|
HC PI-LINKD AG,FLOW ADD'L MRKR,WBC
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914175
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$181.99 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.99
|
| Rate for Payer: Blue Shield of California Commercial |
$132.14
|
| Rate for Payer: Blue Shield of California EPN |
$106.27
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.38
|
| Rate for Payer: Heritage Provider Network Senior |
$25.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC PIN WORM PREP
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
900911636
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.27 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.13
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.82
|
| Rate for Payer: Heritage Provider Network Senior |
$75.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
|
|
HC PIN WORM PREP
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
900911636
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$40.53 |
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.53
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$72.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$69.33
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$53.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC PIPERACILLIN/TAZOBACTAM E TEST
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912422
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$23.16 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.41
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| 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: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$63.76
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$49.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC PIPERACILLIN/TAZOBACTAM E TEST
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912422
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.33
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.73
|
| Rate for Payer: Heritage Provider Network Senior |
$69.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
OP
|
$23,198.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
909081666
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,198.84 |
| Max. Negotiated Rate |
$17,398.50 |
| Rate for Payer: Adventist Health Commercial |
$4,639.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,336.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$10,439.10
|
| Rate for Payer: Cash Price |
$10,439.10
|
| Rate for Payer: Cash Price |
$10,439.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,078.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,156.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,359.56
|
| Rate for Payer: Heritage Provider Network Senior |
$8,802.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,598.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,198.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,230.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,799.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$17,398.50
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,872.55
|
| Rate for Payer: TriValley Medical Group Senior |
$7,872.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
IP
|
$23,198.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
909081666
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,198.84 |
| Max. Negotiated Rate |
$17,398.50 |
| Rate for Payer: Adventist Health Commercial |
$4,639.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,939.51
|
| Rate for Payer: Cash Price |
$10,439.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,705.05
|
| Rate for Payer: Heritage Provider Network Senior |
$15,705.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,198.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,799.50
|
| Rate for Payer: Multiplan Commercial |
$17,398.50
|
|
|
HC PLACENTAL ALPHA MICROGLOB-1POC
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
900912139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.11 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Adventist Health Commercial |
$54.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$168.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$593.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$484.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$484.91
|
| Rate for Payer: Blue Shield of California Commercial |
$522.09
|
| Rate for Payer: Blue Shield of California Commercial |
$522.09
|
| Rate for Payer: Blue Shield of California EPN |
$418.76
|
| Rate for Payer: Blue Shield of California EPN |
$418.76
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$176.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$624.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$98.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$98.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$98.11
|
| Rate for Payer: EPIC Health Plan Medicare |
$98.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$594.24
|
| Rate for Payer: Heritage Provider Network Senior |
$168.37
|
| Rate for Payer: Heritage Provider Network Senior |
$594.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$98.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$98.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$129.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$457.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$131.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$131.47
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$98.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$98.11
|
| Rate for Payer: TriValley Medical Group Senior |
$98.11
|
| Rate for Payer: TriValley Medical Group Senior |
$98.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$105.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$105.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$105.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$105.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.92
|
| Rate for Payer: Vantage Medical Group Senior |
$98.11
|
| Rate for Payer: Vantage Medical Group Senior |
$98.11
|
|
|
HC PLACENTAL ALPHA MICROGLOB-1POC
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
900912139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$173.76 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.24
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$649.92
|
| Rate for Payer: Heritage Provider Network Senior |
$649.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
|
|
HC PLASMA IRON TURNOVER
|
Facility
|
IP
|
$1,047.00
|
|
| Hospital Charge Code |
909301337
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$189.51 |
| Max. Negotiated Rate |
$785.25 |
| Rate for Payer: Adventist Health Commercial |
$209.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$674.27
|
| Rate for Payer: Cash Price |
$471.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$708.82
|
| Rate for Payer: Heritage Provider Network Senior |
$708.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.75
|
| Rate for Payer: Multiplan Commercial |
$785.25
|
|
|
HC PLASMA IRON TURNOVER
|
Facility
|
OP
|
$1,047.00
|
|
| Hospital Charge Code |
909301337
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$189.51 |
| Max. Negotiated Rate |
$889.95 |
| Rate for Payer: Adventist Health Commercial |
$209.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$647.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$889.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$523.71
|
| Rate for Payer: Blue Shield of California Commercial |
$638.67
|
| Rate for Payer: Blue Shield of California EPN |
$510.94
|
| Rate for Payer: Cash Price |
$471.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$680.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$889.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$889.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$889.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$680.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.09
|
| Rate for Payer: Heritage Provider Network Senior |
$648.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$499.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$732.90
|
| Rate for Payer: Multiplan Commercial |
$785.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$523.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$523.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$889.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$889.95
|
| Rate for Payer: Vantage Medical Group Senior |
$889.95
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
|
IP
|
$4,880.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$883.28 |
| Max. Negotiated Rate |
$3,660.00 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,142.72
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$883.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
|
OP
|
$4,880.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$883.28 |
| Max. Negotiated Rate |
$5,158.00 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,015.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,318.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,844.64
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,172.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,172.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,057.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,327.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$883.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,928.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,928.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC PLASTY BALLOON/ACCENT
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$120.60
|
| Rate for Payer: Blue Shield of California EPN |
$120.60
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.90
|
| Rate for Payer: Heritage Provider Network Senior |
$138.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$150.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$150.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$108.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC PLASTY BALLOON/ACCENT
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$120.60
|
| Rate for Payer: Blue Shield of California EPN |
$120.60
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.90
|
| Rate for Payer: Heritage Provider Network Senior |
$138.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$150.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$150.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$108.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.33
|
|
|
HC PLASTY BALLOON/LP/PF+ CORDIS
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$289.44
|
| Rate for Payer: Blue Shield of California EPN |
$289.44
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$331.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.36
|
| Rate for Payer: Heritage Provider Network Senior |
$333.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$360.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$360.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$360.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$260.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$238.39
|
|
|
HC PLASTY BALLOON/LP/PF+ CORDIS
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$444.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$396.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$540.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$289.44
|
| Rate for Payer: Blue Shield of California EPN |
$289.44
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$331.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$612.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$612.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.36
|
| Rate for Payer: Heritage Provider Network Senior |
$333.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$360.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$360.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$360.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$260.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$238.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$612.00
|
| Rate for Payer: Vantage Medical Group Senior |
$612.00
|
|
|
HC PLASTY BALLOON/XXL/MAXI
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$740.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$462.30
|
| Rate for Payer: Blue Shield of California EPN |
$462.30
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$529.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$621.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.45
|
| Rate for Payer: Heritage Provider Network Senior |
$532.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$575.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$575.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$575.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.50
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$415.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$380.76
|
|
|
HC PLASTY BALLOON/XXL/MAXI
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$710.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$862.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$462.30
|
| Rate for Payer: Blue Shield of California EPN |
$462.30
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$529.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$977.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$977.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$736.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.45
|
| Rate for Payer: Heritage Provider Network Senior |
$532.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$575.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$575.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$575.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$805.00
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$415.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$380.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.50
|
| Rate for Payer: Vantage Medical Group Senior |
$977.50
|
|
|
HC PLATELET AGGREGATION ASA
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 85576 QW,91
|
| Hospital Charge Code |
900912034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$26.90 |
| Max. Negotiated Rate |
$189.55 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$266.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$189.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$172.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.29
|
| Rate for Payer: Blue Shield of California Commercial |
$172.86
|
| Rate for Payer: Blue Shield of California Commercial |
$172.86
|
| Rate for Payer: Blue Shield of California EPN |
$138.65
|
| Rate for Payer: Blue Shield of California EPN |
$138.65
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$144.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$203.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$266.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$189.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$266.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$189.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$266.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.75
|
| Rate for Payer: Heritage Provider Network Senior |
$138.04
|
| Rate for Payer: Heritage Provider Network Senior |
$193.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$106.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$149.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$219.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$156.10
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$189.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$266.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$189.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$266.05
|
| Rate for Payer: Vantage Medical Group Senior |
$189.55
|
| Rate for Payer: Vantage Medical Group Senior |
$266.05
|
|
|
HC PLATELET AGGREGATION ASA
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 85576 QW,91
|
| Hospital Charge Code |
900912034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$56.65 |
| Max. Negotiated Rate |
$234.75 |
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$201.57
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.90
|
| Rate for Payer: Heritage Provider Network Senior |
$211.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.25
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
|
|
HC PLATELET AGGREGATION PRU P2Y12
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT 85576 91
|
| Hospital Charge Code |
900912033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$26.90 |
| Max. Negotiated Rate |
$262.65 |
| Rate for Payer: Adventist Health Commercial |
$61.80
|
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$262.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$312.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.29
|
| Rate for Payer: Blue Shield of California Commercial |
$172.86
|
| Rate for Payer: Blue Shield of California Commercial |
$172.86
|
| Rate for Payer: Blue Shield of California EPN |
$138.65
|
| Rate for Payer: Blue Shield of California EPN |
$138.65
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$139.05
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$139.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$200.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$270.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$353.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$262.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$262.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$353.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$262.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$191.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$257.50
|
| Rate for Payer: Heritage Provider Network Senior |
$191.27
|
| Rate for Payer: Heritage Provider Network Senior |
$257.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$147.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$198.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$291.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$216.30
|
| Rate for Payer: Multiplan Commercial |
$231.75
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$262.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$262.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.60
|
| Rate for Payer: Vantage Medical Group Senior |
$262.65
|
| Rate for Payer: Vantage Medical Group Senior |
$353.60
|
|
|
HC PLATELET AGGREGATION PRU P2Y12
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 85576 91
|
| Hospital Charge Code |
900912033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$267.90
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$281.63
|
| Rate for Payer: Heritage Provider Network Senior |
$281.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
|
|
HC PLATELET COUNT
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900910101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.54 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.64
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.56
|
| Rate for Payer: Heritage Provider Network Senior |
$80.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.75
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
|
|
HC PLATELET COUNT
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900910101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$42.51 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.51
|
| Rate for Payer: Blue Shield of California Commercial |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$36.00
|
| Rate for Payer: Blue Shield of California EPN |
$28.88
|
| Rate for Payer: Blue Shield of California EPN |
$28.88
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.81
|
| Rate for Payer: Heritage Provider Network Senior |
$73.66
|
| Rate for Payer: Heritage Provider Network Senior |
$19.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$56.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Senior |
$4.48
|
| Rate for Payer: TriValley Medical Group Senior |
$4.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Vantage Medical Group Senior |
$4.48
|
| Rate for Payer: Vantage Medical Group Senior |
$4.48
|
|
