|
HC BIVONA PED TRACH UNCUFFED 5.0
|
Facility
|
IP
|
$375.26
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.92 |
| Max. Negotiated Rate |
$281.44 |
| Rate for Payer: Adventist Health Commercial |
$75.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$241.67
|
| Rate for Payer: Cash Price |
$168.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$254.05
|
| Rate for Payer: Heritage Provider Network Senior |
$254.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.81
|
| Rate for Payer: Multiplan Commercial |
$281.44
|
|
|
HC BIVONA PED TRACH UNCUFFED 5.0
|
Facility
|
OP
|
$375.26
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.92 |
| Max. Negotiated Rate |
$318.97 |
| Rate for Payer: Adventist Health Commercial |
$75.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$231.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$318.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$206.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$187.71
|
| Rate for Payer: Blue Shield of California Commercial |
$228.91
|
| Rate for Payer: Blue Shield of California EPN |
$183.13
|
| Rate for Payer: Cash Price |
$168.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$243.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$318.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$318.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$318.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$232.29
|
| Rate for Payer: Heritage Provider Network Senior |
$232.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$179.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$262.68
|
| Rate for Payer: Multiplan Commercial |
$281.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$187.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$187.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$318.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.97
|
| Rate for Payer: Vantage Medical Group Senior |
$318.97
|
|
|
HC BIVONA PED TRACH UNCUFFED 5.5
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$222.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$270.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.28
|
| Rate for Payer: Blue Shield of California Commercial |
$219.85
|
| Rate for Payer: Blue Shield of California EPN |
$175.88
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$234.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$223.09
|
| Rate for Payer: Heritage Provider Network Senior |
$223.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$171.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$252.29
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 5.5
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$270.31 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$232.10
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$244.00
|
| Rate for Payer: Heritage Provider Network Senior |
$244.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.10
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
|
|
HC BK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT L5450
|
| Hospital Charge Code |
905355450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$163.25 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$267.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$403.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$489.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$262.51
|
| Rate for Payer: Blue Shield of California EPN |
$262.51
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$300.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$302.34
|
| Rate for Payer: Heritage Provider Network Senior |
$302.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$326.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$457.10
|
| Rate for Payer: Multiplan Commercial |
$489.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$235.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$216.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.05
|
| Rate for Payer: Vantage Medical Group Senior |
$555.05
|
|
|
HC BK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT L5450
|
| Hospital Charge Code |
905355450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$130.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$420.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$262.51
|
| Rate for Payer: Blue Shield of California EPN |
$262.51
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$300.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$302.34
|
| Rate for Payer: Heritage Provider Network Senior |
$302.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$326.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.25
|
| Rate for Payer: Multiplan Commercial |
$489.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$235.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$216.21
|
|
|
HC BK SHRINKER
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
905358440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37.79
|
| Rate for Payer: Blue Shield of California EPN |
$37.79
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.52
|
| Rate for Payer: Heritage Provider Network Senior |
$43.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.12
|
|
|
HC BK SHRINKER
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
905358440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37.79
|
| Rate for Payer: Blue Shield of California EPN |
$37.79
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$79.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.52
|
| Rate for Payer: Heritage Provider Network Senior |
$43.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.90
|
| Rate for Payer: Vantage Medical Group Senior |
$79.90
|
|
|
HC BKV DNA QUANT PCR TEST
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913698
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$344.74 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.65
|
| Rate for Payer: Blue Shield of California Commercial |
$344.74
|
| Rate for Payer: Blue Shield of California Commercial |
$344.74
|
| Rate for Payer: Blue Shield of California EPN |
$276.51
|
| Rate for Payer: Blue Shield of California EPN |
$276.51
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.05
|
| Rate for Payer: Heritage Provider Network Senior |
$28.47
|
| Rate for Payer: Heritage Provider Network Senior |
$34.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC BKV DNA QUANT PCR TEST
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913698
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.42
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.23
|
| Rate for Payer: Heritage Provider Network Senior |
$37.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC BK VIRUS DNA DETECTION BY PCR
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913628
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$65.70 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$233.77
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.75
|
| Rate for Payer: Heritage Provider Network Senior |
$245.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.75
|
| Rate for Payer: Multiplan Commercial |
$272.25
|
|
|
HC BK VIRUS DNA DETECTION BY PCR
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913628
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$224.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.42
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$235.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.17
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.70
|
| Rate for Payer: Heritage Provider Network Senior |
$224.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$173.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$272.25
|
| 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 |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC BK VIRUS DNA QUANT
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913625
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$344.74 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Adventist Health Commercial |
$54.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.65
|
| Rate for Payer: Blue Shield of California Commercial |
$344.74
|
| Rate for Payer: Blue Shield of California Commercial |
$344.74
|
| Rate for Payer: Blue Shield of California EPN |
$276.51
|
| Rate for Payer: Blue Shield of California EPN |
$276.51
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$178.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$169.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$169.61
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$130.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$158.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$205.50
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC BK VIRUS DNA QUANT
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913625
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.81
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
IP
|
$723.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
906551700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.86 |
| Max. Negotiated Rate |
$542.25 |
| Rate for Payer: Adventist Health Commercial |
$144.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$465.61
|
| Rate for Payer: Cash Price |
$325.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$489.47
|
| Rate for Payer: Heritage Provider Network Senior |
$489.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.75
|
| Rate for Payer: Multiplan Commercial |
$542.25
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$149.32 |
| Max. Negotiated Rate |
$618.75 |
| Rate for Payer: Adventist Health Commercial |
$165.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$531.30
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$558.52
|
| Rate for Payer: Heritage Provider Network Senior |
$558.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.25
|
| Rate for Payer: Multiplan Commercial |
$618.75
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
OP
|
$723.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
906551700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.86 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$144.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$446.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$325.35
|
| Rate for Payer: Cash Price |
$325.35
|
| Rate for Payer: Cash Price |
$325.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$469.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$321.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$447.54
|
| Rate for Payer: Heritage Provider Network Senior |
$395.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$610.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$542.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$353.49
|
| Rate for Payer: TriValley Medical Group Senior |
$353.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$149.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$165.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$509.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$503.25
|
| Rate for Payer: Blue Shield of California EPN |
$402.60
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$536.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$321.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$510.68
|
| Rate for Payer: Heritage Provider Network Senior |
$510.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$393.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$618.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$353.49
|
| Rate for Payer: TriValley Medical Group Senior |
$321.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$412.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$412.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.32 |
| Max. Negotiated Rate |
$618.75 |
| Rate for Payer: Adventist Health Commercial |
$165.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$531.30
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$558.52
|
| Rate for Payer: Heritage Provider Network Senior |
$558.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.25
|
| Rate for Payer: Multiplan Commercial |
$618.75
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$165.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$509.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$391.88
|
| Rate for Payer: Blue Shield of California EPN |
$311.85
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$536.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$321.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$558.52
|
| Rate for Payer: Heritage Provider Network Senior |
$558.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$393.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$618.75
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$495.00
|
| Rate for Payer: TriValley Medical Group Senior |
$495.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC BLEEDING TIME TEMPLATE
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
900910065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$251.25 |
| Rate for Payer: Adventist Health Commercial |
$67.00
|
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$207.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.83
|
| Rate for Payer: Blue Shield of California Commercial |
$36.23
|
| Rate for Payer: Blue Shield of California Commercial |
$36.23
|
| Rate for Payer: Blue Shield of California EPN |
$29.06
|
| Rate for Payer: Blue Shield of California EPN |
$29.06
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$217.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.44
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$207.37
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$207.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$159.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.46
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.82
|
| Rate for Payer: TriValley Medical Group Senior |
$4.82
|
| Rate for Payer: TriValley Medical Group Senior |
$4.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4.82
|
|
|
HC BLEEDING TIME TEMPLATE
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
900910065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$60.63 |
| Max. Negotiated Rate |
$251.25 |
| Rate for Payer: Adventist Health Commercial |
$67.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$215.74
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$226.79
|
| Rate for Payer: Heritage Provider Network Senior |
$226.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.75
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.10 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$175.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$543.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$417.52
|
| Rate for Payer: Blue Shield of California EPN |
$332.26
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$571.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$408.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$595.08
|
| Rate for Payer: Heritage Provider Network Senior |
$595.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$419.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$659.25
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$527.40
|
| Rate for Payer: TriValley Medical Group Senior |
$527.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.10 |
| Max. Negotiated Rate |
$659.25 |
| Rate for Payer: Adventist Health Commercial |
$175.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$566.08
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$595.08
|
| Rate for Payer: Heritage Provider Network Senior |
$595.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.75
|
| Rate for Payer: Multiplan Commercial |
$659.25
|
|
|
HC BLLN ANGIO CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$6,886.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
909036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,246.37 |
| Max. Negotiated Rate |
$5,164.50 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,434.58
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,661.82
|
| Rate for Payer: Heritage Provider Network Senior |
$4,661.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,246.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,721.50
|
| Rate for Payer: Multiplan Commercial |
$5,164.50
|
|
