|
HC VNUS ABLATION CATHETER
|
Facility
IP
|
$1,740.00
|
|
|
Service Code
|
CPT C1888
|
| Hospital Charge Code |
909080043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$348.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$835.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,195.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$800.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$939.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,177.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,177.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$870.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$870.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$870.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.00
|
| Rate for Payer: Multiplan Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$634.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$581.33
|
|
|
HC VOIDING CYSTOGRAM
|
Facility
IP
|
$1,647.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
909301428
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$298.11 |
| Max. Negotiated Rate |
$1,235.25 |
| Rate for Payer: Adventist Health Commercial |
$329.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,131.49
|
| Rate for Payer: Cash Price |
$741.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,115.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,115.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.75
|
| Rate for Payer: Multiplan Commercial |
$1,235.25
|
|
|
HC VOIDING CYSTOGRAM
|
Facility
OP
|
$1,647.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
909301428
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$1,235.25 |
| Rate for Payer: Adventist Health Commercial |
$329.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$428.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,131.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$432.59
|
| Rate for Payer: Blue Shield of California EPN |
$246.00
|
| Rate for Payer: Cash Price |
$741.15
|
| Rate for Payer: Cash Price |
$741.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,070.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,070.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,019.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,019.49
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: IEHP Medi-Cal |
$105.30
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,235.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC VOIDING CYSTO URETHROGRAM
|
Facility
IP
|
$1,264.00
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
909001902
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$228.78 |
| Max. Negotiated Rate |
$948.00 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$868.37
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$855.73
|
| Rate for Payer: Heritage Provider Network Senior |
$855.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.00
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
|
|
HC VOIDING CYSTO URETHROGRAM
|
Facility
OP
|
$1,264.00
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
909001902
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.52 |
| Max. Negotiated Rate |
$948.00 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$163.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$868.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$377.89
|
| Rate for Payer: Blue Shield of California Commercial |
$323.87
|
| Rate for Payer: Blue Shield of California EPN |
$184.18
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$821.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$821.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$782.42
|
| Rate for Payer: Heritage Provider Network Senior |
$782.42
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$94.52
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.16
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC VZV AB
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913532
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.15
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.11
|
| Rate for Payer: Heritage Provider Network Senior |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
|
|
HC VZV AB
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913532
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.86
|
| Rate for Payer: Blue Shield of California Commercial |
$100.62
|
| Rate for Payer: Blue Shield of California EPN |
$78.66
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.71
|
| Rate for Payer: Heritage Provider Network Senior |
$16.71
|
| Rate for Payer: Humana Medicare |
$12.88
|
| Rate for Payer: IEHP Medi-Cal |
$17.75
|
| Rate for Payer: IEHP Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC WALNUT TREE IGE
|
Facility
OP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900901631
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: IEHP Medi-Cal |
$7.24
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC WALNUT TREE IGE
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900901631
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
|
|
HC WART DESTRUCTION MULTIPLE
|
Facility
OP
|
$6,778.00
|
|
|
Service Code
|
CPT 56515
|
| Hospital Charge Code |
910400034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$191.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,355.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,656.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,209.14
|
| Rate for Payer: Blue Shield of California EPN |
$3,978.69
|
| Rate for Payer: Cash Price |
$3,050.10
|
| Rate for Payer: Cash Price |
$3,050.10
|
| Rate for Payer: Cash Price |
$3,050.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,195.58
|
| Rate for Payer: Heritage Provider Network Senior |
$4,195.58
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: IEHP Medi-Cal |
$191.29
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,329.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,226.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,694.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: Multiplan Commercial |
$5,083.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,389.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,389.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC WART DESTRUCTION MULTIPLE
|
Facility
IP
|
$6,778.00
|
|
|
Service Code
|
CPT 56515
|
| Hospital Charge Code |
910400034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,226.82 |
| Max. Negotiated Rate |
$5,083.50 |
| Rate for Payer: Adventist Health Commercial |
$1,355.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,656.49
|
| Rate for Payer: Cash Price |
$3,050.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,588.71
|
| Rate for Payer: Heritage Provider Network Senior |
$4,588.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,226.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,694.50
|
| Rate for Payer: Multiplan Commercial |
$5,083.50
|
|
|
HC WART DESTRUCTION SINGLE
|
Facility
OP
|
$5,672.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
910400033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$281.46 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,134.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,896.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,522.31
|
| Rate for Payer: Blue Shield of California EPN |
$3,329.46
|
| Rate for Payer: Cash Price |
$2,552.40
|
| Rate for Payer: Cash Price |
$2,552.40
|
| Rate for Payer: Cash Price |
$2,552.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,510.97
|
| Rate for Payer: Heritage Provider Network Senior |
$3,510.97
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: IEHP Medi-Cal |
$281.46
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,329.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,026.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,418.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: Multiplan Commercial |
$4,254.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,836.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,836.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC WART DESTRUCTION SINGLE
|
Facility
IP
|
$5,672.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
910400033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,026.63 |
| Max. Negotiated Rate |
$4,254.00 |
| Rate for Payer: Adventist Health Commercial |
$1,134.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,896.66
|
| Rate for Payer: Cash Price |
$2,552.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,839.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3,839.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,026.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,418.00
|
| Rate for Payer: Multiplan Commercial |
$4,254.00
|
|
|
HC WASHING OF COMPONENTS RBC
|
Facility
OP
|
$1,053.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904568
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.25 |
| Max. Negotiated Rate |
$789.75 |
| Rate for Payer: Adventist Health Commercial |
$210.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$562.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Blue Shield of California Commercial |
$653.91
|
| Rate for Payer: Blue Shield of California EPN |
$618.11
|
| Rate for Payer: Cash Price |
$473.85
|
| Rate for Payer: Cash Price |
$473.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$684.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$651.81
|
| Rate for Payer: Heritage Provider Network Senior |
$651.81
|
| Rate for Payer: Humana Medicare |
$37.20
|
| Rate for Payer: IEHP Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.87
|
| Rate for Payer: Multiplan Commercial |
$789.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC WASHING OF COMPONENTS RBC
|
Facility
IP
|
$1,053.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904568
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$190.59 |
| Max. Negotiated Rate |
$789.75 |
| Rate for Payer: Adventist Health Commercial |
$210.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.41
|
| Rate for Payer: Cash Price |
$473.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$712.88
|
| Rate for Payer: Heritage Provider Network Senior |
$712.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.25
|
| Rate for Payer: Multiplan Commercial |
$789.75
|
|
|
HC WASP VENOM IGE
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
|
|
HC WASP VENOM IGE
|
Facility
OP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: IEHP Medi-Cal |
$7.24
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC WEAK ACIDIC DRUG CONF & ID
|
Facility
IP
|
$271.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910512
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$203.25 |
| Rate for Payer: Adventist Health Commercial |
$54.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.18
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.47
|
| Rate for Payer: Heritage Provider Network Senior |
$183.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.75
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
|
|
HC WEAK ACIDIC DRUG CONF & ID
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910512
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$515.78 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$165.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$515.78
|
| Rate for Payer: Blue Shield of California Commercial |
$446.14
|
| Rate for Payer: Blue Shield of California EPN |
$348.77
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.28
|
| Rate for Payer: Heritage Provider Network Senior |
$139.28
|
| Rate for Payer: Humana Medicare |
$62.14
|
| Rate for Payer: IEHP Medi-Cal |
$67.86
|
| Rate for Payer: IEHP Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$118.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.30
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
OP
|
$617.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.68 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$123.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$277.65
|
| Rate for Payer: Cash Price |
$277.65
|
| Rate for Payer: Cash Price |
$277.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$401.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$417.71
|
| Rate for Payer: Heritage Provider Network Senior |
$417.71
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$297.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$462.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$224.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$206.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
IP
|
$617.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.68 |
| Max. Negotiated Rate |
$462.75 |
| Rate for Payer: Adventist Health Commercial |
$123.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.88
|
| Rate for Payer: Cash Price |
$277.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$417.71
|
| Rate for Payer: Heritage Provider Network Senior |
$417.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.25
|
| Rate for Payer: Multiplan Commercial |
$462.75
|
|
|
HC WEDGING OF CLUBFOOT CAST
|
Facility
OP
|
$580.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$155.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$377.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: Dignity Health Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$335.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.66
|
| Rate for Payer: Heritage Provider Network Senior |
$392.66
|
| Rate for Payer: Humana Medicare |
$335.55
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$335.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$279.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$422.79
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$210.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$193.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC WEDGING OF CLUBFOOT CAST
|
Facility
IP
|
$580.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.66
|
| Rate for Payer: Heritage Provider Network Senior |
$392.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
|
|
HC WEEKLY PHYSICS
|
Facility
OP
|
$1,306.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
904810813
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$85.92 |
| Max. Negotiated Rate |
$979.50 |
| Rate for Payer: Adventist Health Commercial |
$261.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$116.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$897.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$169.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$629.61
|
| Rate for Payer: Blue Shield of California Commercial |
$608.78
|
| Rate for Payer: Blue Shield of California EPN |
$346.20
|
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$848.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.48
|
| Rate for Payer: Dignity Health Senior |
$169.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$169.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$808.41
|
| Rate for Payer: Heritage Provider Network Senior |
$808.41
|
| Rate for Payer: Humana Medicare |
$169.53
|
| Rate for Payer: IEHP Medi-Cal |
$85.92
|
| Rate for Payer: IEHP Medicare Advantage |
$169.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$322.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.61
|
| Rate for Payer: Multiplan Commercial |
$979.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$144.10
|
| Rate for Payer: TriValley Medical Group Senior |
$144.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Vantage Medical Group Senior |
$169.53
|
|
|
HC WEEKLY PHYSICS
|
Facility
IP
|
$1,306.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
904810813
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$236.39 |
| Max. Negotiated Rate |
$979.50 |
| Rate for Payer: Adventist Health Commercial |
$261.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$897.22
|
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$884.16
|
| Rate for Payer: Heritage Provider Network Senior |
$884.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.50
|
| Rate for Payer: Multiplan Commercial |
$979.50
|
|
