|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
IP
|
$804.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.52 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Adventist Health Commercial |
$160.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$552.35
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$544.31
|
| Rate for Payer: Heritage Provider Network Senior |
$544.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.00
|
| Rate for Payer: Multiplan Commercial |
$603.00
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
OP
|
$804.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.52 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$160.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$552.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$522.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: Dignity Health Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$363.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$544.31
|
| Rate for Payer: Heritage Provider Network Senior |
$544.31
|
| Rate for Payer: Humana Medicare |
$363.98
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$363.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$387.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$458.61
|
| Rate for Payer: Multiplan Commercial |
$603.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$291.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$268.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC BLLN ANGIO CNTRL DIALYSIS SEG
|
Facility
IP
|
$10,324.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
909036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,868.64 |
| Max. Negotiated Rate |
$7,743.00 |
| Rate for Payer: Adventist Health Commercial |
$2,064.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,092.59
|
| Rate for Payer: Cash Price |
$4,645.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,989.35
|
| Rate for Payer: Heritage Provider Network Senior |
$6,989.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,868.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,581.00
|
| Rate for Payer: Multiplan Commercial |
$7,743.00
|
|
|
HC BLLN ANGIO CNTRL DIALYSIS SEG
|
Facility
OP
|
$10,324.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
909036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,064.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,092.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8,775.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,678.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,743.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$4,645.80
|
| Rate for Payer: Cash Price |
$4,645.80
|
| Rate for Payer: Cash Price |
$4,645.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,710.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,775.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,775.40
|
| Rate for Payer: Dignity Health Senior |
$8,775.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,390.56
|
| Rate for Payer: Heritage Provider Network Senior |
$6,390.56
|
| Rate for Payer: IEHP Medi-Cal |
$1,038.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,976.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,868.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,581.00
|
| Rate for Payer: Multiplan Commercial |
$7,743.00
|
| 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 |
$8,775.40
|
| Rate for Payer: Vantage Medical Group Senior |
$8,775.40
|
|
|
HC BLLN ANGIOPLASTY, PULM, ADD'L
|
Facility
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 92998
|
| Hospital Charge Code |
906820076
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$442.59 |
| Max. Negotiated Rate |
$13,016.90 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11,485.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,954.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,016.90
|
| Rate for Payer: Dignity Health Senior |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,479.37
|
| Rate for Payer: Heritage Provider Network Senior |
$9,479.37
|
| Rate for Payer: IEHP Medi-Cal |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,381.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,771.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC BLLN ANGIOPLASTY, PULM, ADD'L
|
Facility
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 92998
|
| Hospital Charge Code |
906820076
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,771.83 |
| Max. Negotiated Rate |
$11,485.50 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,771.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
|
|
HC BLLN ANGIOPLASTY, PULM, INIT
|
Facility
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 92997
|
| Hospital Charge Code |
906820075
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,954.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,479.37
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$849.90
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,771.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$13,745.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC BLLN ANGIOPLASTY, PULM, INIT
|
Facility
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 92997
|
| Hospital Charge Code |
906820075
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,771.83 |
| Max. Negotiated Rate |
$11,485.50 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,771.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
|
|
HC BLLN DILATION URETERAL STRCTR
|
Facility
OP
|
$4,886.00
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
909050706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$977.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,356.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,153.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,687.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,664.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,175.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,153.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,153.10
|
| Rate for Payer: Dignity Health Senior |
$4,153.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,024.43
|
| Rate for Payer: Heritage Provider Network Senior |
$3,024.43
|
| Rate for Payer: IEHP Medi-Cal |
$1,091.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,355.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.50
|
| Rate for Payer: Multiplan Commercial |
$3,664.50
|
| 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 |
$4,153.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,153.10
|
|
|
HC BLLN DILATION URETERAL STRCTR
|
Facility
IP
|
$4,886.00
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
909050706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$884.37 |
| Max. Negotiated Rate |
$3,664.50 |
| Rate for Payer: Adventist Health Commercial |
$977.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,356.68
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,307.82
|
| Rate for Payer: Heritage Provider Network Senior |
$3,307.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.50
|
| Rate for Payer: Multiplan Commercial |
$3,664.50
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
IP
|
$258.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
901200031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.25
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.67
|
| Rate for Payer: Heritage Provider Network Senior |
$174.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
IP
|
$258.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
901200031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.25
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.67
|
| Rate for Payer: Heritage Provider Network Senior |
$174.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
OP
|
$258.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
901200031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.20
|
| Rate for Payer: Blue Shield of California Commercial |
$160.22
|
| Rate for Payer: Blue Shield of California EPN |
$151.45
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$167.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.70
|
| Rate for Payer: Heritage Provider Network Senior |
$159.70
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$159.60
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
OP
|
$258.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
901200031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$167.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.67
|
| Rate for Payer: Heritage Provider Network Senior |
$174.67
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$124.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$93.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$86.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC BLOOD DRAW LT 3YRS FEM/JUGULAR
|
Facility
IP
|
$77.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
900501687
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.90
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.13
|
| Rate for Payer: Heritage Provider Network Senior |
$52.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
|
|
HC BLOOD DRAW LT 3YRS FEM/JUGULAR
|
Facility
OP
|
$77.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
900501687
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$57.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.45
|
| Rate for Payer: Dignity Health Senior |
$65.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.13
|
| Rate for Payer: Heritage Provider Network Senior |
$52.13
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Vantage Medical Group Senior |
$65.45
|
|
|
HC BLOOD GAS AND COOXIMETRY
|
Facility
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
900801109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$1,065.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$82.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$975.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$118.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$86.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$78.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.32
|
| Rate for Payer: Blue Shield of California Commercial |
$221.64
|
| Rate for Payer: Blue Shield of California EPN |
$173.27
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$923.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.65
|
| Rate for Payer: Dignity Health Senior |
$78.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$78.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$878.98
|
| Rate for Payer: Heritage Provider Network Senior |
$878.98
|
| Rate for Payer: Humana Medicare |
$78.77
|
| Rate for Payer: IEHP Medi-Cal |
$37.91
|
| Rate for Payer: IEHP Medicare Advantage |
$78.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$149.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.25
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$78.77
|
| Rate for Payer: TriValley Medical Group Senior |
$78.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$85.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$85.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$118.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.65
|
| Rate for Payer: Vantage Medical Group Senior |
$78.77
|
|
|
HC BLOOD GAS AND COOXIMETRY
|
Facility
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
900801109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$257.02 |
| Max. Negotiated Rate |
$1,065.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$975.54
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$961.34
|
| Rate for Payer: Heritage Provider Network Senior |
$961.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
|
|
HC BLOOD GAS CHLORIDE
|
Facility
IP
|
$110.00
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
900801121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC BLOOD GAS CHLORIDE
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
900801121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.83
|
| Rate for Payer: Blue Shield of California Commercial |
$35.89
|
| Rate for Payer: Blue Shield of California EPN |
$28.06
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.06
|
| Rate for Payer: Dignity Health Senior |
$4.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Humana Medicare |
$4.60
|
| Rate for Payer: IEHP Medi-Cal |
$4.70
|
| Rate for Payer: IEHP Medicare Advantage |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.60
|
| Rate for Payer: TriValley Medical Group Senior |
$4.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.06
|
| Rate for Payer: Vantage Medical Group Senior |
$4.60
|
|
|
HC BLOOD GASES CH
|
Facility
OP
|
$38.47
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
900912188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$235.32 |
| Rate for Payer: Adventist Health Commercial |
$7.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$82.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$118.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$86.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$78.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.32
|
| Rate for Payer: Blue Shield of California Commercial |
$221.64
|
| Rate for Payer: Blue Shield of California EPN |
$173.27
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.65
|
| Rate for Payer: Dignity Health Senior |
$78.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$78.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.81
|
| Rate for Payer: Heritage Provider Network Senior |
$23.81
|
| Rate for Payer: Humana Medicare |
$78.77
|
| Rate for Payer: IEHP Medi-Cal |
$37.91
|
| Rate for Payer: IEHP Medicare Advantage |
$78.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$149.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.25
|
| Rate for Payer: Multiplan Commercial |
$28.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$78.77
|
| Rate for Payer: TriValley Medical Group Senior |
$78.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$85.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$85.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$118.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.65
|
| Rate for Payer: Vantage Medical Group Senior |
$78.77
|
|
|
HC BLOOD GASES CH
|
Facility
IP
|
$38.47
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
900912188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$28.85 |
| Rate for Payer: Adventist Health Commercial |
$7.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.43
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.04
|
| Rate for Payer: Heritage Provider Network Senior |
$26.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.62
|
| Rate for Payer: Multiplan Commercial |
$28.85
|
|
|
HC BLOOD GAS POTASSIUM
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900801122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.83
|
| Rate for Payer: Blue Shield of California Commercial |
$35.89
|
| Rate for Payer: Blue Shield of California EPN |
$28.06
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Senior |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Humana Medicare |
$4.76
|
| Rate for Payer: IEHP Medi-Cal |
$5.37
|
| Rate for Payer: IEHP Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.76
|
| Rate for Payer: TriValley Medical Group Senior |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC BLOOD GAS POTASSIUM
|
Facility
IP
|
$110.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900801122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC BLOOD GAS SODIUM
|
Facility
IP
|
$110.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900801123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
