|
HC PHYS THER COMB MODAL/PROC EA ADDL 15 MIN
|
Facility
|
OP
|
$78.00
|
|
| Hospital Charge Code |
905103305
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$31.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.28
|
| Rate for Payer: Heritage Provider Network Senior |
$48.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.30
|
| Rate for Payer: Vantage Medical Group Senior |
$66.30
|
|
|
HC PHYS THER COMB MODAL/PROC EA ADDL 15 MIN
|
Facility
|
IP
|
$78.00
|
|
| Hospital Charge Code |
905103305
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.23
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.81
|
| Rate for Payer: Heritage Provider Network Senior |
$52.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
|
|
HC PHYS THER COMB MODAL/PROC EA ADDL 15 MIN MCAL
|
Facility
|
IP
|
$78.00
|
|
| Hospital Charge Code |
900419031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.23
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.81
|
| Rate for Payer: Heritage Provider Network Senior |
$52.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
|
|
HC PHYS THER COMB MODAL/PROC EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$78.00
|
|
| Hospital Charge Code |
900419031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$31.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.28
|
| Rate for Payer: Heritage Provider Network Senior |
$48.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.30
|
| Rate for Payer: Vantage Medical Group Senior |
$66.30
|
|
|
HC PHYS THER COMB MODAL/PROC INIT 30 MIN
|
Facility
|
IP
|
$160.00
|
|
| Hospital Charge Code |
905103304
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.04
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
|
|
HC PHYS THER COMB MODAL/PROC INIT 30 MIN
|
Facility
|
OP
|
$160.00
|
|
| Hospital Charge Code |
905103304
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$104.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.04
|
| Rate for Payer: Heritage Provider Network Senior |
$99.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$76.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.00
|
| Rate for Payer: Vantage Medical Group Senior |
$136.00
|
|
|
HC PHYS THER COMB MODAL/PROC INIT 30 MIN MCAL
|
Facility
|
IP
|
$234.00
|
|
| Hospital Charge Code |
900419030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Adventist Health Commercial |
$46.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$150.70
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$158.42
|
| Rate for Payer: Heritage Provider Network Senior |
$158.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$175.50
|
|
|
HC PHYS THER COMB MODAL/PROC INIT 30 MIN MCAL
|
Facility
|
OP
|
$234.00
|
|
| Hospital Charge Code |
900419030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$95.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$198.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$152.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$198.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.85
|
| Rate for Payer: Heritage Provider Network Senior |
$144.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$111.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$175.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$198.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.90
|
| Rate for Payer: Vantage Medical Group Senior |
$198.90
|
|
|
HC PHYS THER ELECT STIM UNATTEND WOUND CARE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900407057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$68.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$102.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$141.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.75
|
| Rate for Payer: Heritage Provider Network Senior |
$102.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$79.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$116.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.10
|
| Rate for Payer: Vantage Medical Group Senior |
$141.10
|
|
|
HC PHYS THER ELECT STIM UNATTEND WOUND CARE
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900407057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.90
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.38
|
| Rate for Payer: Heritage Provider Network Senior |
$112.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
|
|
HC PICC KIT DUAL LUMEN
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$262.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$164.02
|
| Rate for Payer: Blue Shield of California EPN |
$164.02
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.90
|
| Rate for Payer: Heritage Provider Network Senior |
$188.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$204.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$204.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$204.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$135.09
|
|
|
HC PICC KIT DUAL LUMEN
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Vantage Medical Group Senior |
$346.80
|
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$252.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$164.02
|
| Rate for Payer: Blue Shield of California EPN |
$164.02
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.90
|
| Rate for Payer: Heritage Provider Network Senior |
$188.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$204.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$204.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$204.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$135.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.80
|
|
|
HC PICC KIT SINGLE LUMEN
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$194.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$121.40
|
| Rate for Payer: Blue Shield of California EPN |
$121.40
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.83
|
| Rate for Payer: Heritage Provider Network Senior |
$139.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$151.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$151.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.50
|
| Rate for Payer: Multiplan Commercial |
$226.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$109.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.99
|
|
|
HC PICC KIT SINGLE LUMEN
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$121.40
|
| Rate for Payer: Blue Shield of California EPN |
$121.40
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$256.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$256.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.83
|
| Rate for Payer: Heritage Provider Network Senior |
$139.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$151.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$151.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$211.40
|
| Rate for Payer: Multiplan Commercial |
$226.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$109.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.70
|
| Rate for Payer: Vantage Medical Group Senior |
$256.70
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
OP
|
$3,757.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$680.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$751.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,321.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,784.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,420.15
|
| Rate for Payer: Cash Price |
$1,690.65
|
| Rate for Payer: Cash Price |
$1,690.65
|
| Rate for Payer: Cash Price |
$1,690.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,442.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,024.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,543.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2,543.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,792.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$680.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,328.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$939.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$2,817.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,254.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,254.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
IP
|
$3,757.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$680.02 |
| Max. Negotiated Rate |
$2,817.75 |
| Rate for Payer: Adventist Health Commercial |
$751.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,419.51
|
| Rate for Payer: Cash Price |
$1,690.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,543.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2,543.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$680.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$939.25
|
| Rate for Payer: Multiplan Commercial |
$2,817.75
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
IP
|
$3,757.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$680.02 |
| Max. Negotiated Rate |
$2,817.75 |
| Rate for Payer: Adventist Health Commercial |
$751.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,419.51
|
| Rate for Payer: Cash Price |
$1,690.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,543.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2,543.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$680.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$939.25
|
| Rate for Payer: Multiplan Commercial |
$2,817.75
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
OP
|
$3,757.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$680.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$751.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,321.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$1,690.65
|
| Rate for Payer: Cash Price |
$1,690.65
|
| Rate for Payer: Cash Price |
$1,690.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,442.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,024.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,325.58
|
| Rate for Payer: Heritage Provider Network Senior |
$2,490.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,846.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$680.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,328.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$939.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$2,817.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,227.09
|
| Rate for Payer: TriValley Medical Group Senior |
$2,227.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC PICC/MIDLINE INSERTION LT 5 YRS
|
Facility
|
OP
|
$5,324.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
901200081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$963.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,064.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,290.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,247.64
|
| Rate for Payer: Blue Shield of California EPN |
$2,598.11
|
| Rate for Payer: Cash Price |
$2,395.80
|
| Rate for Payer: Cash Price |
$2,395.80
|
| Rate for Payer: Cash Price |
$2,395.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,460.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,024.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,295.56
|
| Rate for Payer: Heritage Provider Network Senior |
$3,295.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,539.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$963.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,328.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$3,993.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,024.63
|
| Rate for Payer: TriValley Medical Group Senior |
$2,024.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,662.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,662.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC PICC/MIDLINE INSERTION LT 5 YRS
|
Facility
|
IP
|
$5,324.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
901200081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$963.64 |
| Max. Negotiated Rate |
$3,993.00 |
| Rate for Payer: Adventist Health Commercial |
$1,064.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,428.66
|
| Rate for Payer: Cash Price |
$2,395.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,604.35
|
| Rate for Payer: Heritage Provider Network Senior |
$3,604.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$963.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.00
|
| Rate for Payer: Multiplan Commercial |
$3,993.00
|
|
|
HC PID
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$76.64 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.14
|
| 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 |
$76.64
|
| 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 |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Heritage Provider Network Senior |
$32.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| 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 PID
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.49
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.20
|
| Rate for Payer: Heritage Provider Network Senior |
$35.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
|
|
HC PI-LINKD AG, FLOW 1ST MRKR WBC
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914174
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$93.94 |
| Max. Negotiated Rate |
$691.53 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$320.74
|
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$370.36
|
| Rate for Payer: Blue Shield of California Commercial |
$269.52
|
| Rate for Payer: Blue Shield of California EPN |
$216.74
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$337.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$461.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$321.26
|
| Rate for Payer: Heritage Provider Network Senior |
$321.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$247.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$530.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.77
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$461.02
|
| Rate for Payer: TriValley Medical Group Senior |
$461.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
HC PI-LINKD AG, FLOW 1ST MRKR WBC
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914174
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$93.94 |
| Max. Negotiated Rate |
$389.25 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$334.24
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$351.36
|
| Rate for Payer: Heritage Provider Network Senior |
$351.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.75
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
|
|
HC PI-LINKD AG,FLOW ADD'L MRKR,WBC
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914175
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.40
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.76
|
| Rate for Payer: Heritage Provider Network Senior |
$27.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
|
