|
HC BILIARY ENDOPROTHESIS
|
Facility
OP
|
$455.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909001066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$218.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$312.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$250.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$341.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$282.56
|
| Rate for Payer: Blue Shield of California EPN |
$267.08
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$209.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.75
|
| Rate for Payer: Dignity Health Senior |
$386.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$210.66
|
| Rate for Payer: Heritage Provider Network Senior |
$210.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$227.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.75
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$165.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$152.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.75
|
| Rate for Payer: Vantage Medical Group Senior |
$386.75
|
|
|
HC BILIARY ENDOPROTHESIS
|
Facility
IP
|
$455.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909001066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$218.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$312.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$209.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$308.04
|
| Rate for Payer: Heritage Provider Network Senior |
$308.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$227.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.75
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$165.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$152.02
|
|
|
HC BILIARY STNT PLCMNT EXT ACCESS
|
Facility
OP
|
$18,314.00
|
|
|
Service Code
|
CPT 47538
|
| Hospital Charge Code |
909047538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,237.00 |
| Max. Negotiated Rate |
$13,735.50 |
| Rate for Payer: Adventist Health Commercial |
$3,662.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,581.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$8,241.30
|
| Rate for Payer: Cash Price |
$8,241.30
|
| Rate for Payer: Cash Price |
$8,241.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,904.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: Dignity Health Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,209.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,336.37
|
| Rate for Payer: Heritage Provider Network Senior |
$8,867.33
|
| Rate for Payer: Humana Medicare |
$7,209.21
|
| Rate for Payer: IEHP Medi-Cal |
$6,535.60
|
| Rate for Payer: IEHP Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,697.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,314.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,506.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,578.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,083.60
|
| Rate for Payer: Multiplan Commercial |
$13,735.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,930.13
|
| Rate for Payer: TriValley Medical Group Senior |
$7,930.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
HC BILIARY STNT PLCMNT EXT ACCESS
|
Facility
IP
|
$18,314.00
|
|
|
Service Code
|
CPT 47538
|
| Hospital Charge Code |
909047538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,314.83 |
| Max. Negotiated Rate |
$13,735.50 |
| Rate for Payer: Adventist Health Commercial |
$3,662.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,581.72
|
| Rate for Payer: Cash Price |
$8,241.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,398.58
|
| Rate for Payer: Heritage Provider Network Senior |
$12,398.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,314.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,578.50
|
| Rate for Payer: Multiplan Commercial |
$13,735.50
|
|
|
HC BILIARY STONE REMVL T-TUBE
|
Facility
IP
|
$6,442.00
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
909000151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,166.00 |
| Max. Negotiated Rate |
$4,831.50 |
| Rate for Payer: Adventist Health Commercial |
$1,288.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,425.65
|
| Rate for Payer: Cash Price |
$2,898.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,361.23
|
| Rate for Payer: Heritage Provider Network Senior |
$4,361.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,166.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,610.50
|
| Rate for Payer: Multiplan Commercial |
$4,831.50
|
|
|
HC BILIARY STONE REMVL T-TUBE
|
Facility
OP
|
$6,442.00
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
909000151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,288.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,425.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,475.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,543.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,831.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$2,898.90
|
| Rate for Payer: Cash Price |
$2,898.90
|
| Rate for Payer: Cash Price |
$2,898.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,187.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,475.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,475.70
|
| Rate for Payer: Dignity Health Senior |
$5,475.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,987.60
|
| Rate for Payer: Heritage Provider Network Senior |
$3,987.60
|
| Rate for Payer: IEHP Medi-Cal |
$1,161.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,105.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,166.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,610.50
|
| Rate for Payer: Multiplan Commercial |
$4,831.50
|
| 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 Medi-Cal |
$5,475.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5,475.70
|
|
|
HC BILIARY TRACT CELLVIZIO
|
Facility
IP
|
$9,381.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
906747999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,697.96 |
| Max. Negotiated Rate |
$7,035.75 |
| Rate for Payer: Adventist Health Commercial |
$1,876.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,444.75
|
| Rate for Payer: Cash Price |
$4,221.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,350.94
|
| Rate for Payer: Heritage Provider Network Senior |
$6,350.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,697.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,345.25
|
| Rate for Payer: Multiplan Commercial |
$7,035.75
|
|
|
HC BILIARY TRACT CELLVIZIO
|
Facility
OP
|
$6,023.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
906747999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,204.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,219.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,137.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$2,710.35
|
| Rate for Payer: Cash Price |
$2,710.35
|
| Rate for Payer: Cash Price |
$2,710.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,914.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,728.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,090.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$4,517.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC BILIARY TUBE CK-CHOLANGIO
|
Facility
IP
|
$4,942.00
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
909000144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$894.50 |
| Max. Negotiated Rate |
$3,706.50 |
| Rate for Payer: Adventist Health Commercial |
$988.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,395.15
|
| Rate for Payer: Cash Price |
$2,223.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,345.73
|
| Rate for Payer: Heritage Provider Network Senior |
$3,345.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$894.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,235.50
|
| Rate for Payer: Multiplan Commercial |
$3,706.50
|
|
|
HC BILIARY TUBE CK-CHOLANGIO
|
Facility
OP
|
$4,942.00
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
909000144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$894.50 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$988.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,395.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$2,223.90
|
| Rate for Payer: Cash Price |
$2,223.90
|
| Rate for Payer: Cash Price |
$2,223.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,212.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: Dignity Health Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,322.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,059.10
|
| Rate for Payer: Heritage Provider Network Senior |
$5,316.82
|
| Rate for Payer: Humana Medicare |
$4,322.62
|
| Rate for Payer: IEHP Medi-Cal |
$1,168.55
|
| Rate for Payer: IEHP Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,212.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$894.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,100.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,235.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,446.50
|
| Rate for Payer: Multiplan Commercial |
$3,706.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,754.88
|
| Rate for Payer: TriValley Medical Group Senior |
$4,754.88
|
| 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 |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC BILI DUCT DILITATION PERC
|
Facility
OP
|
$3,985.00
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
909001856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.54 |
| Max. Negotiated Rate |
$3,387.25 |
| Rate for Payer: Adventist Health Commercial |
$797.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$182.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,737.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,387.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,191.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,988.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,453.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,246.46
|
| Rate for Payer: Blue Shield of California EPN |
$708.82
|
| Rate for Payer: Cash Price |
$1,793.25
|
| Rate for Payer: Cash Price |
$1,793.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,590.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,387.25
|
| Rate for Payer: Dignity Health Senior |
$3,387.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,590.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,466.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,466.72
|
| Rate for Payer: IEHP Medi-Cal |
$206.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,920.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.25
|
| Rate for Payer: Multiplan Commercial |
$2,988.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,387.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,387.25
|
|
|
HC BILI DUCT DILITATION PERC
|
Facility
IP
|
$3,985.00
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
909001856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$721.28 |
| Max. Negotiated Rate |
$2,988.75 |
| Rate for Payer: Adventist Health Commercial |
$797.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,737.70
|
| Rate for Payer: Cash Price |
$1,793.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,697.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,697.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.25
|
| Rate for Payer: Multiplan Commercial |
$2,988.75
|
|
|
HC BILIRUBIN DIRECT
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
900910504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$41.87 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.87
|
| Rate for Payer: Blue Shield of California Commercial |
$39.24
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| 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 |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Senior |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$5.02
|
| Rate for Payer: IEHP Medi-Cal |
$6.88
|
| Rate for Payer: IEHP Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.33
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN DIRECT
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
900910504
|
|
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 BILIRUBIN ICTOTEST
|
Facility
IP
|
$78.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910181
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.59
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.81
|
| Rate for Payer: Heritage Provider Network Senior |
$52.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
|
|
HC BILIRUBIN ICTOTEST
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910181
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$19.96 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.89
|
| Rate for Payer: Blue Shield of California Commercial |
$19.96
|
| Rate for Payer: Blue Shield of California EPN |
$15.60
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Senior |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Humana Medicare |
$3.48
|
| Rate for Payer: IEHP Medi-Cal |
$3.35
|
| Rate for Payer: IEHP Medicare Advantage |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.48
|
| Rate for Payer: TriValley Medical Group Senior |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC BILIRUBIN TOTAL
|
Facility
IP
|
$85.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910273
|
|
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 BILIRUBIN TOTAL
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$41.87 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.87
|
| Rate for Payer: Blue Shield of California Commercial |
$39.24
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| 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 |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Senior |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$5.02
|
| Rate for Payer: IEHP Medi-Cal |
$6.38
|
| Rate for Payer: IEHP Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.33
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN TOTAL CH
|
Facility
IP
|
$85.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900912177
|
|
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 BILIRUBIN TOTAL CH
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900912177
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.87
|
| Rate for Payer: Blue Shield of California Commercial |
$39.24
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Senior |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.62
|
| Rate for Payer: Heritage Provider Network Senior |
$52.62
|
| Rate for Payer: Humana Medicare |
$5.02
|
| Rate for Payer: IEHP Medi-Cal |
$6.38
|
| Rate for Payer: IEHP Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.33
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN TOTAL INDIVIDUAL
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910499
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC BILIRUBIN TOTAL INDIVIDUAL
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910499
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$41.87 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.87
|
| Rate for Payer: Blue Shield of California Commercial |
$39.24
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Senior |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Humana Medicare |
$5.02
|
| Rate for Payer: IEHP Medi-Cal |
$6.38
|
| Rate for Payer: IEHP Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.33
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN TRANSCUTANEOUS
|
Facility
IP
|
$130.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
900912154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$89.31
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.01
|
| Rate for Payer: Heritage Provider Network Senior |
$88.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.50
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
|
|
HC BILIRUBIN TRANSCUTANEOUS
|
Facility
OP
|
$19.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
900912154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$41.93 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.93
|
| Rate for Payer: Blue Shield of California Commercial |
$40.97
|
| Rate for Payer: Blue Shield of California EPN |
$32.03
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Senior |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.76
|
| Rate for Payer: Heritage Provider Network Senior |
$11.76
|
| Rate for Payer: Humana Medicare |
$5.02
|
| Rate for Payer: IEHP Medi-Cal |
$6.71
|
| Rate for Payer: IEHP Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.33
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BIL STNT PLCMNT NEW ACC W CATH
|
Facility
IP
|
$21,061.00
|
|
|
Service Code
|
CPT 47540
|
| Hospital Charge Code |
909047540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,812.04 |
| Max. Negotiated Rate |
$15,795.75 |
| Rate for Payer: Adventist Health Commercial |
$4,212.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,468.91
|
| Rate for Payer: Cash Price |
$9,477.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,258.30
|
| Rate for Payer: Heritage Provider Network Senior |
$14,258.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,812.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,265.25
|
| Rate for Payer: Multiplan Commercial |
$15,795.75
|
|
