|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
OP
|
$639.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$80.03 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Adventist Health Commercial |
$127.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$135.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$415.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: Dignity Health Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$415.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$395.54
|
| Rate for Payer: Heritage Provider Network Senior |
$395.54
|
| Rate for Payer: Humana Medicare |
$267.80
|
| Rate for Payer: IEHP Medi-Cal |
$80.03
|
| Rate for Payer: IEHP Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$508.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.43
|
| Rate for Payer: Multiplan Commercial |
$479.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.58
|
| Rate for Payer: TriValley Medical Group Senior |
$267.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
IP
|
$639.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.66 |
| Max. Negotiated Rate |
$479.25 |
| Rate for Payer: Adventist Health Commercial |
$127.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.99
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$432.60
|
| Rate for Payer: Heritage Provider Network Senior |
$432.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.75
|
| Rate for Payer: Multiplan Commercial |
$479.25
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
OP
|
$639.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.66 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$127.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$135.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$415.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: Dignity Health Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$415.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$432.60
|
| Rate for Payer: Heritage Provider Network Senior |
$432.60
|
| Rate for Payer: Humana Medicare |
$267.80
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$308.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.43
|
| Rate for Payer: Multiplan Commercial |
$479.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$232.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$213.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC HYDROCOIL
|
Facility
OP
|
$3,744.00
|
|
| Hospital Charge Code |
909020028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$748.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,797.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,572.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,182.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,059.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,808.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,325.02
|
| Rate for Payer: Blue Shield of California EPN |
$2,197.73
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,722.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,182.40
|
| Rate for Payer: Dignity Health Senior |
$3,182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,396.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,733.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,733.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,872.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,872.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,872.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$2,808.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,365.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,250.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,182.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,182.40
|
|
|
HC HYDROCOIL
|
Facility
IP
|
$3,744.00
|
|
| Hospital Charge Code |
909020028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$748.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,797.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,572.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,722.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,021.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,534.69
|
| Rate for Payer: Heritage Provider Network Senior |
$2,534.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,872.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,872.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,872.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$2,808.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,365.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,250.87
|
|
|
HC HYDROCOIL DETACHMENT CONTROLLE
|
Facility
IP
|
$828.00
|
|
| Hospital Charge Code |
909020029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.87 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Adventist Health Commercial |
$165.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.84
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$560.56
|
| Rate for Payer: Heritage Provider Network Senior |
$560.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
|
|
HC HYDROCOIL DETACHMENT CONTROLLE
|
Facility
OP
|
$828.00
|
|
| Hospital Charge Code |
909020029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.87 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$165.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$442.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$455.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$621.00
|
| Rate for Payer: Blue Shield of California Commercial |
$514.19
|
| Rate for Payer: Blue Shield of California EPN |
$486.04
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$538.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$703.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$703.80
|
| Rate for Payer: Dignity Health Senior |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$512.53
|
| Rate for Payer: Heritage Provider Network Senior |
$512.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$399.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$703.80
|
| Rate for Payer: Vantage Medical Group Senior |
$703.80
|
|
|
HC HYSTEROSALPINGOGRAM
|
Facility
OP
|
$561.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
909000176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.54 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$112.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$385.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$476.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$308.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$420.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$252.45
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$364.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.85
|
| Rate for Payer: Dignity Health Senior |
$476.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$347.26
|
| Rate for Payer: Heritage Provider Network Senior |
$347.26
|
| Rate for Payer: IEHP Medi-Cal |
$289.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$270.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.25
|
| Rate for Payer: Multiplan Commercial |
$420.75
|
| 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 |
$476.85
|
| Rate for Payer: Vantage Medical Group Senior |
$476.85
|
|
|
HC HYSTEROSALPINGOGRAM
|
Facility
IP
|
$561.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
909000176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.54 |
| Max. Negotiated Rate |
$420.75 |
| Rate for Payer: Adventist Health Commercial |
$112.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$385.41
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$379.80
|
| Rate for Payer: Heritage Provider Network Senior |
$379.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.25
|
| Rate for Payer: Multiplan Commercial |
$420.75
|
|
|
HC HYSTEROSALPINGOGRAM EXAM
|
Facility
OP
|
$1,792.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
909001930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.88 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Adventist Health Commercial |
$358.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$135.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,231.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.38
|
| Rate for Payer: Blue Shield of California Commercial |
$266.69
|
| Rate for Payer: Blue Shield of California EPN |
$151.66
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,164.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,164.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,109.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1,109.25
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$72.88
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,344.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.16
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC HYSTEROSALPINGOGRAM EXAM
|
Facility
IP
|
$1,792.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
909001930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$324.35 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Adventist Health Commercial |
$358.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,231.10
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,213.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,213.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.00
|
| Rate for Payer: Multiplan Commercial |
$1,344.00
|
|
|
HC I-111 OXINE PER .5 MCI
|
Facility
IP
|
$1,468.00
|
|
|
Service Code
|
CPT A9547
|
| Hospital Charge Code |
909301529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$265.71 |
| Max. Negotiated Rate |
$1,101.00 |
| Rate for Payer: Adventist Health Commercial |
$293.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,008.52
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$675.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$792.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$993.84
|
| Rate for Payer: Heritage Provider Network Senior |
$993.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.00
|
| Rate for Payer: Multiplan Commercial |
$1,101.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$535.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$490.46
|
|
|
HC I-111 OXINE PER .5 MCI
|
Facility
OP
|
$1,468.00
|
|
|
Service Code
|
CPT A9547
|
| Hospital Charge Code |
909301529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$265.71 |
| Max. Negotiated Rate |
$1,247.80 |
| Rate for Payer: Adventist Health Commercial |
$293.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,247.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$807.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,101.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$577.04
|
| Rate for Payer: Blue Shield of California Commercial |
$911.63
|
| Rate for Payer: Blue Shield of California EPN |
$861.72
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$675.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,247.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,247.80
|
| Rate for Payer: Dignity Health Senior |
$1,247.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$939.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$679.68
|
| Rate for Payer: Heritage Provider Network Senior |
$679.68
|
| Rate for Payer: IEHP Medi-Cal |
$363.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$707.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.00
|
| Rate for Payer: Multiplan Commercial |
$1,101.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$535.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$490.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,247.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,247.80
|
|
|
HC I-123 CAPSULES PER 100-999 UCI
|
Facility
IP
|
$370.00
|
|
|
Service Code
|
CPT A9516
|
| Hospital Charge Code |
909301511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$254.19
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$170.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$250.49
|
| Rate for Payer: Heritage Provider Network Senior |
$250.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$134.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$123.62
|
|
|
HC I-123 CAPSULES PER 100-999 UCI
|
Facility
OP
|
$370.00
|
|
|
Service Code
|
CPT A9516
|
| Hospital Charge Code |
909301511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$314.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$314.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$203.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$277.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.91
|
| Rate for Payer: Blue Shield of California Commercial |
$229.77
|
| Rate for Payer: Blue Shield of California EPN |
$217.19
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$170.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.50
|
| Rate for Payer: Dignity Health Senior |
$314.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.31
|
| Rate for Payer: Heritage Provider Network Senior |
$171.31
|
| Rate for Payer: IEHP Medi-Cal |
$139.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$178.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$134.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$123.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.50
|
| Rate for Payer: Vantage Medical Group Senior |
$314.50
|
|
|
HC I-125 SEED
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909301514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$126.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$144.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$197.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$163.32
|
| Rate for Payer: Blue Shield of California EPN |
$154.38
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$223.55
|
| Rate for Payer: Dignity Health Senior |
$223.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.77
|
| Rate for Payer: Heritage Provider Network Senior |
$121.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$131.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.75
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$223.55
|
| Rate for Payer: Vantage Medical Group Senior |
$223.55
|
|
|
HC I-125 SEED
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909301514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$126.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.05
|
| Rate for Payer: Heritage Provider Network Senior |
$178.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$131.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.75
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.87
|
|
|
HC I-125 SERUM ALBUMIN PER 5 UCI
|
Facility
IP
|
$438.00
|
|
|
Service Code
|
CPT A9532
|
| Hospital Charge Code |
909301517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.28 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$300.91
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$201.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$296.53
|
| Rate for Payer: Heritage Provider Network Senior |
$296.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.50
|
| Rate for Payer: Multiplan Commercial |
$328.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$146.34
|
|
|
HC I-125 SERUM ALBUMIN PER 5 UCI
|
Facility
OP
|
$438.00
|
|
|
Service Code
|
CPT A9532
|
| Hospital Charge Code |
909301517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$372.30 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$372.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$240.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$328.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.48
|
| Rate for Payer: Blue Shield of California Commercial |
$272.00
|
| Rate for Payer: Blue Shield of California EPN |
$257.11
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$201.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$372.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$372.30
|
| Rate for Payer: Dignity Health Senior |
$372.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.79
|
| Rate for Payer: Heritage Provider Network Senior |
$202.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$211.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.50
|
| Rate for Payer: Multiplan Commercial |
$328.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$146.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$372.30
|
| Rate for Payer: Vantage Medical Group Senior |
$372.30
|
|
|
HC I-131 IOBENGUANE/MIBG PER.5MCI
|
Facility
IP
|
$5,753.00
|
|
|
Service Code
|
CPT A9508
|
| Hospital Charge Code |
909301519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,041.29 |
| Max. Negotiated Rate |
$4,314.75 |
| Rate for Payer: Adventist Health Commercial |
$1,150.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,952.31
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,646.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,106.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,894.78
|
| Rate for Payer: Heritage Provider Network Senior |
$3,894.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,041.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,438.25
|
| Rate for Payer: Multiplan Commercial |
$4,314.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,097.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,922.08
|
|
|
HC I-131 IOBENGUANE/MIBG PER.5MCI
|
Facility
OP
|
$5,753.00
|
|
|
Service Code
|
CPT A9508
|
| Hospital Charge Code |
909301519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$719.10 |
| Max. Negotiated Rate |
$4,890.05 |
| Rate for Payer: Adventist Health Commercial |
$1,150.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,890.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,164.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,314.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$929.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3,572.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,377.01
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,646.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,890.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,890.05
|
| Rate for Payer: Dignity Health Senior |
$4,890.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,681.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,663.64
|
| Rate for Payer: Heritage Provider Network Senior |
$2,663.64
|
| Rate for Payer: IEHP Medi-Cal |
$719.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,772.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,041.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,438.25
|
| Rate for Payer: Multiplan Commercial |
$4,314.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,097.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,922.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,890.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,890.05
|
|
|
HC I-131 SODIUM IODIDE SOL/MCI TH
|
Facility
OP
|
$189.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
909301569
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.40
|
| Rate for Payer: Blue Shield of California Commercial |
$117.37
|
| Rate for Payer: Blue Shield of California EPN |
$110.94
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.44
|
| Rate for Payer: Dignity Health Senior |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.99
|
| Rate for Payer: Heritage Provider Network Senior |
$116.99
|
| Rate for Payer: Humana Medicare |
$20.40
|
| Rate for Payer: IEHP Medicare Advantage |
$20.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.70
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.44
|
| Rate for Payer: TriValley Medical Group Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$68.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$63.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.44
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC I-131 SODIUM IODIDE SOL/MCI TH
|
Facility
IP
|
$189.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
909301569
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.84
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.95
|
| Rate for Payer: Heritage Provider Network Senior |
$127.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$68.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$63.14
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
OP
|
$7,578.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906820051
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,515.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,206.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,441.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,167.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,683.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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 |
$3,410.10
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,925.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,441.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,441.30
|
| Rate for Payer: Dignity Health Senior |
$6,441.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,925.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,690.78
|
| Rate for Payer: Heritage Provider Network Senior |
$4,690.78
|
| Rate for Payer: IEHP Medi-Cal |
$847.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,652.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,371.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,894.50
|
| Rate for Payer: Multiplan Commercial |
$5,683.50
|
| 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 |
$6,441.30
|
| Rate for Payer: Vantage Medical Group Senior |
$6,441.30
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
IP
|
$7,578.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906820051
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,371.62 |
| Max. Negotiated Rate |
$5,683.50 |
| Rate for Payer: Adventist Health Commercial |
$1,515.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,206.09
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Cash Price |
$3,410.10
|
| 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 |
$1,371.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,894.50
|
| Rate for Payer: Multiplan Commercial |
$5,683.50
|
|
