|
HC CO2
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
900910258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.73
|
| Rate for Payer: Blue Shield of California Commercial |
$38.18
|
| Rate for Payer: Blue Shield of California EPN |
$29.85
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.37
|
| Rate for Payer: Dignity Health Senior |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$4.88
|
| Rate for Payer: IEHP Medi-Cal |
$2.12
|
| Rate for Payer: IEHP Medicare Advantage |
$4.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.15
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.88
|
| Rate for Payer: TriValley Medical Group Senior |
$4.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
HC CO57 CYANOCOBALAMIN UP TO 1MCI
|
Facility
OP
|
$395.00
|
|
|
Service Code
|
CPT A9559
|
| Hospital Charge Code |
909301530
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$335.75 |
| Rate for Payer: Adventist Health Commercial |
$79.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$335.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$217.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$296.25
|
| Rate for Payer: Blue Shield of California Commercial |
$245.30
|
| Rate for Payer: Blue Shield of California EPN |
$231.86
|
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$181.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$335.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.75
|
| Rate for Payer: Dignity Health Senior |
$335.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.88
|
| Rate for Payer: Heritage Provider Network Senior |
$182.88
|
| Rate for Payer: IEHP Medi-Cal |
$202.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$190.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.75
|
| Rate for Payer: Multiplan Commercial |
$296.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$144.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.75
|
| Rate for Payer: Vantage Medical Group Senior |
$335.75
|
|
|
HC CO57 CYANOCOBALAMIN UP TO 1MCI
|
Facility
IP
|
$395.00
|
|
|
Service Code
|
CPT A9559
|
| Hospital Charge Code |
909301530
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$296.25 |
| Rate for Payer: Adventist Health Commercial |
$79.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$271.36
|
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$181.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$267.42
|
| Rate for Payer: Heritage Provider Network Senior |
$267.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.75
|
| Rate for Payer: Multiplan Commercial |
$296.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$144.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.97
|
|
|
HC COAG FVIII INHIB EVAL BTHSDA U
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900913970
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.18
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC COAG FVIII INHIB EVAL BTHSDA U
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900913970
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$107.74 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.74
|
| Rate for Payer: Blue Shield of California Commercial |
$100.56
|
| Rate for Payer: Blue Shield of California EPN |
$78.62
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Humana Medicare |
$12.87
|
| Rate for Payer: IEHP Medi-Cal |
$17.85
|
| Rate for Payer: IEHP Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.87
|
| Rate for Payer: TriValley Medical Group Senior |
$12.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC COAG TIME ACTIVATED
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900910011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$35.61 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.61
|
| Rate for Payer: Blue Shield of California Commercial |
$33.26
|
| Rate for Payer: Blue Shield of California EPN |
$26.00
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: Dignity Health Senior |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Senior |
$16.09
|
| Rate for Payer: Humana Medicare |
$4.28
|
| Rate for Payer: IEHP Medi-Cal |
$5.69
|
| Rate for Payer: IEHP Medicare Advantage |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.28
|
| Rate for Payer: TriValley Medical Group Senior |
$4.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
HC COAG TIME ACTIVATED
|
Facility
IP
|
$299.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900910011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$54.12 |
| Max. Negotiated Rate |
$224.25 |
| Rate for Payer: Adventist Health Commercial |
$59.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.41
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.42
|
| Rate for Payer: Heritage Provider Network Senior |
$202.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.75
|
| Rate for Payer: Multiplan Commercial |
$224.25
|
|
|
HC COCAINE METABOLITE CONF
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900910518
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$168.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.72
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: Dignity Health Senior |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.28
|
| Rate for Payer: Heritage Provider Network Senior |
$139.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$108.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC COCAINE METABOLITE CONF
|
Facility
IP
|
$271.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900910518
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$203.25 |
| Rate for Payer: Adventist Health Commercial |
$54.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.18
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.47
|
| Rate for Payer: Heritage Provider Network Senior |
$183.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.75
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
|
|
HC CO DIFFUSION CAPACITY
|
Facility
OP
|
$608.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
900801004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$75.19 |
| Max. Negotiated Rate |
$516.80 |
| Rate for Payer: Adventist Health Commercial |
$121.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$417.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$516.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$334.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$456.00
|
| Rate for Payer: Blue Shield of California Commercial |
$260.26
|
| Rate for Payer: Blue Shield of California EPN |
$148.00
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$395.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$516.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$516.80
|
| Rate for Payer: Dignity Health Senior |
$516.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$395.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.35
|
| Rate for Payer: Heritage Provider Network Senior |
$376.35
|
| Rate for Payer: IEHP Medi-Cal |
$75.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$293.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.00
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$516.80
|
| Rate for Payer: Vantage Medical Group Senior |
$516.80
|
|
|
HC CO DIFFUSION CAPACITY
|
Facility
IP
|
$608.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
900801004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$110.05 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Adventist Health Commercial |
$121.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$417.70
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$411.62
|
| Rate for Payer: Heritage Provider Network Senior |
$411.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.00
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
|
|
HC COIL AXIUM
|
Facility
OP
|
$3,375.00
|
|
| Hospital Charge Code |
909020035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$675.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,318.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,868.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,856.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,531.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,095.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,981.12
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,552.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,868.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,868.75
|
| Rate for Payer: Dignity Health Senior |
$2,868.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,160.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,562.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,562.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,687.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,687.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,687.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.75
|
| Rate for Payer: Multiplan Commercial |
$2,531.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,230.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,127.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,868.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,868.75
|
|
|
HC COIL AXIUM
|
Facility
IP
|
$3,375.00
|
|
| Hospital Charge Code |
909020035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$675.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,318.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,552.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,822.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,284.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,284.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,687.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,687.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,687.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.75
|
| Rate for Payer: Multiplan Commercial |
$2,531.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,230.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,127.59
|
|
|
HC COIL AXIUM 3D
|
Facility
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
|
|
HC COIL AXIUM 3D
|
Facility
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,084.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,421.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,289.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,535.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,414.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,414.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,879.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL CASHMERE
|
Facility
IP
|
$4,575.00
|
|
| Hospital Charge Code |
909020101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$828.08 |
| Max. Negotiated Rate |
$3,431.25 |
| Rate for Payer: Adventist Health Commercial |
$915.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,143.02
|
| Rate for Payer: Cash Price |
$2,058.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,097.28
|
| Rate for Payer: Heritage Provider Network Senior |
$3,097.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$828.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,143.75
|
| Rate for Payer: Multiplan Commercial |
$3,431.25
|
|
|
HC COIL CASHMERE
|
Facility
OP
|
$4,575.00
|
|
| Hospital Charge Code |
909020101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$828.08 |
| Max. Negotiated Rate |
$3,888.75 |
| Rate for Payer: Adventist Health Commercial |
$915.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,445.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,143.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,888.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,516.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,431.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,841.08
|
| Rate for Payer: Blue Shield of California EPN |
$2,685.52
|
| Rate for Payer: Cash Price |
$2,058.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,973.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,888.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,888.75
|
| Rate for Payer: Dignity Health Senior |
$3,888.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,973.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,831.92
|
| Rate for Payer: Heritage Provider Network Senior |
$2,831.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,205.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$828.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,143.75
|
| Rate for Payer: Multiplan Commercial |
$3,431.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,888.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,888.75
|
|
|
HC COIL DELTA PLUSH
|
Facility
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,084.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,421.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,289.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,535.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,414.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,414.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,879.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL DELTA PLUSH
|
Facility
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
|
|
HC COIL GDC-10
|
Facility
IP
|
$4,850.00
|
|
| Hospital Charge Code |
909020104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$877.85 |
| Max. Negotiated Rate |
$3,637.50 |
| Rate for Payer: Adventist Health Commercial |
$970.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,331.95
|
| Rate for Payer: Cash Price |
$2,182.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,283.45
|
| Rate for Payer: Heritage Provider Network Senior |
$3,283.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$877.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,212.50
|
| Rate for Payer: Multiplan Commercial |
$3,637.50
|
|
|
HC COIL GDC-10
|
Facility
OP
|
$4,850.00
|
|
| Hospital Charge Code |
909020104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$877.85 |
| Max. Negotiated Rate |
$4,122.50 |
| Rate for Payer: Adventist Health Commercial |
$970.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,592.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,331.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,122.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,667.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,637.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,011.85
|
| Rate for Payer: Blue Shield of California EPN |
$2,846.95
|
| Rate for Payer: Cash Price |
$2,182.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,152.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,122.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,122.50
|
| Rate for Payer: Dignity Health Senior |
$4,122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,152.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,002.15
|
| Rate for Payer: Heritage Provider Network Senior |
$3,002.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,337.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$877.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,212.50
|
| Rate for Payer: Multiplan Commercial |
$3,637.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,122.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.50
|
|
|
HC COIL GDC-18 FIBERED
|
Facility
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,084.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,421.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,289.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,535.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,414.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,414.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,879.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL GDC-18 FIBERED
|
Facility
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
|
|
HC COIL GDC 360 STANDARD
|
Facility
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
|
|
HC COIL GDC 360 STANDARD
|
Facility
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,084.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,421.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,289.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,535.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,414.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,414.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,879.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
