|
HC BALLOON OCCLUSION ADDL LOBES
|
Facility
IP
|
$4,239.00
|
|
|
Service Code
|
CPT 31651
|
| Hospital Charge Code |
900531651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$767.26 |
| Max. Negotiated Rate |
$3,179.25 |
| Rate for Payer: Adventist Health Commercial |
$847.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,912.19
|
| Rate for Payer: Cash Price |
$1,907.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,869.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2,869.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$767.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,059.75
|
| Rate for Payer: Multiplan Commercial |
$3,179.25
|
|
|
HC BALLOON, OCCLUSION/RETRIEVAL
|
Facility
IP
|
$540.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
900803815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.74 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$370.98
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$365.58
|
| Rate for Payer: Heritage Provider Network Senior |
$365.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
|
|
HC BALLOON, OCCLUSION/RETRIEVAL
|
Facility
OP
|
$540.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
900803815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.74 |
| Max. Negotiated Rate |
$915.35 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$915.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$370.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$405.00
|
| Rate for Payer: Blue Shield of California Commercial |
$335.34
|
| Rate for Payer: Blue Shield of California EPN |
$316.98
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$351.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Senior |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$351.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.26
|
| Rate for Payer: Heritage Provider Network Senior |
$334.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
HC BALLOON, REEF/ADMIRAL
|
Facility
IP
|
$1,035.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$776.25 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$711.04
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$700.70
|
| Rate for Payer: Heritage Provider Network Senior |
$700.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
|
|
HC BALLOON, REEF/ADMIRAL
|
Facility
OP
|
$1,035.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$1,062.28 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,062.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$711.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$879.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$569.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$776.25
|
| Rate for Payer: Blue Shield of California Commercial |
$642.74
|
| Rate for Payer: Blue Shield of California EPN |
$607.54
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$672.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$879.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$879.75
|
| Rate for Payer: Dignity Health Senior |
$879.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$640.66
|
| Rate for Payer: Heritage Provider Network Senior |
$640.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$498.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$879.75
|
| Rate for Payer: Vantage Medical Group Senior |
$879.75
|
|
|
HC BALLOON, VIATRAC
|
Facility
IP
|
$2,070.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$374.67 |
| Max. Negotiated Rate |
$1,552.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,422.09
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,401.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,401.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.50
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
|
|
HC BALLOON, VIATRAC
|
Facility
OP
|
$2,070.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$374.67 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,062.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,422.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,138.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,552.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,285.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,215.09
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,345.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,759.50
|
| Rate for Payer: Dignity Health Senior |
$1,759.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,345.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,281.33
|
| Rate for Payer: Heritage Provider Network Senior |
$1,281.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$997.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.50
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,759.50
|
|
|
HC BARBITUATES CONF & ID
|
Facility
IP
|
$271.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910519
|
|
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 BARBITUATES CONF & ID
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910519
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$168.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.96
|
| 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 |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: Dignity Health Senior |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.28
|
| Rate for Payer: Heritage Provider Network Senior |
$139.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$108.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC BARIUM ENEMA W/AIR C
|
Facility
IP
|
$1,507.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
909001808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.77 |
| Max. Negotiated Rate |
$1,130.25 |
| Rate for Payer: Adventist Health Commercial |
$301.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,035.31
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,020.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1,020.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.75
|
| Rate for Payer: Multiplan Commercial |
$1,130.25
|
|
|
HC BARIUM ENEMA W/AIR C
|
Facility
OP
|
$1,507.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
909001808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.03 |
| Max. Negotiated Rate |
$1,130.25 |
| Rate for Payer: Adventist Health Commercial |
$301.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$316.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,035.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$462.98
|
| Rate for Payer: Blue Shield of California Commercial |
$457.52
|
| Rate for Payer: Blue Shield of California EPN |
$260.18
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$979.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$979.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$932.83
|
| Rate for Payer: Heritage Provider Network Senior |
$932.83
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: IEHP Medi-Cal |
$98.03
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$1,130.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$227.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$227.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC BARRIER SKIN SUR FIT 2.25"
|
Facility
OP
|
$2.73
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901698376
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$6.47 |
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.32
|
| Rate for Payer: Dignity Health Senior |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.32
|
| Rate for Payer: Vantage Medical Group Senior |
$2.32
|
|
|
HC BARRIER SKIN SUR FIT 2.25"
|
Facility
IP
|
$2.73
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901698376
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.88
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.05
|
|
|
HC BARTB 87798 SOM
|
Facility
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914848
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.23
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.12
|
| Rate for Payer: Heritage Provider Network Senior |
$31.12
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: IEHP Medi-Cal |
$47.03
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC BARTB 87798 SOM
|
Facility
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914848
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.54
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.03
|
| Rate for Payer: Heritage Provider Network Senior |
$34.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
IP
|
$481.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
900910421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.06 |
| Max. Negotiated Rate |
$360.75 |
| Rate for Payer: Adventist Health Commercial |
$96.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$330.45
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$325.64
|
| Rate for Payer: Heritage Provider Network Senior |
$325.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.25
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
900910421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$70.83 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.83
|
| Rate for Payer: Blue Shield of California Commercial |
$66.13
|
| Rate for Payer: Blue Shield of California EPN |
$51.70
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.31
|
| Rate for Payer: Dignity Health Senior |
$8.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$8.46
|
| Rate for Payer: IEHP Medi-Cal |
$11.34
|
| Rate for Payer: IEHP Medicare Advantage |
$8.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.66
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.46
|
| Rate for Payer: TriValley Medical Group Senior |
$8.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: Vantage Medical Group Senior |
$8.46
|
|
|
HC BCEDP CASE MANAGEMENT FEE
|
Facility
OP
|
$39.00
|
|
| Hospital Charge Code |
909099998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.85
|
| 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: Blue Shield of California Commercial |
$24.22
|
| Rate for Payer: Blue Shield of California EPN |
$22.89
|
| 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 BCEDP CASE MANAGEMENT FEE
|
Facility
IP
|
$39.00
|
|
| Hospital Charge Code |
909099998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.40
|
| Rate for Payer: Heritage Provider Network Senior |
$26.40
|
| 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
|
|
|
HC B-CELL LYMPH FISH DNA PROBE SO
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914114
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$1,420.05 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,420.05
|
| Rate for Payer: Blue Shield of California Commercial |
$167.31
|
| Rate for Payer: Blue Shield of California EPN |
$130.79
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Senior |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.28
|
| Rate for Payer: Heritage Provider Network Senior |
$61.28
|
| Rate for Payer: Humana Medicare |
$21.42
|
| Rate for Payer: IEHP Medi-Cal |
$26.21
|
| Rate for Payer: IEHP Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.99
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC B-CELL LYMPH FISH DNA PROBE SO
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914114
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.01
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.02
|
| Rate for Payer: Heritage Provider Network Senior |
$67.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
|
|
HC B-CELL LYMPH FISH INTRPHAS IN
|
Facility
OP
|
$162.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914115
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$2,190.93 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$116.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,190.93
|
| Rate for Payer: Blue Shield of California Commercial |
$313.65
|
| Rate for Payer: Blue Shield of California EPN |
$245.20
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Senior |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.28
|
| Rate for Payer: Heritage Provider Network Senior |
$100.28
|
| Rate for Payer: Humana Medicare |
$51.19
|
| Rate for Payer: IEHP Medi-Cal |
$49.42
|
| Rate for Payer: IEHP Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$97.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.19
|
| Rate for Payer: TriValley Medical Group Senior |
$51.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC B-CELL LYMPH FISH INTRPHAS IN
|
Facility
IP
|
$162.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914115
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.29
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.67
|
| Rate for Payer: Heritage Provider Network Senior |
$109.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
|
|
HC BC-GN NUCLEIC ACID ID CULTURE
|
Facility
IP
|
$176.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.91
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.15
|
| Rate for Payer: Heritage Provider Network Senior |
$119.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
|
|
HC BC-GN NUCLEIC ACID ID CULTURE
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$167.70 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$58.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.70
|
| Rate for Payer: Blue Shield of California Commercial |
$156.63
|
| Rate for Payer: Blue Shield of California EPN |
$122.45
|
| 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 |
$30.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.06
|
| Rate for Payer: Dignity Health Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$20.05
|
| Rate for Payer: IEHP Medi-Cal |
$25.33
|
| Rate for Payer: IEHP Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.26
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.05
|
| Rate for Payer: TriValley Medical Group Senior |
$20.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
