|
HC CATH WINGMAN CROSSING
|
Facility
OP
|
$3,881.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909000020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$702.46 |
| Max. Negotiated Rate |
$9,389.21 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9,389.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,666.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,910.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,410.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,278.15
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,522.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,298.85
|
| Rate for Payer: Dignity Health Senior |
$3,298.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,522.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,402.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2,402.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,870.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$702.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.25
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
|
|
HC CATH WINGMAN CROSSING
|
Facility
IP
|
$3,881.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909000020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$702.46 |
| Max. Negotiated Rate |
$2,910.75 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,666.25
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,627.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2,627.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$702.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.25
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
|
|
HC CAVERNOSGRAPHY INJECTION
|
Facility
OP
|
$440.00
|
|
|
Service Code
|
CPT 54230
|
| Hospital Charge Code |
909080039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$302.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$374.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$242.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$330.00
|
| 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 |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$286.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$374.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$374.00
|
| Rate for Payer: Dignity Health Senior |
$374.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$272.36
|
| Rate for Payer: Heritage Provider Network Senior |
$272.36
|
| Rate for Payer: IEHP Medi-Cal |
$95.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$212.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Multiplan Commercial |
$330.00
|
| 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 |
$374.00
|
| Rate for Payer: Vantage Medical Group Senior |
$374.00
|
|
|
HC CAVERNOSGRAPHY INJECTION
|
Facility
IP
|
$440.00
|
|
|
Service Code
|
CPT 54230
|
| Hospital Charge Code |
909080039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.64 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$302.28
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$297.88
|
| Rate for Payer: Heritage Provider Network Senior |
$297.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Multiplan Commercial |
$330.00
|
|
|
HC CBC W DIFFERENTIAL
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910093
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.15
|
| Rate for Payer: Blue Shield of California Commercial |
$50.53
|
| Rate for Payer: Blue Shield of California EPN |
$39.50
|
| 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: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$6.47
|
| Rate for Payer: IEHP Medi-Cal |
$8.91
|
| Rate for Payer: IEHP Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC W DIFFERENTIAL
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910093
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.01
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.02
|
| Rate for Payer: Heritage Provider Network Senior |
$67.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
|
|
HC CBC WITHOUT DIFFERENTIAL
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912020
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$81.75 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.88
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.79
|
| Rate for Payer: Heritage Provider Network Senior |
$73.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.25
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
|
|
HC CBC WITHOUT DIFFERENTIAL
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912020
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.15
|
| Rate for Payer: Blue Shield of California Commercial |
$50.53
|
| Rate for Payer: Blue Shield of California EPN |
$39.50
|
| 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: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$6.47
|
| Rate for Payer: IEHP Medi-Cal |
$8.91
|
| Rate for Payer: IEHP Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC WO DIFFERENTIAL
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$81.75 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.88
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.79
|
| Rate for Payer: Heritage Provider Network Senior |
$73.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.25
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
|
|
HC CBC WO DIFFERENTIAL
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.15
|
| Rate for Payer: Blue Shield of California Commercial |
$50.53
|
| Rate for Payer: Blue Shield of California EPN |
$39.50
|
| 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: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$6.47
|
| Rate for Payer: IEHP Medi-Cal |
$8.91
|
| Rate for Payer: IEHP Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC W WBC AUTO DIFF
|
Facility
IP
|
$171.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900910092
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.48
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.77
|
| Rate for Payer: Heritage Provider Network Senior |
$115.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
|
|
HC CBC W WBC AUTO DIFF
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900910092
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$65.09 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.09
|
| Rate for Payer: Blue Shield of California Commercial |
$60.71
|
| Rate for Payer: Blue Shield of California EPN |
$47.46
|
| 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: Dignity Health Commercial/Exchange |
$11.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.55
|
| Rate for Payer: Dignity Health Senior |
$7.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$7.77
|
| Rate for Payer: IEHP Medi-Cal |
$10.53
|
| Rate for Payer: IEHP Medicare Advantage |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.79
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.77
|
| Rate for Payer: TriValley Medical Group Senior |
$7.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7.77
|
|
|
HC CBC W WBC AUTO DIFFERENTIAL INDIV
|
Facility
IP
|
$153.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900912018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.11
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.58
|
| Rate for Payer: Heritage Provider Network Senior |
$103.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
|
|
HC CBC W WBC AUTO DIFFERENTIAL INDIV
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900912018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$65.09 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.09
|
| Rate for Payer: Blue Shield of California Commercial |
$60.71
|
| Rate for Payer: Blue Shield of California EPN |
$47.46
|
| 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: Dignity Health Commercial/Exchange |
$11.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.55
|
| Rate for Payer: Dignity Health Senior |
$7.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$7.77
|
| Rate for Payer: IEHP Medi-Cal |
$10.53
|
| Rate for Payer: IEHP Medicare Advantage |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.79
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.77
|
| Rate for Payer: TriValley Medical Group Senior |
$7.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7.77
|
|
|
HC CBC W WO DIFFERENTIAL INDIVIDUAL
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.15
|
| Rate for Payer: Blue Shield of California Commercial |
$50.53
|
| Rate for Payer: Blue Shield of California EPN |
$39.50
|
| 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: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$6.47
|
| Rate for Payer: IEHP Medi-Cal |
$8.91
|
| Rate for Payer: IEHP Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC W WO DIFFERENTIAL INDIVIDUAL
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.01
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.02
|
| Rate for Payer: Heritage Provider Network Senior |
$67.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
|
|
HC C DIFFICILE TOXIN A/B ASSAY
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900911750
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$75.23 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.23
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$11.98
|
| Rate for Payer: IEHP Medi-Cal |
$13.09
|
| Rate for Payer: IEHP Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC C DIFFICILE TOXIN A/B ASSAY
|
Facility
IP
|
$250.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900911750
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.75
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$169.25
|
| Rate for Payer: Heritage Provider Network Senior |
$169.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.50
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
|
|
HC CDIFF NUCLEIC ACID TEST
|
Facility
OP
|
$62.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
900912489
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$360.31 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.31
|
| Rate for Payer: Blue Shield of California Commercial |
$281.01
|
| Rate for Payer: Blue Shield of California EPN |
$219.68
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.00
|
| Rate for Payer: Dignity Health Senior |
$37.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.38
|
| Rate for Payer: Heritage Provider Network Senior |
$38.38
|
| Rate for Payer: Humana Medicare |
$37.27
|
| Rate for Payer: IEHP Medi-Cal |
$44.68
|
| Rate for Payer: IEHP Medicare Advantage |
$37.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.96
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.27
|
| Rate for Payer: TriValley Medical Group Senior |
$37.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: Vantage Medical Group Senior |
$37.27
|
|
|
HC CDIFF NUCLEIC ACID TEST
|
Facility
IP
|
$84.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
900912489
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.71
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.87
|
| Rate for Payer: Heritage Provider Network Senior |
$56.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
|
|
HC CEFINASE
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900912424
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.14
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.08
|
| Rate for Payer: Heritage Provider Network Senior |
$71.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
|
|
HC CEFINASE
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900912424
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$24.12 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.12
|
| Rate for Payer: Blue Shield of California Commercial |
$22.47
|
| Rate for Payer: Blue Shield of California EPN |
$17.57
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Humana Medicare |
$4.75
|
| Rate for Payer: IEHP Medi-Cal |
$1.89
|
| Rate for Payer: IEHP Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| 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 |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC CELIAC BLOCK INJECTION
|
Facility
OP
|
$5,230.00
|
|
|
Service Code
|
CPT 64620
|
| Hospital Charge Code |
906764620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.06 |
| Max. Negotiated Rate |
$3,922.50 |
| Rate for Payer: Adventist Health Commercial |
$1,046.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,593.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$2,353.50
|
| Rate for Payer: Cash Price |
$2,353.50
|
| Rate for Payer: Cash Price |
$2,353.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,399.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,138.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.76
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: IEHP Medi-Cal |
$155.06
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,163.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$946.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,307.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$3,922.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,252.71
|
| Rate for Payer: TriValley Medical Group Senior |
$1,252.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC CELIAC BLOCK INJECTION
|
Facility
IP
|
$5,230.00
|
|
|
Service Code
|
CPT 64620
|
| Hospital Charge Code |
906764620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$946.63 |
| Max. Negotiated Rate |
$3,922.50 |
| Rate for Payer: Adventist Health Commercial |
$1,046.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,593.01
|
| Rate for Payer: Cash Price |
$2,353.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,540.71
|
| Rate for Payer: Heritage Provider Network Senior |
$3,540.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$946.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,307.50
|
| Rate for Payer: Multiplan Commercial |
$3,922.50
|
|
|
HC CELL COUNT & DIFF
|
Facility
IP
|
$292.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
900910124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$200.60
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.68
|
| Rate for Payer: Heritage Provider Network Senior |
$197.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
|
