Heritage Provider Network Senior |
$38,371.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,258.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,169.50
|
| Rate for Payer: Multiplan Commercial |
$42,508.50
|
|
|
HC TRSNCATH INS/REPL LEADLESS PCR
|
Facility
OP
|
$56,678.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
906811498
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$651.64 |
| Max. Negotiated Rate |
$46,256.43 |
| Rate for Payer: Adventist Health Commercial |
$11,335.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38,937.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24,345.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$25,505.10
|
| Rate for Payer: Cash Price |
$25,505.10
|
| Rate for Payer: Cash Price |
$25,505.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36,840.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,780.04
|
| Rate for Payer: Dignity Health Senior |
$24,345.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,345.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,083.68
|
| Rate for Payer: Heritage Provider Network Senior |
$29,944.95
|
| Rate for Payer: Humana Medicare |
$24,345.49
|
| Rate for Payer: IEHP Medi-Cal |
$651.64
|
| Rate for Payer: IEHP Medicare Advantage |
$24,345.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,256.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,258.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,727.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,169.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,675.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,675.32
|
| Rate for Payer: Multiplan Commercial |
$42,508.50
|
| Rate for Payer: Multiplan WC |
$33,283.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,780.04
|
| Rate for Payer: TriValley Medical Group Senior |
$26,780.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,042.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,173.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: Vantage Medical Group Senior |
$24,345.49
|
|
|
HC TRT SPEECH/LANG/VOICE INDIV
|
Facility
OP
|
$668.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907001401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$46.36 |
| Max. Negotiated Rate |
$567.80 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$160.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$458.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$367.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$501.00
|
| 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 |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$434.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.80
|
| Rate for Payer: Dignity Health Senior |
$567.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$413.49
|
| Rate for Payer: Heritage Provider Network Senior |
$413.49
|
| Rate for Payer: IEHP Medi-Cal |
$46.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$321.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| 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 |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$567.80
|
|
|
HC TRT SPEECH/LANG/VOICE INDIV
|
Facility
IP
|
$668.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907001401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$120.91 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$458.92
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$452.24
|
| Rate for Payer: Heritage Provider Network Senior |
$452.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING
|
Facility
IP
|
$590.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
905601801
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$106.79 |
| Max. Negotiated Rate |
$442.50 |
| Rate for Payer: Adventist Health Commercial |
$118.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$405.33
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$399.43
|
| Rate for Payer: Heritage Provider Network Senior |
$399.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.50
|
| Rate for Payer: Multiplan Commercial |
$442.50
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING
|
Facility
OP
|
$590.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
905601801
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$52.76 |
| Max. Negotiated Rate |
$501.50 |
| Rate for Payer: Adventist Health Commercial |
$118.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$217.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$405.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$501.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$442.50
|
| 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 |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$383.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$501.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$501.50
|
| Rate for Payer: Dignity Health Senior |
$501.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$365.21
|
| Rate for Payer: Heritage Provider Network Senior |
$365.21
|
| Rate for Payer: IEHP Medi-Cal |
$52.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$284.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.50
|
| Rate for Payer: Multiplan Commercial |
$442.50
|
| 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 |
$501.50
|
| Rate for Payer: Vantage Medical Group Senior |
$501.50
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
IP
|
$742.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
907000039
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$556.50 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$509.75
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
OP
|
$742.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$52.76 |
| Max. Negotiated Rate |
$630.70 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$217.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$509.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$630.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$408.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$556.50
|
| 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 |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$482.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$630.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$630.70
|
| Rate for Payer: Dignity Health Senior |
$630.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$482.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$459.30
|
| Rate for Payer: Heritage Provider Network Senior |
$459.30
|
| Rate for Payer: IEHP Medi-Cal |
$52.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$357.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
| 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 |
$630.70
|
| Rate for Payer: Vantage Medical Group Senior |
$630.70
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
IP
|
$742.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$556.50 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$509.75
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
OP
|
$742.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
907000039
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$52.76 |
| Max. Negotiated Rate |
$630.70 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$217.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$509.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$630.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$408.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$556.50
|
| 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 |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$482.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$630.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$630.70
|
| Rate for Payer: Dignity Health Senior |
$630.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$482.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$459.30
|
| Rate for Payer: Heritage Provider Network Senior |
$459.30
|
| Rate for Payer: IEHP Medi-Cal |
$52.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$357.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
| 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 |
$630.70
|
| Rate for Payer: Vantage Medical Group Senior |
$630.70
|
|
|
HC TRT SWALLOW ORAL FUNC FEEDING MCARE COMM
|
Facility
OP
|
$742.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300802
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$52.76 |
| Max. Negotiated Rate |
$630.70 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$217.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$509.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$630.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$408.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$556.50
|
| 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 |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$482.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$630.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$630.70
|
| Rate for Payer: Dignity Health Senior |
$630.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$482.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$459.30
|
| Rate for Payer: Heritage Provider Network Senior |
$459.30
|
| Rate for Payer: IEHP Medi-Cal |
$52.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$357.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
| 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 |
$630.70
|
| Rate for Payer: Vantage Medical Group Senior |
$630.70
|
|
|
HC TRT SWALLOW ORAL FUNC FEEDING MCARE COMM
|
Facility
IP
|
$742.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300802
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$556.50 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$509.75
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
|
|
HC TRT TARS BONE FX;W/MANIPUL, EA
|
Facility
OP
|
$1,182.00
|
|
|
Service Code
|
CPT 28455
|
| Hospital Charge Code |
900501247
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.94 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$236.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$812.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$531.90
|
| Rate for Payer: Cash Price |
$531.90
|
| Rate for Payer: Cash Price |
$531.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$768.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$800.21
|
| Rate for Payer: Heritage Provider Network Senior |
$800.21
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$569.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: Multiplan Commercial |
$886.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$429.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$394.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC TRT TARS BONE FX;W/MANIPUL, EA
|
Facility
IP
|
$1,182.00
|
|
|
Service Code
|
CPT 28455
|
| Hospital Charge Code |
900501247
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.94 |
| Max. Negotiated Rate |
$886.50 |
| Rate for Payer: Adventist Health Commercial |
$236.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$812.03
|
| Rate for Payer: Cash Price |
$531.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$800.21
|
| Rate for Payer: Heritage Provider Network Senior |
$800.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.50
|
| Rate for Payer: Multiplan Commercial |
$886.50
|
|
|
HC TRUE CUT SOFT TISSUE
|
Facility
IP
|
$79.00
|
|
| Hospital Charge Code |
909001070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.27
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
|
HC TRUE CUT SOFT TISSUE
|
Facility
OP
|
$79.00
|
|
| Hospital Charge Code |
909001070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$59.25
|
| Rate for Payer: Blue Shield of California Commercial |
$49.06
|
| Rate for Payer: Blue Shield of California EPN |
$46.37
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Senior |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC TRUFILL N-BCA
|
Facility
IP
|
$6,235.00
|
|
| Hospital Charge Code |
909081833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,128.54 |
| Max. Negotiated Rate |
$4,676.25 |
| Rate for Payer: Adventist Health Commercial |
$1,247.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,283.44
|
| Rate for Payer: Cash Price |
$2,805.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,221.10
|
| Rate for Payer: Heritage Provider Network Senior |
$4,221.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,128.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,558.75
|
| Rate for Payer: Multiplan Commercial |
$4,676.25
|
|
|
HC TRUFILL N-BCA
|
Facility
OP
|
$6,235.00
|
|
| Hospital Charge Code |
909081833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,128.54 |
| Max. Negotiated Rate |
$5,299.75 |
| Rate for Payer: Adventist Health Commercial |
$1,247.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,332.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,283.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,299.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,429.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,676.25
|
| Rate for Payer: Blue Shield of California Commercial |
$3,871.94
|
| Rate for Payer: Blue Shield of California EPN |
$3,659.94
|
| Rate for Payer: Cash Price |
$2,805.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,052.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,299.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,299.75
|
| Rate for Payer: Dignity Health Senior |
$5,299.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,052.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,859.46
|
| Rate for Payer: Heritage Provider Network Senior |
$3,859.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,005.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,128.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,558.75
|
| Rate for Payer: Multiplan Commercial |
$4,676.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,299.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,299.75
|
|
|
HC TRYPSIN STOOL
|
Facility
IP
|
$406.00
|
|
|
Service Code
|
CPT 84488
|
| Hospital Charge Code |
900910231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.49 |
| Max. Negotiated Rate |
$304.50 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$278.92
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$274.86
|
| Rate for Payer: Heritage Provider Network Senior |
$274.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.50
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
|
