|
HC AIRWAY DILATION WO STENT
|
Facility
OP
|
$10,232.00
|
|
|
Service Code
|
CPT 31630
|
| Hospital Charge Code |
900803450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.47 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,046.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,029.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$4,604.40
|
| Rate for Payer: Cash Price |
$4,604.40
|
| Rate for Payer: Cash Price |
$4,604.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,650.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: Dignity Health Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,678.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,333.61
|
| Rate for Payer: Heritage Provider Network Senior |
$5,755.08
|
| Rate for Payer: Humana Medicare |
$4,678.93
|
| Rate for Payer: IEHP Medi-Cal |
$348.47
|
| Rate for Payer: IEHP Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,889.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,851.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,521.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,558.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,895.45
|
| Rate for Payer: Multiplan Commercial |
$7,674.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,146.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5,146.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC AIRWAY DILATION WO STENT
|
Facility
IP
|
$10,232.00
|
|
|
Service Code
|
CPT 31630
|
| Hospital Charge Code |
900803450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,851.99 |
| Max. Negotiated Rate |
$7,674.00 |
| Rate for Payer: Adventist Health Commercial |
$2,046.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,029.38
|
| Rate for Payer: Cash Price |
$4,604.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,927.06
|
| Rate for Payer: Heritage Provider Network Senior |
$6,927.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,851.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,558.00
|
| Rate for Payer: Multiplan Commercial |
$7,674.00
|
|
|
HC AIRWAY DILATION W STENT
|
Facility
OP
|
$6,915.00
|
|
|
Service Code
|
CPT 31631
|
| Hospital Charge Code |
900803451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$302.02 |
| Max. Negotiated Rate |
$16,247.85 |
| Rate for Payer: Adventist Health Commercial |
$1,383.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,750.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,551.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$3,111.75
|
| Rate for Payer: Cash Price |
$3,111.75
|
| Rate for Payer: Cash Price |
$3,111.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,494.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,406.65
|
| Rate for Payer: Dignity Health Senior |
$8,551.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,551.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,280.38
|
| Rate for Payer: Heritage Provider Network Senior |
$10,518.34
|
| Rate for Payer: Humana Medicare |
$8,551.50
|
| Rate for Payer: IEHP Medi-Cal |
$302.02
|
| Rate for Payer: IEHP Medicare Advantage |
$8,551.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,247.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,090.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,728.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,774.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,774.89
|
| Rate for Payer: Multiplan Commercial |
$5,186.25
|
| Rate for Payer: Multiplan WC |
$11,691.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,406.65
|
| Rate for Payer: TriValley Medical Group Senior |
$9,406.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,551.50
|
|
|
HC AIRWAY DILATION W STENT
|
Facility
IP
|
$6,915.00
|
|
|
Service Code
|
CPT 31631
|
| Hospital Charge Code |
900803451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,251.62 |
| Max. Negotiated Rate |
$5,186.25 |
| Rate for Payer: Adventist Health Commercial |
$1,383.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,750.60
|
| Rate for Payer: Cash Price |
$3,111.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,681.46
|
| Rate for Payer: Heritage Provider Network Senior |
$4,681.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,728.75
|
| Rate for Payer: Multiplan Commercial |
$5,186.25
|
|
|
HC AIRWAY TRACH/BRONCH REVIS STNT
|
Facility
IP
|
$6,545.00
|
|
|
Service Code
|
CPT 31638
|
| Hospital Charge Code |
900803519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,184.64 |
| Max. Negotiated Rate |
$4,908.75 |
| Rate for Payer: Adventist Health Commercial |
$1,309.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,496.42
|
| Rate for Payer: Cash Price |
$2,945.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,430.96
|
| Rate for Payer: Heritage Provider Network Senior |
$4,430.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,184.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,636.25
|
| Rate for Payer: Multiplan Commercial |
$4,908.75
|
|
|
HC AIRWAY TRACH/BRONCH REVIS STNT
|
Facility
OP
|
$6,545.00
|
|
|
Service Code
|
CPT 31638
|
| Hospital Charge Code |
900803519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.62 |
| Max. Negotiated Rate |
$16,247.85 |
| Rate for Payer: Adventist Health Commercial |
$1,309.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,496.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,551.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,064.44
|
| Rate for Payer: Blue Shield of California EPN |
$3,841.92
|
| Rate for Payer: Cash Price |
$2,945.25
|
| Rate for Payer: Cash Price |
$2,945.25
|
| Rate for Payer: Cash Price |
$2,945.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,254.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,406.65
|
| Rate for Payer: Dignity Health Senior |
$8,551.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,551.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,051.36
|
| Rate for Payer: Heritage Provider Network Senior |
$4,051.36
|
| Rate for Payer: Humana Medicare |
$8,551.50
|
| Rate for Payer: IEHP Medi-Cal |
$246.62
|
| Rate for Payer: IEHP Medicare Advantage |
$8,551.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,247.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,184.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,090.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,636.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,774.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,774.89
|
| Rate for Payer: Multiplan Commercial |
$4,908.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,406.65
|
| Rate for Payer: TriValley Medical Group Senior |
$9,406.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,551.50
|
|
|
HC ALBUMIN
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900910220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC ALBUMIN
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900910220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$41.47 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.47
|
| Rate for Payer: Blue Shield of California Commercial |
$38.68
|
| Rate for Payer: Blue Shield of California EPN |
$30.24
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.44
|
| Rate for Payer: Dignity Health Senior |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$4.95
|
| Rate for Payer: IEHP Medi-Cal |
$6.27
|
| Rate for Payer: IEHP Medicare Advantage |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.95
|
| Rate for Payer: TriValley Medical Group Senior |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
|
|
HC ALBUMIN BODY FLUID
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900910715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC ALBUMIN BODY FLUID
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900910715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$43.28 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.28
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Senior |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$7.78
|
| Rate for Payer: IEHP Medi-Cal |
$4.41
|
| Rate for Payer: IEHP Medicare Advantage |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.78
|
| Rate for Payer: TriValley Medical Group Senior |
$7.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
|
|
HC ALCOHOL ETHANOL (SERUM/URINE)
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910322
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$86.78 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.78
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: Dignity Health Senior |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC ALCOHOL ETHANOL (SERUM/URINE)
|
Facility
IP
|
$380.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910322
|
|
Hospital Revenue Code
|
301
|
| 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 ALCOHOL INJECTION INTO ORBIT
|
Facility
IP
|
$1,222.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$221.18 |
| Max. Negotiated Rate |
$916.50 |
| Rate for Payer: Adventist Health Commercial |
$244.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$839.51
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$827.29
|
| Rate for Payer: Heritage Provider Network Senior |
$827.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.50
|
| Rate for Payer: Multiplan Commercial |
$916.50
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
OP
|
$1,222.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.18 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$244.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$839.51
|
| 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 |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$794.30
|
| 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 |
$733.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$363.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$756.42
|
| Rate for Payer: Heritage Provider Network Senior |
$447.70
|
| Rate for Payer: Humana Medicare |
$363.98
|
| Rate for Payer: IEHP Medi-Cal |
$188.18
|
| 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 |
$221.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.50
|
| 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 |
$916.50
|
| 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 ALCOHOL INJECTION INTO ORBIT
|
Facility
IP
|
$1,222.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.18 |
| Max. Negotiated Rate |
$916.50 |
| Rate for Payer: Adventist Health Commercial |
$244.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$839.51
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$827.29
|
| Rate for Payer: Heritage Provider Network Senior |
$827.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.50
|
| Rate for Payer: Multiplan Commercial |
$916.50
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
OP
|
$1,222.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.18 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$244.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$839.51
|
| 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 |
$3,237.00
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$794.30
|
| 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 |
$794.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$363.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$827.29
|
| Rate for Payer: Heritage Provider Network Senior |
$827.29
|
| 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 |
$589.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.50
|
| 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 |
$916.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$443.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$408.27
|
| 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 ALCOHOL URINE
|
Facility
IP
|
$322.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900912192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$241.50 |
| Rate for Payer: Adventist Health Commercial |
$64.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$221.21
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$217.99
|
| Rate for Payer: Heritage Provider Network Senior |
$217.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.50
|
| Rate for Payer: Multiplan Commercial |
$241.50
|
|
|
HC ALCOHOL URINE
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900912192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$86.78 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.78
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.90
|
| Rate for Payer: Dignity Health Senior |
$28.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.90
|
| Rate for Payer: Vantage Medical Group Senior |
$28.90
|
|
|
HC ALELRGEN CUCUMBER IGE
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913581
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| 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 |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| 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 |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| 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 |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| 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 |
$11.25
|
| 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 ALELRGEN CUCUMBER IGE
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913581
|
|
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 ALELRGEN GRAPEFRUIT IGE
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913587
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| 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 |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| 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 |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| 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 |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| 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 |
$11.25
|
| 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 ALELRGEN GRAPEFRUIT IGE
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913587
|
|
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 ALKALINE PHOSPHATASE
|
Facility
IP
|
$85.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
900910219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.40
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.54
|
| Rate for Payer: Heritage Provider Network Senior |
$57.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
|
|
HC ALKALINE PHOSPHATASE
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
900910219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$43.28 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.28
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: IEHP Medi-Cal |
$6.44
|
| Rate for Payer: IEHP Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC ALKALINE PHOSPHATASE INDIV
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
900910508
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
