|
HC PLEURX CHEST DRAIN
|
Facility
|
IP
|
$1,205.20
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909020015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.04 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$241.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$578.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$484.49
|
| Rate for Payer: Blue Shield of California EPN |
$484.49
|
| Rate for Payer: Cash Price |
$662.86
|
| Rate for Payer: Cash Price |
$662.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$554.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$558.01
|
| Rate for Payer: Heritage Provider Network Senior |
$558.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$602.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$602.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.30
|
| Rate for Payer: Multiplan Commercial |
$903.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$435.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$399.04
|
|
|
HC PLEURX PERITONEAL DRAIN
|
Facility
|
OP
|
$1,973.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909020016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.60 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$394.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$947.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,355.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,677.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,085.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,479.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$793.15
|
| Rate for Payer: Blue Shield of California EPN |
$793.15
|
| Rate for Payer: Cash Price |
$1,085.15
|
| Rate for Payer: Cash Price |
$1,085.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$907.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,677.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,677.05
|
| Rate for Payer: Dignity Health Senior |
$1,677.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,262.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$913.50
|
| Rate for Payer: Heritage Provider Network Senior |
$913.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$986.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$986.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$986.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$493.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,381.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,381.10
|
| Rate for Payer: Multiplan Commercial |
$1,479.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$712.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$653.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,677.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,677.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,677.05
|
|
|
HC PLEURX PERITONEAL DRAIN
|
Facility
|
IP
|
$1,973.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909020016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.60 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$394.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$947.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$793.15
|
| Rate for Payer: Blue Shield of California EPN |
$793.15
|
| Rate for Payer: Cash Price |
$1,085.15
|
| Rate for Payer: Cash Price |
$1,085.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$907.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,065.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$913.50
|
| Rate for Payer: Heritage Provider Network Senior |
$913.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$986.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$986.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$986.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$493.25
|
| Rate for Payer: Multiplan Commercial |
$1,479.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$712.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$653.26
|
|
|
HC PLEXA PROMRI SD 65/18
|
Facility
|
OP
|
$7,400.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
900102747
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,339.40 |
| Max. Negotiated Rate |
$6,290.00 |
| Rate for Payer: Adventist Health Commercial |
$1,480.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,552.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,083.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,290.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,070.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,550.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,974.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,974.80
|
| Rate for Payer: Cash Price |
$4,070.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,404.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,290.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,290.00
|
| Rate for Payer: Dignity Health Senior |
$6,290.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,736.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,426.20
|
| Rate for Payer: Heritage Provider Network Senior |
$3,426.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,529.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,339.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,850.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,180.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,180.00
|
| Rate for Payer: Multiplan Commercial |
$5,550.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,673.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,450.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,290.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,290.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,290.00
|
|
|
HC PLEXA PROMRI SD 65/18
|
Facility
|
IP
|
$7,400.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
900102747
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,339.40 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$1,480.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,552.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,974.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,974.80
|
| Rate for Payer: Cash Price |
$4,070.00
|
| Rate for Payer: Cash Price |
$4,070.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,404.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,996.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,426.20
|
| Rate for Payer: Heritage Provider Network Senior |
$3,426.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,339.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,850.00
|
| Rate for Payer: Multiplan Commercial |
$5,550.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,673.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,450.14
|
|
|
HC PLUG DECANNULATION 10.0
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
900800861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Blue Shield of California Commercial |
$23.56
|
| Rate for Payer: Blue Shield of California EPN |
$18.85
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.83
|
| Rate for Payer: Dignity Health Senior |
$32.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.91
|
| Rate for Payer: Heritage Provider Network Senior |
$23.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.03
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
HC PLUG DECANNULATION 10.0
|
Facility
|
IP
|
$38.62
|
|
| Hospital Charge Code |
900800861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$28.96 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.15
|
| Rate for Payer: Heritage Provider Network Senior |
$26.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.65
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
|
|
HC PLUG DECANNULATION 4.0
|
Facility
|
IP
|
$38.62
|
|
| Hospital Charge Code |
900800858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$28.96 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.15
|
| Rate for Payer: Heritage Provider Network Senior |
$26.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.65
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
|
|
HC PLUG DECANNULATION 4.0
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
900800858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Blue Shield of California Commercial |
$23.56
|
| Rate for Payer: Blue Shield of California EPN |
$18.85
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.83
|
| Rate for Payer: Dignity Health Senior |
$32.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.91
|
| Rate for Payer: Heritage Provider Network Senior |
$23.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.03
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
HC PLUG DECANNULATION 6.0
|
Facility
|
IP
|
$38.62
|
|
| Hospital Charge Code |
900800859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$28.96 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.15
|
| Rate for Payer: Heritage Provider Network Senior |
$26.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.65
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
|
|
HC PLUG DECANNULATION 6.0
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
900800859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Blue Shield of California Commercial |
$23.56
|
| Rate for Payer: Blue Shield of California EPN |
$18.85
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.83
|
| Rate for Payer: Dignity Health Senior |
$32.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.91
|
| Rate for Payer: Heritage Provider Network Senior |
$23.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.03
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
HC PLUG DECANNULATION 8.0
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
900800860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Blue Shield of California Commercial |
$23.56
|
| Rate for Payer: Blue Shield of California EPN |
$18.85
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.83
|
| Rate for Payer: Dignity Health Senior |
$32.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.91
|
| Rate for Payer: Heritage Provider Network Senior |
$23.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.03
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
HC PLUG DECANNULATION 8.0
|
Facility
|
IP
|
$38.62
|
|
| Hospital Charge Code |
900800860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$28.96 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.15
|
| Rate for Payer: Heritage Provider Network Senior |
$26.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.65
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
|
|
HC PLUG SHILEY DISP DECANNULATION
|
Facility
|
IP
|
$30.99
|
|
| Hospital Charge Code |
900800857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$23.24 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$17.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.98
|
| Rate for Payer: Heritage Provider Network Senior |
$20.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$23.24
|
|
|
HC PLUG SHILEY DISP DECANNULATION
|
Facility
|
OP
|
$30.99
|
|
| Hospital Charge Code |
900800857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$26.34 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.24
|
| Rate for Payer: Blue Shield of California Commercial |
$18.90
|
| Rate for Payer: Blue Shield of California EPN |
$15.12
|
| Rate for Payer: Cash Price |
$17.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.34
|
| Rate for Payer: Dignity Health Senior |
$26.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.18
|
| Rate for Payer: Heritage Provider Network Senior |
$19.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.69
|
| Rate for Payer: Multiplan Commercial |
$23.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.34
|
| Rate for Payer: Vantage Medical Group Senior |
$26.34
|
|
|
HC PMIC110
|
Facility
|
IP
|
$92.47
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900913007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.74 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Adventist Health Commercial |
$18.49
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.60
|
| Rate for Payer: Heritage Provider Network Senior |
$62.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.12
|
| Rate for Payer: Multiplan Commercial |
$69.35
|
|
|
HC PMIC110
|
Facility
|
OP
|
$92.47
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900913007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$78.92 |
| Rate for Payer: Adventist Health Commercial |
$18.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.92
|
| Rate for Payer: Blue Shield of California Commercial |
$69.58
|
| Rate for Payer: Blue Shield of California EPN |
$55.81
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Senior |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.11
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.24
|
| Rate for Payer: Heritage Provider Network Senior |
$57.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.90
|
| Rate for Payer: Multiplan Commercial |
$69.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.65
|
| Rate for Payer: TriValley Medical Group Senior |
$8.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC PNEUMOCYSTIS STAIN
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911625
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.57
|
| Rate for Payer: Heritage Provider Network Senior |
$124.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
|
|
HC PNEUMOCYSTIS STAIN
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911625
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.97
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.90
|
| Rate for Payer: Heritage Provider Network Senior |
$113.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$87.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC PNEUMOTHORAX SET (COOK)
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$357.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$299.49
|
| Rate for Payer: Blue Shield of California EPN |
$299.49
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$342.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.94
|
| Rate for Payer: Heritage Provider Network Senior |
$344.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$372.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$372.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$269.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$246.67
|
|
|
HC PNEUMOTHORAX SET (COOK)
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$357.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$511.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$299.49
|
| Rate for Payer: Blue Shield of California EPN |
$299.49
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$342.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.25
|
| Rate for Payer: Dignity Health Senior |
$633.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.94
|
| Rate for Payer: Heritage Provider Network Senior |
$344.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$372.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$372.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$521.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$521.50
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$269.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$246.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC POLYS MICRO EXAM
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900910045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.09
|
| Rate for Payer: Heritage Provider Network Senior |
$115.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.50
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
|
|
HC POLYS MICRO EXAM
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900910045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.97
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.23
|
| Rate for Payer: Heritage Provider Network Senior |
$105.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC POOL EXERCISE EA ADDL 15 MIN PT
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.57 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$118.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$155.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$199.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$188.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Senior |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$179.51
|
| Rate for Payer: Heritage Provider Network Senior |
$179.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$138.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC POOL EXERCISE EA ADDL 15 MIN PT
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$217.50 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$196.33
|
| Rate for Payer: Heritage Provider Network Senior |
$196.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.50
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
|
