|
HC PORTEX DIC TRACH 8.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800827
|
|
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 8.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800827
|
|
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 9.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800828
|
|
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 9.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800828
|
|
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 POS COMBO 43 PANEL ID
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$55.50 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.66
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.10
|
| Rate for Payer: Heritage Provider Network Senior |
$50.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.50
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
|
|
HC POS COMBO 43 PANEL ID
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$76.64 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| 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 Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| 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: 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 Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.81
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$45.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC POST NON-SEG INSTRUMENTATION
|
Facility
|
OP
|
$27,033.00
|
|
|
Service Code
|
CPT 22840
|
| Hospital Charge Code |
909000840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$22,978.05 |
| Rate for Payer: Adventist Health Commercial |
$5,406.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,706.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,978.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,868.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,274.75
|
| 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 |
$12,164.85
|
| Rate for Payer: Cash Price |
$12,164.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,571.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,978.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,978.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,978.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,733.43
|
| Rate for Payer: Heritage Provider Network Senior |
$16,733.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,894.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,892.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,758.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,923.10
|
| Rate for Payer: Multiplan Commercial |
$20,274.75
|
| 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 |
$22,978.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,978.05
|
| Rate for Payer: Vantage Medical Group Senior |
$22,978.05
|
|
|
HC POST NON-SEG INSTRUMENTATION
|
Facility
|
IP
|
$27,033.00
|
|
|
Service Code
|
CPT 22840
|
| Hospital Charge Code |
909000840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,892.97 |
| Max. Negotiated Rate |
$20,274.75 |
| Rate for Payer: Adventist Health Commercial |
$5,406.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,409.25
|
| Rate for Payer: Cash Price |
$12,164.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,301.34
|
| Rate for Payer: Heritage Provider Network Senior |
$18,301.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,892.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,758.25
|
| Rate for Payer: Multiplan Commercial |
$20,274.75
|
|
|
HC POST TRANSFUSION INVESTIGATION
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 86078
|
| Hospital Charge Code |
900904761
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Adventist Health Commercial |
$80.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$258.89
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$272.15
|
| Rate for Payer: Heritage Provider Network Senior |
$272.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.50
|
| Rate for Payer: Multiplan Commercial |
$301.50
|
|
|
HC POST TRANSFUSION INVESTIGATION
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 86078
|
| Hospital Charge Code |
900904761
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$80.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$248.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$225.92
|
| Rate for Payer: Blue Shield of California Commercial |
$245.22
|
| Rate for Payer: Blue Shield of California EPN |
$196.18
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$261.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$248.84
|
| Rate for Payer: Heritage Provider Network Senior |
$248.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$191.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$301.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$241.03
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC POST VERT ARTHRPLST 1 LMBR LVL
|
Facility
|
IP
|
$77,449.00
|
|
|
Service Code
|
CPT 0202T
|
| Hospital Charge Code |
900100964
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,018.27 |
| Max. Negotiated Rate |
$58,086.75 |
| Rate for Payer: Adventist Health Commercial |
$15,489.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49,877.16
|
| Rate for Payer: Cash Price |
$34,852.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$52,432.97
|
| Rate for Payer: Heritage Provider Network Senior |
$52,432.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,018.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,362.25
|
| Rate for Payer: Multiplan Commercial |
$58,086.75
|
|
|
HC POST VERT ARTHRPLST 1 LMBR LVL
|
Facility
|
OP
|
$77,449.00
|
|
|
Service Code
|
CPT 0202T
|
| Hospital Charge Code |
900100964
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,245.00 |
| Max. Negotiated Rate |
$58,086.75 |
| Rate for Payer: Adventist Health Commercial |
$15,489.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47,863.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,512.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$34,852.05
|
| Rate for Payer: Cash Price |
$34,852.05
|
| Rate for Payer: Cash Price |
$34,852.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50,341.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,163.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,512.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,469.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$16,512.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$47,940.93
|
| Rate for Payer: Heritage Provider Network Senior |
$20,310.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31,374.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,018.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,989.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,362.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,127.00
|
| Rate for Payer: Multiplan Commercial |
$58,086.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18,163.96
|
| Rate for Payer: TriValley Medical Group Senior |
$18,163.96
|
| 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 |
$24,769.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Vantage Medical Group Senior |
$16,512.69
|
|
|
HC POTASSIUM
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.11
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC POTASSIUM
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.04
|
| Rate for Payer: Blue Shield of California Commercial |
$36.98
|
| Rate for Payer: Blue Shield of California Commercial |
$36.98
|
| Rate for Payer: Blue Shield of California EPN |
$29.66
|
| Rate for Payer: Blue Shield of California EPN |
$29.66
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.76
|
| Rate for Payer: TriValley Medical Group Senior |
$4.76
|
| Rate for Payer: TriValley Medical Group Senior |
$4.76
|
| 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 |
$7.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC POTASSIUM
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.04
|
| Rate for Payer: Blue Shield of California Commercial |
$36.98
|
| Rate for Payer: Blue Shield of California Commercial |
$36.98
|
| Rate for Payer: Blue Shield of California EPN |
$29.66
|
| Rate for Payer: Blue Shield of California EPN |
$29.66
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.76
|
| Rate for Payer: TriValley Medical Group Senior |
$4.76
|
| Rate for Payer: TriValley Medical Group Senior |
$4.76
|
| 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 |
$7.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC POTASSIUM
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900910488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.11
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC POTASSIUM BODY FLUID
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900912245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.03
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.96
|
| Rate for Payer: Heritage Provider Network Senior |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
|
|
HC POTASSIUM BODY FLUID
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900912245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.51
|
| Rate for Payer: Blue Shield of California Commercial |
$17.08
|
| Rate for Payer: Blue Shield of California Commercial |
$16.47
|
| Rate for Payer: Blue Shield of California EPN |
$13.18
|
| Rate for Payer: Blue Shield of California EPN |
$13.66
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.71
|
| Rate for Payer: Heritage Provider Network Senior |
$16.71
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.90
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.80
|
| Rate for Payer: Vantage Medical Group Senior |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$23.80
|
|
|
HC POTASSIUM CH
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900912185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.74
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Heritage Provider Network Senior |
$57.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
|
|
HC POTASSIUM CH
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900912185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.04
|
| Rate for Payer: Blue Shield of California Commercial |
$36.98
|
| Rate for Payer: Blue Shield of California EPN |
$29.66
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.62
|
| Rate for Payer: Heritage Provider Network Senior |
$52.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$40.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.76
|
| Rate for Payer: TriValley Medical Group Senior |
$4.76
|
| 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: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC POTASSIUM POC
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900912117
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.04
|
| Rate for Payer: Blue Shield of California Commercial |
$36.98
|
| Rate for Payer: Blue Shield of California EPN |
$29.66
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.33
|
| Rate for Payer: Heritage Provider Network Senior |
$56.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$43.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.76
|
| Rate for Payer: TriValley Medical Group Senior |
$4.76
|
| 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: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC POTASSIUM POC
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900912117
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.60
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.61
|
| Rate for Payer: Heritage Provider Network Senior |
$61.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.75
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
|
|
HC POTASSIUM STOOL
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.85
|
| Rate for Payer: Blue Shield of California Commercial |
$34.62
|
| Rate for Payer: Blue Shield of California Commercial |
$34.62
|
| Rate for Payer: Blue Shield of California EPN |
$27.77
|
| Rate for Payer: Blue Shield of California EPN |
$27.77
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$122.56
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$94.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.34
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.73
|
| Rate for Payer: TriValley Medical Group Senior |
$4.73
|
| Rate for Payer: TriValley Medical Group Senior |
$4.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
|
|
HC POTASSIUM STOOL
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.51
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.05
|
| Rate for Payer: Heritage Provider Network Senior |
$134.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
|
|
HC POTASSIUM URINE
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.35
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.21
|
| Rate for Payer: Heritage Provider Network Senior |
$79.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.25
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
|
