|
HC UNLISTED TX PROC 15 MIN PT
|
Facility
OP
|
$194.00
|
|
|
Service Code
|
CPT 97139
|
| Hospital Charge Code |
900407139
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$103.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$106.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$145.50
|
| 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 |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.90
|
| Rate for Payer: Dignity Health Senior |
$164.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.09
|
| Rate for Payer: Heritage Provider Network Senior |
$120.09
|
| Rate for Payer: IEHP Medi-Cal |
$11.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| 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 |
$164.90
|
| Rate for Payer: Vantage Medical Group Senior |
$164.90
|
|
|
HC UNLIST PROC CONJUNCTIVA
|
Facility
OP
|
$788.00
|
|
|
Service Code
|
CPT 68399
|
| Hospital Charge Code |
900501500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.63 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$421.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$541.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$512.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: Dignity Health Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$363.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$533.48
|
| Rate for Payer: Heritage Provider Network Senior |
$533.48
|
| Rate for Payer: Humana Medicare |
$363.98
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$363.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$379.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$458.61
|
| Rate for Payer: Multiplan Commercial |
$591.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$286.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$263.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC UNLIST PROC CONJUNCTIVA
|
Facility
IP
|
$788.00
|
|
|
Service Code
|
CPT 68399
|
| Hospital Charge Code |
900501500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.63 |
| Max. Negotiated Rate |
$591.00 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$541.36
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$533.48
|
| Rate for Payer: Heritage Provider Network Senior |
$533.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.00
|
| Rate for Payer: Multiplan Commercial |
$591.00
|
|
|
HC UNLIST PROC, FOOT OR TOES
|
Facility
OP
|
$1,118.00
|
|
|
Service Code
|
CPT 28899
|
| Hospital Charge Code |
900501584
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.36 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$768.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$726.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$756.89
|
| Rate for Payer: Heritage Provider Network Senior |
$756.89
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$538.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$405.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$373.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC UNLIST PROC, FOOT OR TOES
|
Facility
IP
|
$1,118.00
|
|
|
Service Code
|
CPT 28899
|
| Hospital Charge Code |
900501584
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.36 |
| Max. Negotiated Rate |
$838.50 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$768.07
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$756.89
|
| Rate for Payer: Heritage Provider Network Senior |
$756.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.50
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
|
|
HC UNLIST PROC, HANDS OR FINGERS
|
Facility
IP
|
$357.00
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
900501535
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.26
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.69
|
| Rate for Payer: Heritage Provider Network Senior |
$241.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.25
|
| Rate for Payer: Multiplan Commercial |
$267.75
|
|
|
HC UNLIST PROC, HANDS OR FINGERS
|
Facility
OP
|
$357.00
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
900501535
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$232.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.69
|
| Rate for Payer: Heritage Provider Network Senior |
$241.69
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$172.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$267.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$129.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$119.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC UNLIST PROC, PELVIS OR HIP JNT
|
Facility
IP
|
$620.00
|
|
|
Service Code
|
CPT 27299
|
| Hospital Charge Code |
900501429
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.94
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.74
|
| Rate for Payer: Heritage Provider Network Senior |
$419.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
|
|
HC UNLIST PROC, PELVIS OR HIP JNT
|
Facility
OP
|
$620.00
|
|
|
Service Code
|
CPT 27299
|
| Hospital Charge Code |
900501429
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$403.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.74
|
| Rate for Payer: Heritage Provider Network Senior |
$419.74
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$298.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$225.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$207.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC UNLIST PROC, SHOULDER
|
Facility
OP
|
$357.00
|
|
|
Service Code
|
CPT 23929
|
| Hospital Charge Code |
900501430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$232.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.69
|
| Rate for Payer: Heritage Provider Network Senior |
$241.69
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$172.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$267.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$129.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$119.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC UNLIST PROC, SHOULDER
|
Facility
IP
|
$357.00
|
|
|
Service Code
|
CPT 23929
|
| Hospital Charge Code |
900501430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.26
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.69
|
| Rate for Payer: Heritage Provider Network Senior |
$241.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.25
|
| Rate for Payer: Multiplan Commercial |
$267.75
|
|
|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
IP
|
$1,947.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$352.41 |
| Max. Negotiated Rate |
$1,460.25 |
| Rate for Payer: Adventist Health Commercial |
$389.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,337.59
|
| Rate for Payer: Cash Price |
$876.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,318.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1,318.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.75
|
| Rate for Payer: Multiplan Commercial |
$1,460.25
|
|
|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
OP
|
$1,179.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$235.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$630.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$809.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$530.55
|
| Rate for Payer: Cash Price |
$530.55
|
| Rate for Payer: Cash Price |
$530.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$766.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$707.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$729.80
|
| Rate for Payer: Heritage Provider Network Senior |
$240.06
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$884.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| 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 Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
IP
|
$1,947.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$352.41 |
| Max. Negotiated Rate |
$1,460.25 |
| Rate for Payer: Adventist Health Commercial |
$389.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,337.59
|
| Rate for Payer: Cash Price |
$876.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,318.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1,318.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.75
|
| Rate for Payer: Multiplan Commercial |
$1,460.25
|
|
|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
OP
|
$1,179.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$235.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$630.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$809.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$530.55
|
| Rate for Payer: Cash Price |
$530.55
|
| Rate for Payer: Cash Price |
$530.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$766.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$798.18
|
| Rate for Payer: Heritage Provider Network Senior |
$798.18
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$568.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$884.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$428.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$393.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC UNLSTD MALE GENITAL SURG PROC
|
Facility
IP
|
$380.00
|
|
|
Service Code
|
CPT 55899
|
| Hospital Charge Code |
900501624
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Adventist Health Commercial |
$76.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$261.06
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$257.26
|
| Rate for Payer: Heritage Provider Network Senior |
$257.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.00
|
| Rate for Payer: Multiplan Commercial |
$285.00
|
|
|
HC UNLSTD MALE GENITAL SURG PROC
|
Facility
OP
|
$380.00
|
|
|
Service Code
|
CPT 55899
|
| Hospital Charge Code |
900501624
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$76.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$261.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$247.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: Dignity Health Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$257.26
|
| Rate for Payer: Heritage Provider Network Senior |
$257.26
|
| Rate for Payer: Humana Medicare |
$308.79
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$183.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$364.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.08
|
| Rate for Payer: Multiplan Commercial |
$285.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$126.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC UNLSTD PROCEDURE TRACHEA BRONC
|
Facility
IP
|
$2,546.00
|
|
|
Service Code
|
CPT 31899
|
| Hospital Charge Code |
900501511
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$460.83 |
| Max. Negotiated Rate |
$1,909.50 |
| Rate for Payer: Adventist Health Commercial |
$509.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,749.10
|
| Rate for Payer: Cash Price |
$1,145.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,723.64
|
| Rate for Payer: Heritage Provider Network Senior |
$1,723.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$460.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.50
|
| Rate for Payer: Multiplan Commercial |
$1,909.50
|
|
|
HC UNLSTD PROCEDURE TRACHEA BRONC
|
Facility
OP
|
$2,546.00
|
|
|
Service Code
|
CPT 31899
|
| Hospital Charge Code |
900501511
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$247.49 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$509.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,749.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$247.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$1,145.70
|
| Rate for Payer: Cash Price |
$1,145.70
|
| Rate for Payer: Cash Price |
$1,145.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,654.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$371.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.24
|
| Rate for Payer: Dignity Health Senior |
$247.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$247.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,723.64
|
| Rate for Payer: Heritage Provider Network Senior |
$1,723.64
|
| Rate for Payer: Humana Medicare |
$247.49
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,227.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$460.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$311.84
|
| Rate for Payer: Multiplan Commercial |
$1,909.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$924.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$850.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Vantage Medical Group Senior |
$247.49
|
|
|
HC UNLSTD PROC PALATE/UVULA
|
Facility
OP
|
$363.00
|
|
|
Service Code
|
CPT 42299
|
| Hospital Charge Code |
900501745
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$65.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$194.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$249.38
|
| 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 |
$1,756.00
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$235.95
|
| 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 |
$245.75
|
| Rate for Payer: Heritage Provider Network Senior |
$245.75
|
| 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 |
$174.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.75
|
| 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 |
$272.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$131.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$121.28
|
| 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 UNLSTD PROC PALATE/UVULA
|
Facility
IP
|
$363.00
|
|
|
Service Code
|
CPT 42299
|
| Hospital Charge Code |
900501745
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$65.70 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$249.38
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.75
|
| Rate for Payer: Heritage Provider Network Senior |
$245.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.75
|
| Rate for Payer: Multiplan Commercial |
$272.25
|
|
|
HC UNLSTD TEAR DUCT SYSTEM SURGRY
|
Facility
OP
|
$837.00
|
|
|
Service Code
|
CPT 68899
|
| Hospital Charge Code |
900501716
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Adventist Health Commercial |
$167.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$447.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$575.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Blue Shield of California Commercial |
$519.78
|
| Rate for Payer: Blue Shield of California EPN |
$491.32
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$544.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: Dignity Health Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$363.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$518.10
|
| Rate for Payer: Heritage Provider Network Senior |
$447.70
|
| Rate for Payer: Humana Medicare |
$363.98
|
| Rate for Payer: IEHP Medicare Advantage |
$363.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$691.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$458.61
|
| Rate for Payer: Multiplan Commercial |
$627.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$400.38
|
| Rate for Payer: TriValley Medical Group Senior |
$400.38
|
| 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 Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC UNLSTD TEAR DUCT SYSTEM SURGRY
|
Facility
IP
|
$837.00
|
|
|
Service Code
|
CPT 68899
|
| Hospital Charge Code |
900501716
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$627.75 |
| Rate for Payer: Adventist Health Commercial |
$167.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$575.02
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$566.65
|
| Rate for Payer: Heritage Provider Network Senior |
$566.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$627.75
|
|
|
HC UNLST PROC CASTING/STRAPPING
|
Facility
OP
|
$302.00
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
900501651
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.66 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$161.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$207.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$196.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.56
|
| Rate for Payer: Dignity Health Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$196.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.45
|
| Rate for Payer: Heritage Provider Network Senior |
$204.45
|
| Rate for Payer: Humana Medicare |
$196.87
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$196.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$232.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.06
|
| Rate for Payer: Multiplan Commercial |
$226.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$109.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC UNLST PROC CASTING/STRAPPING
|
Facility
IP
|
$302.00
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
900501651
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.66 |
| Max. Negotiated Rate |
$226.50 |
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$207.47
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.45
|
| Rate for Payer: Heritage Provider Network Senior |
$204.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.50
|
| Rate for Payer: Multiplan Commercial |
$226.50
|
|
