|
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: Cash Price |
$19.66
|
| 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 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 |
$19.11
|
| 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 |
$21.81
|
| Rate for Payer: Blue Shield of California EPN |
$17.45
|
| Rate for Payer: Cash Price |
$19.66
|
| 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 |
$17.05
|
| 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: Molina Healthcare of CA Medi-Cal |
$25.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.02
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| 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: Cash Price |
$19.66
|
| 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 |
$102.55
|
| 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 |
$117.04
|
| Rate for Payer: Blue Shield of California EPN |
$93.63
|
| Rate for Payer: Cash Price |
$105.53
|
| 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 |
$91.52
|
| 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: Molina Healthcare of CA Medi-Cal |
$134.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| 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: Cash Price |
$105.53
|
| 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
|
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 |
$95.41
|
| 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 |
$98.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.88
|
| Rate for Payer: Blue Shield of California Commercial |
$108.89
|
| Rate for Payer: Blue Shield of California EPN |
$87.11
|
| Rate for Payer: Cash Price |
$98.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$116.03
|
| 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 |
$116.03
|
| 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 |
$85.14
|
| 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: Molina Healthcare of CA Medi-Cal |
$124.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.95
|
| Rate for Payer: Multiplan Commercial |
$133.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$89.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$89.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.72
|
| Rate for Payer: Vantage Medical Group Senior |
$151.72
|
|
|
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: Cash Price |
$98.18
|
| 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 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 |
$102.55
|
| 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 |
$117.04
|
| Rate for Payer: Blue Shield of California EPN |
$93.63
|
| Rate for Payer: Cash Price |
$105.53
|
| 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 |
$91.52
|
| 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: Molina Healthcare of CA Medi-Cal |
$134.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| 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: Cash Price |
$105.53
|
| 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
|
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: Cash Price |
$105.53
|
| 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 |
$102.55
|
| 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 |
$117.04
|
| Rate for Payer: Blue Shield of California EPN |
$93.63
|
| Rate for Payer: Cash Price |
$105.53
|
| 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 |
$91.52
|
| 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: Molina Healthcare of CA Medi-Cal |
$134.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
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: Cash Price |
$105.53
|
| 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 |
$102.55
|
| 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 |
$117.04
|
| Rate for Payer: Blue Shield of California EPN |
$93.63
|
| Rate for Payer: Cash Price |
$105.53
|
| 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 |
$91.52
|
| 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: Molina Healthcare of CA Medi-Cal |
$134.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| 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
|
$74.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$73.69 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.84
|
| 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 |
$73.69
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.10
|
| 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 |
$48.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.81
|
| Rate for Payer: Heritage Provider Network Senior |
$45.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.50
|
| 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 |
$55.50
|
| 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
|
$74.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$55.50 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.10
|
| Rate for Payer: Heritage Provider Network Senior |
$50.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.50
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
|
|
HC POST NON-SEG INSTRUMENTATION
|
Facility
|
IP
|
$27,033.00
|
|
|
Service Code
|
CPT 22840
|
| Hospital Charge Code |
909000840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,892.97 |
| Max. Negotiated Rate |
$20,274.75 |
| Rate for Payer: Adventist Health Commercial |
$5,406.60
|
| Rate for Payer: Cash Price |
$14,868.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,301.34
|
| Rate for Payer: Heritage Provider Network Senior |
$18,301.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,892.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,758.25
|
| Rate for Payer: Multiplan Commercial |
$20,274.75
|
|
|
HC POST NON-SEG INSTRUMENTATION
|
Facility
|
OP
|
$27,033.00
|
|
|
Service Code
|
CPT 22840
|
| Hospital Charge Code |
909000840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$22,978.05 |
| Rate for Payer: Adventist Health Commercial |
$5,406.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,571.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,978.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,868.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,274.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$14,868.15
|
| Rate for Payer: Cash Price |
$14,868.15
|
| Rate for Payer: Cash Price |
$14,868.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,571.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,978.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,978.05
|
| Rate for Payer: Dignity Health Senior |
$22,978.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,733.43
|
| Rate for Payer: Heritage Provider Network Senior |
$16,733.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$595.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,894.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,892.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,758.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,923.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,923.10
|
| Rate for Payer: Multiplan Commercial |
$20,274.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,978.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,978.05
|
| Rate for Payer: Vantage Medical Group Senior |
$22,978.05
|
|
|
HC POST TRANSFUSION INVESTIGATION
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 86078
|
| Hospital Charge Code |
900904761
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Adventist Health Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$272.15
|
| Rate for Payer: Heritage Provider Network Senior |
$272.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.50
|
| Rate for Payer: Multiplan Commercial |
$301.50
|
|
|
HC POST TRANSFUSION INVESTIGATION
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 86078
|
| Hospital Charge Code |
900904761
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$71.04 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$80.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$214.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$276.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$228.09
|
| Rate for Payer: Blue Shield of California Commercial |
$245.22
|
| Rate for Payer: Blue Shield of California EPN |
$196.18
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$261.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Senior |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$217.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$248.84
|
| Rate for Payer: Heritage Provider Network Senior |
$248.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$71.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$191.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$274.34
|
| Rate for Payer: Multiplan Commercial |
$301.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$239.50
|
| Rate for Payer: TriValley Medical Group Senior |
$217.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC POST VERT ARTHRPLST 1 LMBR LVL
|
Facility
|
OP
|
$77,449.00
|
|
|
Service Code
|
CPT 0202T
|
| Hospital Charge Code |
900100964
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$65,831.65 |
| Rate for Payer: Adventist Health Commercial |
$15,489.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53,207.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65,831.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42,596.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58,086.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$42,596.95
|
| Rate for Payer: Cash Price |
$42,596.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50,341.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65,831.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$65,831.65
|
| Rate for Payer: Dignity Health Senior |
$65,831.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,469.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$47,940.93
|
| Rate for Payer: Heritage Provider Network Senior |
$47,940.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36,943.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,018.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,362.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54,214.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54,214.30
|
| Rate for Payer: Multiplan Commercial |
$58,086.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65,831.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65,831.65
|
| Rate for Payer: Vantage Medical Group Senior |
$65,831.65
|
|
|
HC POST VERT ARTHRPLST 1 LMBR LVL
|
Facility
|
IP
|
$77,449.00
|
|
|
Service Code
|
CPT 0202T
|
| Hospital Charge Code |
900100964
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,018.27 |
| Max. Negotiated Rate |
$58,086.75 |
| Rate for Payer: Adventist Health Commercial |
$15,489.80
|
| Rate for Payer: Cash Price |
$42,596.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$52,432.97
|
| Rate for Payer: Heritage Provider Network Senior |
$52,432.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,018.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,362.25
|
| Rate for Payer: Multiplan Commercial |
$58,086.75
|
|
|
HC POTASSIUM
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.33
|
| 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 |
$42.35
|
| Rate for Payer: Blue Shield of California Commercial |
$36.98
|
| Rate for Payer: Blue Shield of California EPN |
$29.66
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| 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 |
$63.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| 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 |
$73.50
|
| 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
|
$98.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC POTASSIUM
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.33
|
| 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 |
$42.35
|
| Rate for Payer: Blue Shield of California Commercial |
$36.98
|
| Rate for Payer: Blue Shield of California EPN |
$29.66
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| 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 |
$63.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| 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 |
$73.50
|
| 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
|
$98.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
