|
HC PREGNANCY TEST URINE
|
Facility
IP
|
$247.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
910400131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.71 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Adventist Health Commercial |
$49.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.69
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.22
|
| Rate for Payer: Heritage Provider Network Senior |
$167.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.75
|
| Rate for Payer: Multiplan Commercial |
$185.25
|
|
|
HC PREPARE FACE/ORAL PROSTHESIS
|
Facility
OP
|
$3,447.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
900501350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$689.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,251.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,368.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,551.15
|
| Rate for Payer: Cash Price |
$1,551.15
|
| Rate for Payer: Cash Price |
$1,551.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,240.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: Dignity Health Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$305.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,333.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2,333.62
|
| Rate for Payer: Humana Medicare |
$305.19
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,661.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$623.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$2,585.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,251.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,151.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC PREPARE FACE/ORAL PROSTHESIS
|
Facility
IP
|
$3,447.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
900501350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$623.91 |
| Max. Negotiated Rate |
$2,585.25 |
| Rate for Payer: Adventist Health Commercial |
$689.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,368.09
|
| Rate for Payer: Cash Price |
$1,551.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,333.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2,333.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$623.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$861.75
|
| Rate for Payer: Multiplan Commercial |
$2,585.25
|
|
|
HC PREPARE OF FECAL MICROBIOTA
|
Facility
IP
|
$1,976.00
|
|
|
Service Code
|
CPT 44705
|
| Hospital Charge Code |
906700705
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$357.66 |
| Max. Negotiated Rate |
$1,482.00 |
| Rate for Payer: Adventist Health Commercial |
$395.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,357.51
|
| Rate for Payer: Cash Price |
$889.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,337.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1,337.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.00
|
| Rate for Payer: Multiplan Commercial |
$1,482.00
|
|
|
HC PREPARE OF FECAL MICROBIOTA
|
Facility
OP
|
$1,976.00
|
|
|
Service Code
|
CPT 44705
|
| Hospital Charge Code |
906700705
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$357.66 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$395.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,357.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,679.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,086.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,482.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$889.20
|
| Rate for Payer: Cash Price |
$889.20
|
| Rate for Payer: Cash Price |
$889.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,284.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,679.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,679.60
|
| Rate for Payer: Dignity Health Senior |
$1,679.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,223.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,223.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$952.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.00
|
| Rate for Payer: Multiplan Commercial |
$1,482.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,679.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,679.60
|
|
|
HC PRE POST CHALLENGE SPIROMETRY
|
Facility
IP
|
$1,086.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
900801002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$196.57 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$746.08
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$735.22
|
| Rate for Payer: Heritage Provider Network Senior |
$735.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.50
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
|
|
HC PRE POST CHALLENGE SPIROMETRY
|
Facility
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
900801002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$70.25 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$111.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$746.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Blue Shield of California Commercial |
$208.44
|
| Rate for Payer: Blue Shield of California EPN |
$118.53
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$705.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$705.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$672.23
|
| Rate for Payer: Heritage Provider Network Senior |
$672.23
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: IEHP Medi-Cal |
$70.25
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$745.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$431.39
|
| Rate for Payer: TriValley Medical Group Senior |
$392.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC PREVIEW TRT PLANNING
|
Facility
OP
|
$770.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201982
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$139.37 |
| Max. Negotiated Rate |
$1,024.00 |
| Rate for Payer: Adventist Health Commercial |
$154.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$528.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$654.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$423.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$577.50
|
| Rate for Payer: Blue Shield of California Commercial |
$716.15
|
| Rate for Payer: Blue Shield of California EPN |
$407.25
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$654.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$654.50
|
| Rate for Payer: Dignity Health Senior |
$654.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$371.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.50
|
| Rate for Payer: Multiplan Commercial |
$577.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$654.50
|
| Rate for Payer: Vantage Medical Group Senior |
$654.50
|
|
|
HC PREVIEW TRT PLANNING
|
Facility
IP
|
$770.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201982
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$139.37 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$154.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$528.99
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$521.29
|
| Rate for Payer: Heritage Provider Network Senior |
$521.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.50
|
| Rate for Payer: Multiplan Commercial |
$577.50
|
|
|
HC PRGRMG DEV EVAL IMPLTBL SYS
|
Facility
OP
|
$121.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
900293260
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$47.12
|
| Rate for Payer: Blue Shield of California Commercial |
$75.14
|
| Rate for Payer: Blue Shield of California EPN |
$71.03
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.83
|
| Rate for Payer: Dignity Health Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$47.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.90
|
| Rate for Payer: Heritage Provider Network Senior |
$74.90
|
| Rate for Payer: Humana Medicare |
$47.12
|
| Rate for Payer: IEHP Medi-Cal |
$92.12
|
| Rate for Payer: IEHP Medicare Advantage |
$47.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$89.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.37
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.83
|
| Rate for Payer: TriValley Medical Group Senior |
$47.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Vantage Medical Group Senior |
$47.12
|
|
|
HC PRGRMG DEV EVAL IMPLTBL SYS
|
Facility
IP
|
$121.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
900293260
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.13
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.92
|
| Rate for Payer: Heritage Provider Network Senior |
$81.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR DC
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 0804T
|
| Hospital Charge Code |
906819787
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$47.12
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.83
|
| Rate for Payer: Dignity Health Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$47.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.76
|
| Rate for Payer: Heritage Provider Network Senior |
$57.96
|
| Rate for Payer: Humana Medicare |
$47.12
|
| Rate for Payer: IEHP Medicare Advantage |
$47.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$89.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.37
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.83
|
| Rate for Payer: TriValley Medical Group Senior |
$47.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Vantage Medical Group Senior |
$47.12
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR DC
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT 0804T
|
| Hospital Charge Code |
906819787
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.76
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR SC
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 0826T
|
| Hospital Charge Code |
906819776
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$47.12
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.83
|
| Rate for Payer: Dignity Health Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$47.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.76
|
| Rate for Payer: Heritage Provider Network Senior |
$57.96
|
| Rate for Payer: Humana Medicare |
$47.12
|
| Rate for Payer: IEHP Medicare Advantage |
$47.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$89.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.37
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.83
|
| Rate for Payer: TriValley Medical Group Senior |
$47.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Vantage Medical Group Senior |
$47.12
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR SC
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT 0826T
|
| Hospital Charge Code |
906819776
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.76
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
IP
|
$21,515.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906811428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,894.22 |
| Max. Negotiated Rate |
$16,136.25 |
| Rate for Payer: Adventist Health Commercial |
$4,303.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,780.80
|
| Rate for Payer: Cash Price |
$9,681.75
|
| Rate for Payer: Cash Price |
$9,681.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,894.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,378.75
|
| Rate for Payer: Multiplan Commercial |
$16,136.25
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
IP
|
$14,829.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906820231
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,684.05 |
| Max. Negotiated Rate |
$11,121.75 |
| Rate for Payer: Adventist Health Commercial |
$2,965.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,187.52
|
| Rate for Payer: Cash Price |
$6,673.05
|
| Rate for Payer: Cash Price |
$6,673.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,684.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,707.25
|
| Rate for Payer: Multiplan Commercial |
$11,121.75
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
OP
|
$21,515.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
909081843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$631.89 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$4,303.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,995.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,780.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$9,681.75
|
| Rate for Payer: Cash Price |
$9,681.75
|
| Rate for Payer: Cash Price |
$9,681.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,984.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,317.78
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medi-Cal |
$631.89
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,894.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,378.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$16,136.25
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$24,099.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
OP
|
$14,829.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906820231
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$631.89 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$2,965.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,995.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,187.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$6,673.05
|
| Rate for Payer: Cash Price |
$6,673.05
|
| Rate for Payer: Cash Price |
$6,673.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,179.15
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medi-Cal |
$631.89
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,684.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,707.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$11,121.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$21,908.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
OP
|
$21,515.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906811428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$631.89 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$4,303.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,995.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,780.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$9,681.75
|
| Rate for Payer: Cash Price |
$9,681.75
|
| Rate for Payer: Cash Price |
$9,681.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,317.78
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medi-Cal |
$631.89
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,894.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,378.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$16,136.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$21,908.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
IP
|
$21,515.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
909081843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,894.22 |
| Max. Negotiated Rate |
$16,136.25 |
| Rate for Payer: Adventist Health Commercial |
$4,303.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,780.80
|
| Rate for Payer: Cash Price |
$9,681.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,565.66
|
| Rate for Payer: Heritage Provider Network Senior |
$14,565.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,894.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,378.75
|
| Rate for Payer: Multiplan Commercial |
$16,136.25
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
OP
|
$12,452.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
906820198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$10,584.20 |
| Rate for Payer: Adventist Health Commercial |
$2,490.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,554.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,584.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,848.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,339.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$5,603.40
|
| Rate for Payer: Cash Price |
$5,603.40
|
| Rate for Payer: Cash Price |
$5,603.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,093.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,584.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,584.20
|
| Rate for Payer: Dignity Health Senior |
$10,584.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,707.79
|
| Rate for Payer: Heritage Provider Network Senior |
$7,707.79
|
| Rate for Payer: IEHP Medi-Cal |
$1,337.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,001.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,253.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,113.00
|
| Rate for Payer: Multiplan Commercial |
$9,339.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,584.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10,584.20
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
IP
|
$14,344.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
909081844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,596.26 |
| Max. Negotiated Rate |
$10,758.00 |
| Rate for Payer: Adventist Health Commercial |
$2,868.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,854.33
|
| Rate for Payer: Cash Price |
$6,454.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,710.89
|
| Rate for Payer: Heritage Provider Network Senior |
$9,710.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,596.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,586.00
|
| Rate for Payer: Multiplan Commercial |
$10,758.00
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
OP
|
$14,344.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
909081844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$12,192.40 |
| Rate for Payer: Adventist Health Commercial |
$2,868.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,854.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,192.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,889.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10,758.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$6,454.80
|
| Rate for Payer: Cash Price |
$6,454.80
|
| Rate for Payer: Cash Price |
$6,454.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,323.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,192.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,192.40
|
| Rate for Payer: Dignity Health Senior |
$12,192.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,878.94
|
| Rate for Payer: Heritage Provider Network Senior |
$8,878.94
|
| Rate for Payer: IEHP Medi-Cal |
$1,337.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,913.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,596.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,586.00
|
| Rate for Payer: Multiplan Commercial |
$10,758.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,192.40
|
| Rate for Payer: Vantage Medical Group Senior |
$12,192.40
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
IP
|
$12,452.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
906820198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,253.81 |
| Max. Negotiated Rate |
$9,339.00 |
| Rate for Payer: Adventist Health Commercial |
$2,490.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,554.52
|
| Rate for Payer: Cash Price |
$5,603.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,430.00
|
| Rate for Payer: Heritage Provider Network Senior |
$8,430.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,253.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,113.00
|
| Rate for Payer: Multiplan Commercial |
$9,339.00
|
|
