|
HC PORTEX DIC INNER CANNULA 7.0
|
Facility
|
OP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$30.39 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.81
|
| Rate for Payer: Blue Shield of California Commercial |
$22.20
|
| Rate for Payer: Blue Shield of California EPN |
$20.99
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.39
|
| Rate for Payer: Dignity Health Senior |
$30.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.13
|
| Rate for Payer: Heritage Provider Network Senior |
$22.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.39
|
| Rate for Payer: Vantage Medical Group Senior |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 8.0
|
Facility
|
IP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$26.81 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.56
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.20
|
| Rate for Payer: Heritage Provider Network Senior |
$24.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
|
|
HC PORTEX DIC INNER CANNULA 8.0
|
Facility
|
OP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$30.39 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.81
|
| Rate for Payer: Blue Shield of California Commercial |
$22.20
|
| Rate for Payer: Blue Shield of California EPN |
$20.99
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.39
|
| Rate for Payer: Dignity Health Senior |
$30.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.13
|
| Rate for Payer: Heritage Provider Network Senior |
$22.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.39
|
| Rate for Payer: Vantage Medical Group Senior |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 9.0
|
Facility
|
OP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$30.39 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.81
|
| Rate for Payer: Blue Shield of California Commercial |
$22.20
|
| Rate for Payer: Blue Shield of California EPN |
$20.99
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.39
|
| Rate for Payer: Dignity Health Senior |
$30.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.13
|
| Rate for Payer: Heritage Provider Network Senior |
$22.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.39
|
| Rate for Payer: Vantage Medical Group Senior |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 9.0
|
Facility
|
IP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$26.81 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.56
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.20
|
| Rate for Payer: Heritage Provider Network Senior |
$24.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
|
|
HC PORTEX DIC TRACH 10.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Blue Shield of California Commercial |
$119.15
|
| Rate for Payer: Blue Shield of California EPN |
$112.63
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Senior |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.77
|
| Rate for Payer: Heritage Provider Network Senior |
$118.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$92.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.97
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 10.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$143.90 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.81
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.90
|
| Rate for Payer: Heritage Provider Network Senior |
$129.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.97
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
|
|
HC PORTEX DIC TRACH 6.00MM
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$133.88 |
| Rate for Payer: Adventist Health Commercial |
$35.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.63
|
| Rate for Payer: Cash Price |
$80.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.84
|
| Rate for Payer: Heritage Provider Network Senior |
$120.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.62
|
| Rate for Payer: Multiplan Commercial |
$133.88
|
|
|
HC PORTEX DIC TRACH 6.00MM
|
Facility
|
OP
|
$178.50
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Adventist Health Commercial |
$35.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.88
|
| Rate for Payer: Blue Shield of California Commercial |
$110.85
|
| Rate for Payer: Blue Shield of California EPN |
$104.78
|
| Rate for Payer: Cash Price |
$80.33
|
| Rate for Payer: Cash Price |
$80.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$116.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.72
|
| Rate for Payer: Dignity Health Senior |
$151.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.49
|
| Rate for Payer: Heritage Provider Network Senior |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.62
|
| Rate for Payer: Multiplan Commercial |
$133.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.72
|
| Rate for Payer: Vantage Medical Group Senior |
$151.72
|
|
|
HC PORTEX DIC TRACH 7.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Blue Shield of California Commercial |
$119.15
|
| Rate for Payer: Blue Shield of California EPN |
$112.63
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Senior |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.77
|
| Rate for Payer: Heritage Provider Network Senior |
$118.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$92.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.97
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 7.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$143.90 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.81
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.90
|
| Rate for Payer: Heritage Provider Network Senior |
$129.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.97
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
|
|
HC PORTEX DIC TRACH 8.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Blue Shield of California Commercial |
$119.15
|
| Rate for Payer: Blue Shield of California EPN |
$112.63
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Senior |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.77
|
| Rate for Payer: Heritage Provider Network Senior |
$118.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$92.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.97
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 8.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$143.90 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.81
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.90
|
| Rate for Payer: Heritage Provider Network Senior |
$129.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.97
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
|
|
HC PORTEX DIC TRACH 9.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$143.90 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.81
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.90
|
| Rate for Payer: Heritage Provider Network Senior |
$129.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.97
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
|
|
HC PORTEX DIC TRACH 9.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Blue Shield of California Commercial |
$119.15
|
| Rate for Payer: Blue Shield of California EPN |
$112.63
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Senior |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.77
|
| Rate for Payer: Heritage Provider Network Senior |
$118.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$92.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.97
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC POS COMBO 43 PANEL ID
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$67.56 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.56
|
| Rate for Payer: Blue Shield of California Commercial |
$63.11
|
| Rate for Payer: Blue Shield of California EPN |
$49.34
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC POS COMBO 43 PANEL ID
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.98
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
|
|
HC POST TRANSFUSION INVESTIGATION
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 86078
|
| Hospital Charge Code |
900904761
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$55.02 |
| Max. Negotiated Rate |
$596.00 |
| Rate for Payer: Adventist Health Commercial |
$60.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$101.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$208.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.34
|
| Rate for Payer: Blue Shield of California Commercial |
$188.78
|
| Rate for Payer: Blue Shield of California EPN |
$178.45
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$197.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.18
|
| Rate for Payer: Heritage Provider Network Senior |
$188.18
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$234.75
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| 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 |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC POST TRANSFUSION INVESTIGATION
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 86078
|
| Hospital Charge Code |
900904761
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$55.02 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Adventist Health Commercial |
$60.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$208.85
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.81
|
| Rate for Payer: Heritage Provider Network Senior |
$205.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.00
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
|
|
HC POTASSIUM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$38.83 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.83
|
| Rate for Payer: Blue Shield of California Commercial |
$35.89
|
| Rate for Payer: Blue Shield of California EPN |
$28.06
|
| Rate for Payer: Cash Price |
$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 |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Senior |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$4.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.76
|
| Rate for Payer: TriValley Medical Group Senior |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC POTASSIUM
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC POTASSIUM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$38.83 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.83
|
| Rate for Payer: Blue Shield of California Commercial |
$35.89
|
| Rate for Payer: Blue Shield of California EPN |
$28.06
|
| Rate for Payer: Cash Price |
$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 |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Senior |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$4.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.76
|
| Rate for Payer: TriValley Medical Group Senior |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC POTASSIUM
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC POTASSIUM BODY FLUID
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900912245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC POTASSIUM BODY FLUID
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900912245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$14.45 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.75
|
| Rate for Payer: Blue Shield of California Commercial |
$10.56
|
| Rate for Payer: Blue Shield of California EPN |
$9.98
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.45
|
| Rate for Payer: Dignity Health Senior |
$14.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.45
|
| Rate for Payer: Vantage Medical Group Senior |
$14.45
|
|
