|
HC PLEURODESIS
|
Facility
IP
|
$2,163.00
|
|
|
Service Code
|
CPT 32560
|
| Hospital Charge Code |
909000202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$391.50 |
| Max. Negotiated Rate |
$1,622.25 |
| Rate for Payer: Adventist Health Commercial |
$432.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,485.98
|
| Rate for Payer: Cash Price |
$973.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,464.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,464.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.75
|
| Rate for Payer: Multiplan Commercial |
$1,622.25
|
|
|
HC PLEURX CHEST DRAIN
|
Facility
OP
|
$1,205.20
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909020015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.04 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$241.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$578.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$827.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,024.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$662.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$903.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$748.43
|
| Rate for Payer: Blue Shield of California EPN |
$707.45
|
| Rate for Payer: Cash Price |
$542.34
|
| Rate for Payer: Cash Price |
$542.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$554.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,024.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,024.42
|
| Rate for Payer: Dignity Health Senior |
$1,024.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$771.33
|
| 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 |
$439.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$402.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,024.42
|
| Rate for Payer: Vantage Medical Group Senior |
$1,024.42
|
|
|
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 |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$241.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$578.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$827.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$542.34
|
| Rate for Payer: Cash Price |
$542.34
|
| 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 |
$815.92
|
| Rate for Payer: Heritage Provider Network Senior |
$815.92
|
| 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 |
$439.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$402.66
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$887.85
|
| Rate for Payer: Cash Price |
$887.85
|
| 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 |
$1,335.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,335.72
|
| 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 |
$719.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$659.18
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$1,677.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,085.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,479.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,225.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,158.15
|
| Rate for Payer: Cash Price |
$887.85
|
| Rate for Payer: Cash Price |
$887.85
|
| 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: Multiplan Commercial |
$1,479.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$719.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$659.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,677.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,677.05
|
|
|
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: Aetna of CA Non-Gatekeeper |
$26.53
|
| Rate for Payer: Cash Price |
$17.38
|
| 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 |
$9.66
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Blue Shield of California Commercial |
$23.98
|
| Rate for Payer: Blue Shield of California EPN |
$22.67
|
| Rate for Payer: Cash Price |
$17.38
|
| 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 |
$18.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.66
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Blue Shield of California Commercial |
$23.98
|
| Rate for Payer: Blue Shield of California EPN |
$22.67
|
| Rate for Payer: Cash Price |
$17.38
|
| 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 |
$18.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.66
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
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: Aetna of CA Non-Gatekeeper |
$26.53
|
| Rate for Payer: Cash Price |
$17.38
|
| 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 |
$9.66
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Blue Shield of California Commercial |
$23.98
|
| Rate for Payer: Blue Shield of California EPN |
$22.67
|
| Rate for Payer: Cash Price |
$17.38
|
| 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 |
$18.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.66
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| 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: Aetna of CA Non-Gatekeeper |
$26.53
|
| Rate for Payer: Cash Price |
$17.38
|
| 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 |
$9.66
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
|
|
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: Aetna of CA Non-Gatekeeper |
$26.53
|
| Rate for Payer: Cash Price |
$17.38
|
| 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 |
$9.66
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Blue Shield of California Commercial |
$23.98
|
| Rate for Payer: Blue Shield of California EPN |
$22.67
|
| Rate for Payer: Cash Price |
$17.38
|
| 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 |
$18.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.66
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$26.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.24
|
| Rate for Payer: Blue Shield of California Commercial |
$19.24
|
| Rate for Payer: Blue Shield of California EPN |
$18.19
|
| Rate for Payer: Cash Price |
$13.95
|
| 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 |
$14.94
|
| 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.34
|
| Rate for Payer: Vantage Medical Group Senior |
$26.34
|
|
|
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: Aetna of CA Non-Gatekeeper |
$21.29
|
| Rate for Payer: Cash Price |
$13.95
|
| 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 PMIC110
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900913007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.63
|
| Rate for Payer: Heritage Provider Network Senior |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
|
|
HC PMIC110
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900913007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$72.35 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.35
|
| Rate for Payer: Blue Shield of California Commercial |
$67.53
|
| Rate for Payer: Blue Shield of California EPN |
$52.79
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Senior |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.95
|
| Rate for Payer: Heritage Provider Network Senior |
$17.95
|
| Rate for Payer: Humana Medicare |
$8.65
|
| Rate for Payer: IEHP Medi-Cal |
$11.72
|
| Rate for Payer: IEHP Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| 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 |
$21.75
|
| 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 |
$12.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC PNEUMOCYSTIS STAIN
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911625
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$35.73 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.73
|
| Rate for Payer: Blue Shield of California Commercial |
$33.32
|
| Rate for Payer: Blue Shield of California EPN |
$26.05
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$4.27
|
| Rate for Payer: IEHP Medi-Cal |
$5.40
|
| Rate for Payer: IEHP Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| 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 |
$12.75
|
| 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 |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC PNEUMOCYSTIS STAIN
|
Facility
IP
|
$189.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911625
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.84
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.95
|
| Rate for Payer: Heritage Provider Network Senior |
$127.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
|
|
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 |
$12,173.00 |
| 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 |
$511.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| 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 |
$504.36
|
| Rate for Payer: Heritage Provider Network Senior |
$504.36
|
| 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 |
$271.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$248.90
|
|
|
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 |
$12,139.00 |
| 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 |
$511.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$558.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$462.64
|
| Rate for Payer: Blue Shield of California EPN |
$437.32
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| 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: Multiplan Commercial |
$558.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$271.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$248.90
|
| 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
|
$179.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900910045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.97
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.18
|
| Rate for Payer: Heritage Provider Network Senior |
$121.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.75
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
|
|
HC POLYS MICRO EXAM
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900910045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$35.73 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.73
|
| Rate for Payer: Blue Shield of California Commercial |
$33.32
|
| Rate for Payer: Blue Shield of California EPN |
$26.05
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$4.27
|
| Rate for Payer: IEHP Medi-Cal |
$5.93
|
| Rate for Payer: IEHP Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| 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 |
$12.75
|
| 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 |
$6.40
|
| 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
IP
|
$305.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$228.75 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$209.54
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$206.48
|
| Rate for Payer: Heritage Provider Network Senior |
$206.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.25
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
|
|
HC POOL EXERCISE EA ADDL 15 MIN PT
|
Facility
OP
|
$305.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$209.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$228.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$198.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.25
|
| Rate for Payer: Dignity Health Senior |
$259.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.80
|
| Rate for Payer: Heritage Provider Network Senior |
$188.80
|
| Rate for Payer: IEHP Medi-Cal |
$21.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$147.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.25
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.25
|
| Rate for Payer: Vantage Medical Group Senior |
$259.25
|
|
