|
HC US GUIDE AMNIOCENTESIS TWIN
|
Facility
IP
|
$1,521.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
910400118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$275.30 |
| Max. Negotiated Rate |
$1,140.75 |
| Rate for Payer: Adventist Health Commercial |
$304.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,044.93
|
| Rate for Payer: Cash Price |
$684.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,029.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,029.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.25
|
| Rate for Payer: Multiplan Commercial |
$1,140.75
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
IP
|
$1,011.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$182.99 |
| Max. Negotiated Rate |
$758.25 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$694.56
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$684.45
|
| Rate for Payer: Heritage Provider Network Senior |
$684.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.75
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
|
|
HC US GUIDE FETAL TRANSFUSION
|
Facility
OP
|
$1,011.00
|
|
|
Service Code
|
CPT 76941
|
| Hospital Charge Code |
906601995
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$127.65 |
| Max. Negotiated Rate |
$859.35 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$127.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$694.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$859.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$556.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$758.25
|
| Rate for Payer: Blue Shield of California Commercial |
$311.24
|
| Rate for Payer: Blue Shield of California EPN |
$176.99
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$657.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$859.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$859.35
|
| Rate for Payer: Dignity Health Senior |
$859.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$625.81
|
| Rate for Payer: Heritage Provider Network Senior |
$625.81
|
| Rate for Payer: IEHP Medi-Cal |
$176.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$487.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.75
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$859.35
|
| Rate for Payer: Vantage Medical Group Senior |
$859.35
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
OP
|
$1,694.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
900501576
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$78.97 |
| Max. Negotiated Rate |
$1,439.90 |
| Rate for Payer: Adventist Health Commercial |
$338.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$366.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,163.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,439.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$931.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,270.50
|
| Rate for Payer: Blue Shield of California Commercial |
$512.13
|
| Rate for Payer: Blue Shield of California EPN |
$291.24
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,101.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,439.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,439.90
|
| Rate for Payer: Dignity Health Senior |
$1,439.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,101.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,048.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,048.59
|
| Rate for Payer: IEHP Medi-Cal |
$78.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$816.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$1,270.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,439.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,439.90
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
IP
|
$1,694.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
900501576
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$306.61 |
| Max. Negotiated Rate |
$1,270.50 |
| Rate for Payer: Adventist Health Commercial |
$338.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,163.78
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,146.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,146.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$1,270.50
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
OP
|
$1,694.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
906601444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$78.97 |
| Max. Negotiated Rate |
$1,439.90 |
| Rate for Payer: Adventist Health Commercial |
$338.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$366.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,163.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,439.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$931.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,270.50
|
| Rate for Payer: Blue Shield of California Commercial |
$512.13
|
| Rate for Payer: Blue Shield of California EPN |
$291.24
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,101.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,439.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,439.90
|
| Rate for Payer: Dignity Health Senior |
$1,439.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,101.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,048.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,048.59
|
| Rate for Payer: IEHP Medi-Cal |
$78.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$816.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$1,270.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,439.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,439.90
|
|
|
HC US GUIDE NEEDLE PLACEMENT
|
Facility
IP
|
$1,694.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
906601444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$306.61 |
| Max. Negotiated Rate |
$1,270.50 |
| Rate for Payer: Adventist Health Commercial |
$338.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,163.78
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,146.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,146.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$1,270.50
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
OP
|
$2,143.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
906820091
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.54 |
| Max. Negotiated Rate |
$1,821.55 |
| Rate for Payer: Adventist Health Commercial |
$428.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,472.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,821.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,178.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,607.25
|
| Rate for Payer: Blue Shield of California Commercial |
$86.58
|
| Rate for Payer: Blue Shield of California EPN |
$49.24
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,392.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,821.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,821.55
|
| Rate for Payer: Dignity Health Senior |
$1,821.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,392.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,326.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,326.52
|
| Rate for Payer: IEHP Medi-Cal |
$43.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,032.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.75
|
| Rate for Payer: Multiplan Commercial |
$1,607.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,821.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,821.55
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
IP
|
$2,143.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
906820091
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$387.88 |
| Max. Negotiated Rate |
$1,607.25 |
| Rate for Payer: Adventist Health Commercial |
$428.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,472.24
|
| Rate for Payer: Cash Price |
$964.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,450.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,450.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.75
|
| Rate for Payer: Multiplan Commercial |
$1,607.25
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
OP
|
$698.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
909001488
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.54 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$479.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$523.50
|
| Rate for Payer: Blue Shield of California Commercial |
$86.58
|
| Rate for Payer: Blue Shield of California EPN |
$49.24
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$453.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Dignity Health Senior |
$593.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$432.06
|
| Rate for Payer: Heritage Provider Network Senior |
$432.06
|
| Rate for Payer: IEHP Medi-Cal |
$43.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$336.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.50
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC US GUIDE VASCULAR ACCESS
|
Facility
IP
|
$698.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
909001488
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.34 |
| Max. Negotiated Rate |
$523.50 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$479.53
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$472.55
|
| Rate for Payer: Heritage Provider Network Senior |
$472.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.50
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
|
|
HC US GUIDE VISCERAL TISS ABLATN
|
Facility
IP
|
$1,383.00
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
909001920
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$250.32 |
| Max. Negotiated Rate |
$1,037.25 |
| Rate for Payer: Adventist Health Commercial |
$276.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$950.12
|
| Rate for Payer: Cash Price |
$622.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$936.29
|
| Rate for Payer: Heritage Provider Network Senior |
$936.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.75
|
| Rate for Payer: Multiplan Commercial |
$1,037.25
|
|
|
HC US GUIDE VISCERAL TISS ABLATN
|
Facility
OP
|
$1,383.00
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
909001920
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$140.90 |
| Max. Negotiated Rate |
$1,175.55 |
| Rate for Payer: Adventist Health Commercial |
$276.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$140.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$950.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,175.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$760.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,037.25
|
| Rate for Payer: Blue Shield of California Commercial |
$338.78
|
| Rate for Payer: Blue Shield of California EPN |
$192.66
|
| Rate for Payer: Cash Price |
$622.35
|
| Rate for Payer: Cash Price |
$622.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$898.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,175.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,175.55
|
| Rate for Payer: Dignity Health Senior |
$1,175.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$898.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$856.08
|
| Rate for Payer: Heritage Provider Network Senior |
$856.08
|
| Rate for Payer: IEHP Medi-Cal |
$217.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$666.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.75
|
| Rate for Payer: Multiplan Commercial |
$1,037.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,175.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,175.55
|
|
|
HC US SOFT TISS EXT COMP
|
Facility
OP
|
$1,219.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
906601419
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$83.13 |
| Max. Negotiated Rate |
$914.25 |
| Rate for Payer: Adventist Health Commercial |
$243.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$191.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$837.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$497.55
|
| Rate for Payer: Blue Shield of California EPN |
$282.94
|
| Rate for Payer: Cash Price |
$548.55
|
| Rate for Payer: Cash Price |
$548.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$792.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$792.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$754.56
|
| Rate for Payer: Heritage Provider Network Senior |
$754.56
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$83.13
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$914.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US SOFT TISS EXT COMP
|
Facility
IP
|
$1,219.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
906601419
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$220.64 |
| Max. Negotiated Rate |
$914.25 |
| Rate for Payer: Adventist Health Commercial |
$243.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$837.45
|
| Rate for Payer: Cash Price |
$548.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$825.26
|
| Rate for Payer: Heritage Provider Network Senior |
$825.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.75
|
| Rate for Payer: Multiplan Commercial |
$914.25
|
|
|
HC US SOFT TISS EXT LMTD
|
Facility
OP
|
$1,219.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
906601421
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$914.25 |
| Rate for Payer: Adventist Health Commercial |
$243.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$837.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$58.25
|
| Rate for Payer: Blue Shield of California EPN |
$33.12
|
| Rate for Payer: Cash Price |
$548.55
|
| Rate for Payer: Cash Price |
$548.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$792.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$792.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$754.56
|
| Rate for Payer: Heritage Provider Network Senior |
$754.56
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$40.95
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$914.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US SOFT TISS EXT LMTD
|
Facility
IP
|
$1,219.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
906601421
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$220.64 |
| Max. Negotiated Rate |
$914.25 |
| Rate for Payer: Adventist Health Commercial |
$243.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$837.45
|
| Rate for Payer: Cash Price |
$548.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$825.26
|
| Rate for Payer: Heritage Provider Network Senior |
$825.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.75
|
| Rate for Payer: Multiplan Commercial |
$914.25
|
|
|
HC US SOFT TISSUE MASS,HEAD/NECK
|
Facility
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
906601405
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$93.19 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Adventist Health Commercial |
$242.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$202.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$831.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$291.67
|
| Rate for Payer: Blue Shield of California EPN |
$165.86
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$786.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$786.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$748.99
|
| Rate for Payer: Heritage Provider Network Senior |
$748.99
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$93.19
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$907.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US SOFT TISSUE MASS,HEAD/NECK
|
Facility
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
906601405
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$219.01 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Adventist Health Commercial |
$242.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$831.27
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$819.17
|
| Rate for Payer: Heritage Provider Network Senior |
$819.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.50
|
| Rate for Payer: Multiplan Commercial |
$907.50
|
|
|
HC US TRANSRECTAL
|
Facility
IP
|
$1,576.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
906601408
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$285.26 |
| Max. Negotiated Rate |
$1,182.00 |
| Rate for Payer: Adventist Health Commercial |
$315.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,082.71
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,066.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1,066.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.00
|
| Rate for Payer: Multiplan Commercial |
$1,182.00
|
|
|
HC US TRANSRECTAL
|
Facility
OP
|
$1,576.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
906601408
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$105.53 |
| Max. Negotiated Rate |
$1,182.00 |
| Rate for Payer: Adventist Health Commercial |
$315.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$213.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,082.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$378.76
|
| Rate for Payer: Blue Shield of California EPN |
$215.39
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,024.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,024.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$975.54
|
| Rate for Payer: Heritage Provider Network Senior |
$975.54
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$105.53
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,182.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US TRGT DYN MBUBB 1ST LSN
|
Facility
OP
|
$616.00
|
|
|
Service Code
|
CPT 76978
|
| Hospital Charge Code |
906676978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$111.50 |
| Max. Negotiated Rate |
$1,348.60 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$550.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,348.60
|
| Rate for Payer: Blue Shield of California EPN |
$766.91
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$400.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$381.30
|
| Rate for Payer: Heritage Provider Network Senior |
$381.30
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: IEHP Medi-Cal |
$435.91
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$462.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$322.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$322.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC US TRGT DYN MBUBB 1ST LSN
|
Facility
IP
|
$616.00
|
|
|
Service Code
|
CPT 76978
|
| Hospital Charge Code |
906676978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$111.50 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.19
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$417.03
|
| Rate for Payer: Heritage Provider Network Senior |
$417.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.00
|
| Rate for Payer: Multiplan Commercial |
$462.00
|
|
|
HC US TRGT DYN MBUBB EA ADD LSN
|
Facility
OP
|
$307.00
|
|
|
Service Code
|
CPT 76979
|
| Hospital Charge Code |
906676979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.57 |
| Max. Negotiated Rate |
$984.42 |
| Rate for Payer: Adventist Health Commercial |
$61.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$401.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$210.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$260.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$168.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$230.25
|
| Rate for Payer: Blue Shield of California Commercial |
$984.42
|
| Rate for Payer: Blue Shield of California EPN |
$559.81
|
| Rate for Payer: Cash Price |
$138.15
|
| Rate for Payer: Cash Price |
$138.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$199.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.95
|
| Rate for Payer: Dignity Health Senior |
$260.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.03
|
| Rate for Payer: Heritage Provider Network Senior |
$190.03
|
| Rate for Payer: IEHP Medi-Cal |
$290.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$147.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.75
|
| Rate for Payer: Multiplan Commercial |
$230.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.95
|
| Rate for Payer: Vantage Medical Group Senior |
$260.95
|
|
|
HC US TRGT DYN MBUBB EA ADD LSN
|
Facility
IP
|
$307.00
|
|
|
Service Code
|
CPT 76979
|
| Hospital Charge Code |
906676979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.57 |
| Max. Negotiated Rate |
$230.25 |
| Rate for Payer: Adventist Health Commercial |
$61.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$210.91
|
| Rate for Payer: Cash Price |
$138.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$207.84
|
| Rate for Payer: Heritage Provider Network Senior |
$207.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.75
|
| Rate for Payer: Multiplan Commercial |
$230.25
|
|
