|
HC AMNIOBAND MTF 14MM MEMBRANE AG MTX DISK
|
Facility
IP
|
$900.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.30
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.30
|
| Rate for Payer: Heritage Provider Network Senior |
$609.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$328.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$300.69
|
|
|
HC AMNIOBAND MTF 16MM MEMBRANE AG MTX DISK
|
Facility
OP
|
$1,157.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$188.51 |
| Max. Negotiated Rate |
$983.45 |
| Rate for Payer: Adventist Health Commercial |
$231.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$326.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$794.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$983.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$636.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$867.75
|
| Rate for Payer: Blue Shield of California Commercial |
$718.50
|
| Rate for Payer: Blue Shield of California EPN |
$679.16
|
| Rate for Payer: Cash Price |
$520.65
|
| Rate for Payer: Cash Price |
$520.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$532.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$983.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.45
|
| Rate for Payer: Dignity Health Senior |
$983.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$535.69
|
| Rate for Payer: Heritage Provider Network Senior |
$535.69
|
| Rate for Payer: IEHP Medi-Cal |
$188.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$557.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$867.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$421.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$386.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.45
|
| Rate for Payer: Vantage Medical Group Senior |
$983.45
|
|
|
HC AMNIOBAND MTF 16MM MEMBRANE AG MTX DISK
|
Facility
IP
|
$1,157.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$209.42 |
| Max. Negotiated Rate |
$867.75 |
| Rate for Payer: Adventist Health Commercial |
$231.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$794.86
|
| Rate for Payer: Cash Price |
$520.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$532.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$783.29
|
| Rate for Payer: Heritage Provider Network Senior |
$783.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$867.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$421.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$386.55
|
|
|
HC AMNIOBAND MTF 18MM MEMBRANE AG MTX DISK
|
Facility
OP
|
$937.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.60 |
| Max. Negotiated Rate |
$796.45 |
| Rate for Payer: Adventist Health Commercial |
$187.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$326.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$643.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$796.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$515.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$702.75
|
| Rate for Payer: Blue Shield of California Commercial |
$581.88
|
| Rate for Payer: Blue Shield of California EPN |
$550.02
|
| Rate for Payer: Cash Price |
$421.65
|
| Rate for Payer: Cash Price |
$421.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$431.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$796.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$796.45
|
| Rate for Payer: Dignity Health Senior |
$796.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$599.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.83
|
| Rate for Payer: Heritage Provider Network Senior |
$433.83
|
| Rate for Payer: IEHP Medi-Cal |
$188.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$451.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.25
|
| Rate for Payer: Multiplan Commercial |
$702.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$341.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$313.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$796.45
|
| Rate for Payer: Vantage Medical Group Senior |
$796.45
|
|
|
HC AMNIOBAND MTF 18MM MEMBRANE AG MTX DISK
|
Facility
IP
|
$937.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.60 |
| Max. Negotiated Rate |
$702.75 |
| Rate for Payer: Adventist Health Commercial |
$187.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$643.72
|
| Rate for Payer: Cash Price |
$421.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$431.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$634.35
|
| Rate for Payer: Heritage Provider Network Senior |
$634.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.25
|
| Rate for Payer: Multiplan Commercial |
$702.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$341.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$313.05
|
|
|
HC AMNIOBAND MTF 2CMX2CM MEMBRANE AG MTX
|
Facility
IP
|
$944.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.86 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$648.53
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$434.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$509.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$639.09
|
| Rate for Payer: Heritage Provider Network Senior |
$639.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.00
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$344.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$315.39
|
|
|
HC AMNIOBAND MTF 2CMX2CM MEMBRANE AG MTX
|
Facility
OP
|
$944.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.86 |
| Max. Negotiated Rate |
$802.40 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$326.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$648.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$802.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$519.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$708.00
|
| Rate for Payer: Blue Shield of California Commercial |
$586.22
|
| Rate for Payer: Blue Shield of California EPN |
$554.13
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$434.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$802.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$802.40
|
| Rate for Payer: Dignity Health Senior |
$802.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$604.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.07
|
| Rate for Payer: Heritage Provider Network Senior |
$437.07
|
| Rate for Payer: IEHP Medi-Cal |
$188.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$455.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.00
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$344.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$315.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$802.40
|
| Rate for Payer: Vantage Medical Group Senior |
$802.40
|
|
|
HC AMNIOBAND MTF 2CMX3CM MEMBRANE AG MTX
|
Facility
IP
|
$658.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$493.50 |
| Rate for Payer: Adventist Health Commercial |
$131.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$452.05
|
| Rate for Payer: Cash Price |
$296.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$302.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$355.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$445.47
|
| Rate for Payer: Heritage Provider Network Senior |
$445.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.50
|
| Rate for Payer: Multiplan Commercial |
$493.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$239.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$219.84
|
|
|
HC AMNIOBAND MTF 2CMX3CM MEMBRANE AG MTX
|
Facility
OP
|
$658.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$559.30 |
| Rate for Payer: Adventist Health Commercial |
$131.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$326.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$452.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$559.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$361.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$493.50
|
| Rate for Payer: Blue Shield of California Commercial |
$408.62
|
| Rate for Payer: Blue Shield of California EPN |
$386.25
|
| Rate for Payer: Cash Price |
$296.10
|
| Rate for Payer: Cash Price |
$296.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$302.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$559.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$559.30
|
| Rate for Payer: Dignity Health Senior |
$559.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$304.65
|
| Rate for Payer: Heritage Provider Network Senior |
$304.65
|
| Rate for Payer: IEHP Medi-Cal |
$188.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$317.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.50
|
| Rate for Payer: Multiplan Commercial |
$493.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$239.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$219.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$559.30
|
| Rate for Payer: Vantage Medical Group Senior |
$559.30
|
|
|
HC AMNIOBAND MTF 2CMX4CM MEMBRANE AG MTX
|
Facility
IP
|
$527.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.39 |
| Max. Negotiated Rate |
$395.25 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$362.05
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$242.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$356.78
|
| Rate for Payer: Heritage Provider Network Senior |
$356.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.75
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$192.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$176.07
|
|
|
HC AMNIOBAND MTF 2CMX4CM MEMBRANE AG MTX
|
Facility
OP
|
$527.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.39 |
| Max. Negotiated Rate |
$447.95 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$326.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$362.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$447.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$289.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$395.25
|
| Rate for Payer: Blue Shield of California Commercial |
$327.27
|
| Rate for Payer: Blue Shield of California EPN |
$309.35
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$242.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$447.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$447.95
|
| Rate for Payer: Dignity Health Senior |
$447.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$244.00
|
| Rate for Payer: Heritage Provider Network Senior |
$244.00
|
| Rate for Payer: IEHP Medi-Cal |
$188.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$254.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.75
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$192.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$176.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$447.95
|
| Rate for Payer: Vantage Medical Group Senior |
$447.95
|
|
|
HC AMNIOBAND MTF 3CMX4CM MEMBRANE AG MTX
|
Facility
IP
|
$318.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.56 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$218.47
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.29
|
| Rate for Payer: Heritage Provider Network Senior |
$215.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.50
|
| Rate for Payer: Multiplan Commercial |
$238.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$115.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$106.24
|
|
|
HC AMNIOBAND MTF 3CMX4CM MEMBRANE AG MTX
|
Facility
OP
|
$318.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.56 |
| Max. Negotiated Rate |
$326.41 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$326.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$218.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$270.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$174.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$238.50
|
| Rate for Payer: Blue Shield of California Commercial |
$197.48
|
| Rate for Payer: Blue Shield of California EPN |
$186.67
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$270.30
|
| Rate for Payer: Dignity Health Senior |
$270.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.23
|
| Rate for Payer: Heritage Provider Network Senior |
$147.23
|
| Rate for Payer: IEHP Medi-Cal |
$188.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$153.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.50
|
| Rate for Payer: Multiplan Commercial |
$238.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$115.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$106.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$270.30
|
| Rate for Payer: Vantage Medical Group Senior |
$270.30
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC
|
Facility
OP
|
$1,078.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
910400080
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$215.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$740.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,004.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$669.44
|
| Rate for Payer: Blue Shield of California EPN |
$632.79
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.87
|
| Rate for Payer: Dignity Health Senior |
$1,004.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,004.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$667.28
|
| Rate for Payer: Heritage Provider Network Senior |
$667.28
|
| Rate for Payer: Humana Medicare |
$1,004.43
|
| Rate for Payer: IEHP Medi-Cal |
$89.33
|
| Rate for Payer: IEHP Medicare Advantage |
$1,004.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,908.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,265.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,265.58
|
| Rate for Payer: Multiplan Commercial |
$808.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$539.00
|
| Rate for Payer: TriValley Medical Group Senior |
$539.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1,004.43
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC
|
Facility
IP
|
$1,078.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
910400080
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$195.12 |
| Max. Negotiated Rate |
$808.50 |
| Rate for Payer: Adventist Health Commercial |
$215.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$740.59
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$729.81
|
| Rate for Payer: Heritage Provider Network Senior |
$729.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.50
|
| Rate for Payer: Multiplan Commercial |
$808.50
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC ADDL FETUS
|
Facility
IP
|
$1,078.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
910400081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$195.12 |
| Max. Negotiated Rate |
$808.50 |
| Rate for Payer: Adventist Health Commercial |
$215.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$740.59
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$729.81
|
| Rate for Payer: Heritage Provider Network Senior |
$729.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.50
|
| Rate for Payer: Multiplan Commercial |
$808.50
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC ADDL FETUS
|
Facility
OP
|
$1,078.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
910400081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$215.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$740.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,004.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$669.44
|
| Rate for Payer: Blue Shield of California EPN |
$632.79
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.87
|
| Rate for Payer: Dignity Health Senior |
$1,004.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,004.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$667.28
|
| Rate for Payer: Heritage Provider Network Senior |
$667.28
|
| Rate for Payer: Humana Medicare |
$1,004.43
|
| Rate for Payer: IEHP Medi-Cal |
$89.33
|
| Rate for Payer: IEHP Medicare Advantage |
$1,004.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,908.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,265.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,265.58
|
| Rate for Payer: Multiplan Commercial |
$808.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$539.00
|
| Rate for Payer: TriValley Medical Group Senior |
$539.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1,004.43
|
|
|
HC AMNIOCENTESIS THERAPEUTIC
|
Facility
OP
|
$1,456.00
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
910400082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$236.65 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$291.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,000.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$904.18
|
| Rate for Payer: Blue Shield of California EPN |
$854.67
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: Dignity Health Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$400.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$901.26
|
| Rate for Payer: Heritage Provider Network Senior |
$901.26
|
| Rate for Payer: Humana Medicare |
$400.82
|
| Rate for Payer: IEHP Medi-Cal |
$236.65
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$761.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$505.03
|
| Rate for Payer: Multiplan Commercial |
$1,092.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$728.00
|
| Rate for Payer: TriValley Medical Group Senior |
$728.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC AMNIOCENTESIS THERAPEUTIC
|
Facility
IP
|
$1,456.00
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
910400082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$263.54 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Adventist Health Commercial |
$291.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,000.27
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$985.71
|
| Rate for Payer: Heritage Provider Network Senior |
$985.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$1,092.00
|
|
|
HC AMNIOCENTESIS THERAPEUTIC ADDL FETUS
|
Facility
OP
|
$1,456.00
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
910400083
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$236.65 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$291.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,000.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$904.18
|
| Rate for Payer: Blue Shield of California EPN |
$854.67
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: Dignity Health Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$400.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$901.26
|
| Rate for Payer: Heritage Provider Network Senior |
$901.26
|
| Rate for Payer: Humana Medicare |
$400.82
|
| Rate for Payer: IEHP Medi-Cal |
$236.65
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$761.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$505.03
|
| Rate for Payer: Multiplan Commercial |
$1,092.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$728.00
|
| Rate for Payer: TriValley Medical Group Senior |
$728.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC AMNIOCENTESIS THERAPEUTIC ADDL FETUS
|
Facility
IP
|
$1,456.00
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
910400083
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$263.54 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Adventist Health Commercial |
$291.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,000.27
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$985.71
|
| Rate for Payer: Heritage Provider Network Senior |
$985.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$1,092.00
|
|
|
HC AMNIOTIC FLUID SCA
|
Facility
IP
|
$253.00
|
|
|
Service Code
|
CPT 82143
|
| Hospital Charge Code |
900910277
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$189.75 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.81
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.28
|
| Rate for Payer: Heritage Provider Network Senior |
$171.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.25
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
|
|
HC AMNIOTIC FLUID SCA
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT 82143
|
| Hospital Charge Code |
900910277
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$57.53 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.53
|
| Rate for Payer: Blue Shield of California Commercial |
$53.72
|
| Rate for Payer: Blue Shield of California EPN |
$42.00
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.28
|
| Rate for Payer: Dignity Health Senior |
$9.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Senior |
$16.09
|
| Rate for Payer: Humana Medicare |
$9.35
|
| Rate for Payer: IEHP Medi-Cal |
$11.67
|
| Rate for Payer: IEHP Medicare Advantage |
$9.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.78
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.35
|
| Rate for Payer: TriValley Medical Group Senior |
$9.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.28
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
HC AMP FING/THUMB PRI/SEC SING
|
Facility
OP
|
$3,653.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
900501081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$730.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,509.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,374.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,473.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,473.08
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,760.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$2,739.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,326.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,220.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC AMP FING/THUMB PRI/SEC SING
|
Facility
IP
|
$3,653.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
900501081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.19 |
| Max. Negotiated Rate |
$2,739.75 |
| Rate for Payer: Adventist Health Commercial |
$730.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,509.61
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,473.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,473.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| Rate for Payer: Multiplan Commercial |
$2,739.75
|
|
