|
HC THERAPUTIC BRONCH SUB
|
Facility
|
OP
|
$4,756.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
900803511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$951.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,267.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$740.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$542.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$493.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,901.16
|
| Rate for Payer: Blue Shield of California EPN |
$2,320.93
|
| Rate for Payer: Cash Price |
$2,615.80
|
| Rate for Payer: Cash Price |
$2,615.80
|
| Rate for Payer: Cash Price |
$2,615.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,091.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$740.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$542.73
|
| Rate for Payer: Dignity Health Senior |
$493.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$493.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,943.96
|
| Rate for Payer: Heritage Provider Network Senior |
$2,943.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$493.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,268.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$860.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$567.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,189.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$621.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$621.67
|
| Rate for Payer: Multiplan Commercial |
$3,567.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$542.73
|
| Rate for Payer: TriValley Medical Group Senior |
$542.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,378.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,378.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$740.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$542.73
|
| Rate for Payer: Vantage Medical Group Senior |
$493.39
|
|
|
HC THERAPUTIC BRONCH SUB
|
Facility
|
IP
|
$4,756.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
900803511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$860.84 |
| Max. Negotiated Rate |
$3,567.00 |
| Rate for Payer: Adventist Health Commercial |
$951.20
|
| Rate for Payer: Cash Price |
$2,615.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,219.81
|
| Rate for Payer: Heritage Provider Network Senior |
$3,219.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$860.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,189.00
|
| Rate for Payer: Multiplan Commercial |
$3,567.00
|
|
|
HC THERMAL DEST INRA BN INCL IG 1ST 2 VB LUM OR SAC
|
Facility
|
OP
|
$47,276.00
|
|
|
Service Code
|
CPT 64628
|
| Hospital Charge Code |
909050628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$35,457.00 |
| Rate for Payer: Adventist Health Commercial |
$9,455.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32,478.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,522.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,983.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,348.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$26,001.80
|
| Rate for Payer: Cash Price |
$26,001.80
|
| Rate for Payer: Cash Price |
$26,001.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30,729.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,522.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,983.44
|
| Rate for Payer: Dignity Health Senior |
$16,348.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,365.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$16,348.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$29,263.84
|
| Rate for Payer: Heritage Provider Network Senior |
$20,108.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$633.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,348.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31,062.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,556.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,800.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,819.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,599.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,599.21
|
| Rate for Payer: Multiplan Commercial |
$35,457.00
|
| Rate for Payer: Multiplan WC |
$26,048.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$17,983.44
|
| Rate for Payer: TriValley Medical Group Senior |
$17,983.44
|
| 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 |
$24,522.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,983.44
|
| Rate for Payer: Vantage Medical Group Senior |
$16,348.58
|
|
|
HC THERMAL DEST INRA BN INCL IG 1ST 2 VB LUM OR SAC
|
Facility
|
IP
|
$47,276.00
|
|
|
Service Code
|
CPT 64628
|
| Hospital Charge Code |
909050628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,556.96 |
| Max. Negotiated Rate |
$35,457.00 |
| Rate for Payer: Adventist Health Commercial |
$9,455.20
|
| Rate for Payer: Cash Price |
$26,001.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$32,005.85
|
| Rate for Payer: Heritage Provider Network Senior |
$32,005.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,556.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,819.00
|
| Rate for Payer: Multiplan Commercial |
$35,457.00
|
|
|
HC THERMAL DEST INRA BN INCL IG EA ADDL VB LUM OR SAC
|
Facility
|
OP
|
$23,638.00
|
|
|
Service Code
|
CPT 64629
|
| Hospital Charge Code |
909050629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$20,092.30 |
| Rate for Payer: Adventist Health Commercial |
$4,727.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,239.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,092.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,000.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,728.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$13,000.90
|
| Rate for Payer: Cash Price |
$13,000.90
|
| Rate for Payer: Cash Price |
$13,000.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,364.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,092.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,092.30
|
| Rate for Payer: Dignity Health Senior |
$20,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,182.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,631.92
|
| Rate for Payer: Heritage Provider Network Senior |
$14,631.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$291.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,275.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,909.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,546.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,546.60
|
| Rate for Payer: Multiplan Commercial |
$17,728.50
|
| 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 |
$20,092.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,092.30
|
| Rate for Payer: Vantage Medical Group Senior |
$20,092.30
|
|
|
HC THERMAL DEST INRA BN INCL IG EA ADDL VB LUM OR SAC
|
Facility
|
IP
|
$23,638.00
|
|
|
Service Code
|
CPT 64629
|
| Hospital Charge Code |
909050629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,278.48 |
| Max. Negotiated Rate |
$17,728.50 |
| Rate for Payer: Adventist Health Commercial |
$4,727.60
|
| Rate for Payer: Cash Price |
$13,000.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,002.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16,002.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,909.50
|
| Rate for Payer: Multiplan Commercial |
$17,728.50
|
|
|
HC THERMODILUTION CONGENITAL
|
Facility
|
IP
|
$3,319.00
|
|
|
Service Code
|
CPT 93561
|
| Hospital Charge Code |
906811494
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$600.74 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$663.80
|
| Rate for Payer: Cash Price |
$1,825.45
|
| Rate for Payer: Cash Price |
$1,825.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$600.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$829.75
|
| Rate for Payer: Multiplan Commercial |
$2,489.25
|
|
|
HC THERMODILUTION CONGENITAL
|
Facility
|
OP
|
$3,319.00
|
|
|
Service Code
|
CPT 93561
|
| Hospital Charge Code |
906811494
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$600.74 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$663.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,774.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,280.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,821.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,825.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,489.25
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,825.45
|
| Rate for Payer: Cash Price |
$1,825.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,821.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,821.15
|
| Rate for Payer: Dignity Health Senior |
$2,821.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,157.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,054.46
|
| Rate for Payer: Heritage Provider Network Senior |
$2,054.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,583.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$600.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$829.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,323.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,323.30
|
| Rate for Payer: Multiplan Commercial |
$2,489.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,659.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,659.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,821.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,821.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,821.15
|
|
|
HC THERMODILUTION CONGENITAL ADDL
|
Facility
|
OP
|
$1,660.00
|
|
|
Service Code
|
CPT 93562
|
| Hospital Charge Code |
906811495
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$300.46 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$332.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$887.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,140.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,411.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$913.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,245.00
|
| 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 |
$913.00
|
| Rate for Payer: Cash Price |
$913.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,411.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,411.00
|
| Rate for Payer: Dignity Health Senior |
$1,411.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,079.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,027.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,027.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$791.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,162.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,162.00
|
| Rate for Payer: Multiplan Commercial |
$1,245.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$830.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$830.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,411.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,411.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,411.00
|
|
|
HC THERMODILUTION CONGENITAL ADDL
|
Facility
|
IP
|
$1,660.00
|
|
|
Service Code
|
CPT 93562
|
| Hospital Charge Code |
906811495
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$300.46 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$332.00
|
| Rate for Payer: Cash Price |
$913.00
|
| Rate for Payer: Cash Price |
$913.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.00
|
| Rate for Payer: Multiplan Commercial |
$1,245.00
|
|
|
HC THERMODILUTION CONG EVAL DEFECTS
|
Facility
|
OP
|
$3,341.00
|
|
|
Service Code
|
CPT 93598
|
| Hospital Charge Code |
906820098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$604.72 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$668.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,785.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,295.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,839.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,837.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,505.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,837.55
|
| Rate for Payer: Cash Price |
$1,837.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,839.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,839.85
|
| Rate for Payer: Dignity Health Senior |
$2,839.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,171.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,068.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,068.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,593.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$604.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,338.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,338.70
|
| Rate for Payer: Multiplan Commercial |
$2,505.75
|
| 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 |
$2,839.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,839.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,839.85
|
|
|
HC THERMODILUTION CONG EVAL DEFECTS
|
Facility
|
IP
|
$3,341.00
|
|
|
Service Code
|
CPT 93598
|
| Hospital Charge Code |
906820098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$604.72 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$668.20
|
| Rate for Payer: Cash Price |
$1,837.55
|
| Rate for Payer: Cash Price |
$1,837.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$604.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.25
|
| Rate for Payer: Multiplan Commercial |
$2,505.75
|
|
|
HC THIOCYANATE SERUM
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 84430
|
| Hospital Charge Code |
900910463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.59
|
| Rate for Payer: Heritage Provider Network Senior |
$344.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
|
|
HC THIOCYANATE SERUM
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 84430
|
| Hospital Charge Code |
900910463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$272.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.21
|
| Rate for Payer: Blue Shield of California Commercial |
$93.66
|
| Rate for Payer: Blue Shield of California EPN |
$75.12
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.79
|
| Rate for Payer: Dignity Health Senior |
$11.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$242.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.65
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.63
|
| Rate for Payer: TriValley Medical Group Senior |
$11.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Vantage Medical Group Senior |
$11.63
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
|
OP
|
$4,093.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
900200007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$818.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,811.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$2,251.15
|
| Rate for Payer: Cash Price |
$2,251.15
|
| Rate for Payer: Cash Price |
$2,251.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,660.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Senior |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$785.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,533.57
|
| Rate for Payer: Heritage Provider Network Senior |
$966.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$149.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,492.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$740.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$903.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,023.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.81
|
| Rate for Payer: Multiplan Commercial |
$3,069.75
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$864.12
|
| Rate for Payer: TriValley Medical Group Senior |
$864.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
|
OP
|
$4,093.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
909020158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$818.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,811.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$2,251.15
|
| Rate for Payer: Cash Price |
$2,251.15
|
| Rate for Payer: Cash Price |
$2,251.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,660.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Senior |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$785.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,533.57
|
| Rate for Payer: Heritage Provider Network Senior |
$966.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$149.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,492.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$740.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$903.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,023.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.81
|
| Rate for Payer: Multiplan Commercial |
$3,069.75
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$864.12
|
| Rate for Payer: TriValley Medical Group Senior |
$864.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
|
IP
|
$4,093.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
909020158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$740.83 |
| Max. Negotiated Rate |
$3,069.75 |
| Rate for Payer: Adventist Health Commercial |
$818.60
|
| Rate for Payer: Cash Price |
$2,251.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,770.96
|
| Rate for Payer: Heritage Provider Network Senior |
$2,770.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$740.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,023.25
|
| Rate for Payer: Multiplan Commercial |
$3,069.75
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
|
IP
|
$4,093.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
900200007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$740.83 |
| Max. Negotiated Rate |
$3,069.75 |
| Rate for Payer: Adventist Health Commercial |
$818.60
|
| Rate for Payer: Cash Price |
$2,251.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,770.96
|
| Rate for Payer: Heritage Provider Network Senior |
$2,770.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$740.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,023.25
|
| Rate for Payer: Multiplan Commercial |
$3,069.75
|
|
|
HC THORACENTESIS ASPIRATN WO GUID
|
Facility
|
OP
|
$2,502.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
900800117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$500.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,718.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,626.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Senior |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$785.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,548.74
|
| Rate for Payer: Heritage Provider Network Senior |
$966.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$120.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,492.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$903.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.81
|
| Rate for Payer: Multiplan Commercial |
$1,876.50
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$864.12
|
| Rate for Payer: TriValley Medical Group Senior |
$864.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC THORACENTESIS ASPIRATN WO GUID
|
Facility
|
IP
|
$2,502.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
900800117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.86 |
| Max. Negotiated Rate |
$1,876.50 |
| Rate for Payer: Adventist Health Commercial |
$500.40
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,693.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,693.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.50
|
| Rate for Payer: Multiplan Commercial |
$1,876.50
|
|
|
HC THORACENTESIS ASPIRATN WO GUID
|
Facility
|
IP
|
$2,502.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
901200036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.86 |
| Max. Negotiated Rate |
$1,876.50 |
| Rate for Payer: Adventist Health Commercial |
$500.40
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,693.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,693.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.50
|
| Rate for Payer: Multiplan Commercial |
$1,876.50
|
|
|
HC THORACENTESIS ASPIRATN WO GUID
|
Facility
|
OP
|
$2,502.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
901200036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$500.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,718.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,626.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Senior |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$785.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,548.74
|
| Rate for Payer: Heritage Provider Network Senior |
$966.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$120.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,492.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$903.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.81
|
| Rate for Payer: Multiplan Commercial |
$1,876.50
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$864.12
|
| Rate for Payer: TriValley Medical Group Senior |
$864.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC THORACENTESIS ASPIRATN WO GUID
|
Facility
|
IP
|
$2,502.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
900800117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$452.86 |
| Max. Negotiated Rate |
$1,876.50 |
| Rate for Payer: Adventist Health Commercial |
$500.40
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,693.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,693.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.50
|
| Rate for Payer: Multiplan Commercial |
$1,876.50
|
|
|
HC THORACENTESIS ASPIRATN WO GUID
|
Facility
|
OP
|
$2,502.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
900800117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$500.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,718.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,626.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Senior |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$785.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,693.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,693.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,193.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$903.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.81
|
| Rate for Payer: Multiplan Commercial |
$1,876.50
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$900.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$828.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC THORACIC FACET JONT INJ,EA ADL
|
Facility
|
IP
|
$1,634.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
909000231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$295.75 |
| Max. Negotiated Rate |
$1,225.50 |
| Rate for Payer: Adventist Health Commercial |
$326.80
|
| Rate for Payer: Cash Price |
$898.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,106.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,106.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.50
|
| Rate for Payer: Multiplan Commercial |
$1,225.50
|
|
