|
HC POOL THRPY W/EXERCISE INTL 30
|
Facility
|
OP
|
$288.00
|
|
| Hospital Charge Code |
905103311
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$118.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.00
|
| 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 |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.27
|
| Rate for Payer: Heritage Provider Network Senior |
$178.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$137.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| 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 |
$244.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
|
HC POOL THRPY W EXERCISE INTL 30 MCAL
|
Facility
|
OP
|
$411.00
|
|
| Hospital Charge Code |
900419080
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.39 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$168.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$254.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$226.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.25
|
| 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 |
$184.95
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$267.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$349.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$349.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$254.41
|
| Rate for Payer: Heritage Provider Network Senior |
$254.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$196.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$287.70
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
| 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 |
$349.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$349.35
|
| Rate for Payer: Vantage Medical Group Senior |
$349.35
|
|
|
HC POOL THRPY W EXERCISE INTL 30 MCAL
|
Facility
|
IP
|
$411.00
|
|
| Hospital Charge Code |
900419080
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.39 |
| Max. Negotiated Rate |
$308.25 |
| Rate for Payer: Adventist Health Commercial |
$82.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$264.68
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.25
|
| Rate for Payer: Heritage Provider Network Senior |
$278.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.75
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
|
|
HC PORPHOBILINOGEN QUAL
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 84106
|
| Hospital Charge Code |
900910297
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$40.65 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.65
|
| Rate for Payer: Blue Shield of California Commercial |
$34.50
|
| Rate for Payer: Blue Shield of California Commercial |
$34.50
|
| Rate for Payer: Blue Shield of California EPN |
$27.67
|
| Rate for Payer: Blue Shield of California EPN |
$27.67
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$83.56
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC PORPHOBILINOGEN QUAL
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 84106
|
| Hospital Charge Code |
900910297
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.94
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.39
|
| Rate for Payer: Heritage Provider Network Senior |
$91.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
|
|
HC PORT A CATH PERITONEAL PERM
|
Facility
|
IP
|
$1,318.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$263.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$848.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$529.84
|
| Rate for Payer: Blue Shield of California EPN |
$529.84
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$606.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$610.23
|
| Rate for Payer: Heritage Provider Network Senior |
$610.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$659.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$659.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$659.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.50
|
| Rate for Payer: Multiplan Commercial |
$988.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$476.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$436.39
|
|
|
HC PORT A CATH PERITONEAL PERM
|
Facility
|
OP
|
$1,318.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$263.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$814.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,120.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$724.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$988.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$529.84
|
| Rate for Payer: Blue Shield of California EPN |
$529.84
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$606.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,120.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,120.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,120.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$843.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$610.23
|
| Rate for Payer: Heritage Provider Network Senior |
$610.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$659.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$659.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$659.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$922.60
|
| Rate for Payer: Multiplan Commercial |
$988.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$476.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$436.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,120.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,120.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,120.30
|
|
|
HC PORTAL VEIN CATHETER
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
909081327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.51 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$97.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$302.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$415.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$366.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$220.05
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$317.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$415.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$415.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$415.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$302.69
|
| Rate for Payer: Heritage Provider Network Senior |
$302.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$233.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$342.30
|
| Rate for Payer: Multiplan Commercial |
$366.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$415.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$415.65
|
| Rate for Payer: Vantage Medical Group Senior |
$415.65
|
|
|
HC PORTAL VEIN CATHETER
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
909081327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.51 |
| Max. Negotiated Rate |
$366.75 |
| Rate for Payer: Adventist Health Commercial |
$97.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$314.92
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$331.05
|
| Rate for Payer: Heritage Provider Network Senior |
$331.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.25
|
| Rate for Payer: Multiplan Commercial |
$366.75
|
|
|
HC PORTEX DIC INNER CANNULA 10.0
|
Facility
|
IP
|
$37.47
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800824
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$28.10 |
| Rate for Payer: Adventist Health Commercial |
$7.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.13
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.37
|
| Rate for Payer: Heritage Provider Network Senior |
$25.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.37
|
| Rate for Payer: Multiplan Commercial |
$28.10
|
|
|
HC PORTEX DIC INNER CANNULA 10.0
|
Facility
|
OP
|
$37.47
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800824
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Adventist Health Commercial |
$7.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.74
|
| Rate for Payer: Blue Shield of California Commercial |
$22.86
|
| Rate for Payer: Blue Shield of California EPN |
$18.29
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.19
|
| Rate for Payer: Heritage Provider Network Senior |
$23.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.23
|
| Rate for Payer: Multiplan Commercial |
$28.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.85
|
| Rate for Payer: Vantage Medical Group Senior |
$31.85
|
|
|
HC PORTEX DIC INNER CANNULA 6.0
|
Facility
|
IP
|
$35.26
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Adventist Health Commercial |
$7.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.71
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.87
|
| Rate for Payer: Heritage Provider Network Senior |
$23.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.81
|
| Rate for Payer: Multiplan Commercial |
$26.45
|
|
|
HC PORTEX DIC INNER CANNULA 6.0
|
Facility
|
OP
|
$35.26
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$29.97 |
| Rate for Payer: Adventist Health Commercial |
$7.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.64
|
| Rate for Payer: Blue Shield of California Commercial |
$21.51
|
| Rate for Payer: Blue Shield of California EPN |
$17.21
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.83
|
| Rate for Payer: Heritage Provider Network Senior |
$21.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.68
|
| Rate for Payer: Multiplan Commercial |
$26.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.97
|
| Rate for Payer: Vantage Medical Group Senior |
$29.97
|
|
|
HC PORTEX DIC INNER CANNULA 7.0
|
Facility
|
IP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$26.81 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.02
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.20
|
| Rate for Payer: Heritage Provider Network Senior |
$24.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
|
|
HC PORTEX DIC INNER CANNULA 7.0
|
Facility
|
OP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$30.39 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.88
|
| Rate for Payer: Blue Shield of California Commercial |
$21.81
|
| Rate for Payer: Blue Shield of California EPN |
$17.45
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.13
|
| Rate for Payer: Heritage Provider Network Senior |
$22.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.02
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.39
|
| Rate for Payer: Vantage Medical Group Senior |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 8.0
|
Facility
|
OP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$30.39 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.88
|
| Rate for Payer: Blue Shield of California Commercial |
$21.81
|
| Rate for Payer: Blue Shield of California EPN |
$17.45
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.13
|
| Rate for Payer: Heritage Provider Network Senior |
$22.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.02
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.39
|
| Rate for Payer: Vantage Medical Group Senior |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 8.0
|
Facility
|
IP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$26.81 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.02
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.20
|
| Rate for Payer: Heritage Provider Network Senior |
$24.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
|
|
HC PORTEX DIC INNER CANNULA 9.0
|
Facility
|
OP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$30.39 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.88
|
| Rate for Payer: Blue Shield of California Commercial |
$21.81
|
| Rate for Payer: Blue Shield of California EPN |
$17.45
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.13
|
| Rate for Payer: Heritage Provider Network Senior |
$22.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.02
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.39
|
| Rate for Payer: Vantage Medical Group Senior |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 9.0
|
Facility
|
IP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$26.81 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.02
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.20
|
| Rate for Payer: Heritage Provider Network Senior |
$24.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
|
|
HC PORTEX DIC TRACH 10.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$143.90 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.56
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.90
|
| Rate for Payer: Heritage Provider Network Senior |
$129.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.97
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
|
|
HC PORTEX DIC TRACH 10.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.97
|
| Rate for Payer: Blue Shield of California Commercial |
$117.04
|
| Rate for Payer: Blue Shield of California EPN |
$93.63
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.77
|
| Rate for Payer: Heritage Provider Network Senior |
$118.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$91.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 6.00MM
|
Facility
|
OP
|
$178.50
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Adventist Health Commercial |
$35.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.29
|
| Rate for Payer: Blue Shield of California Commercial |
$108.89
|
| Rate for Payer: Blue Shield of California EPN |
$87.11
|
| Rate for Payer: Cash Price |
$80.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$116.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.49
|
| Rate for Payer: Heritage Provider Network Senior |
$110.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$85.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.95
|
| Rate for Payer: Multiplan Commercial |
$133.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$89.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$89.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.72
|
| Rate for Payer: Vantage Medical Group Senior |
$151.72
|
|
|
HC PORTEX DIC TRACH 6.00MM
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$133.88 |
| Rate for Payer: Adventist Health Commercial |
$35.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.95
|
| Rate for Payer: Cash Price |
$80.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.84
|
| Rate for Payer: Heritage Provider Network Senior |
$120.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.62
|
| Rate for Payer: Multiplan Commercial |
$133.88
|
|
|
HC PORTEX DIC TRACH 7.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.97
|
| Rate for Payer: Blue Shield of California Commercial |
$117.04
|
| Rate for Payer: Blue Shield of California EPN |
$93.63
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.77
|
| Rate for Payer: Heritage Provider Network Senior |
$118.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$91.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 7.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$143.90 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.56
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.90
|
| Rate for Payer: Heritage Provider Network Senior |
$129.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.97
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
|
