|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
OP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
901300059
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$497.25 |
| Rate for Payer: Adventist Health Commercial |
$117.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$401.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$497.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$321.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$438.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$380.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$497.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$497.25
|
| Rate for Payer: Dignity Health Senior |
$497.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$362.12
|
| Rate for Payer: Heritage Provider Network Senior |
$362.12
|
| Rate for Payer: IEHP Medi-Cal |
$21.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$281.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.25
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$497.25
|
| Rate for Payer: Vantage Medical Group Senior |
$497.25
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
IP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
901300059
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$105.88 |
| Max. Negotiated Rate |
$438.75 |
| Rate for Payer: Adventist Health Commercial |
$117.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$401.90
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$396.04
|
| Rate for Payer: Heritage Provider Network Senior |
$396.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.25
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
|
|
HC THERAPEUTIC PROCEDURE GRP OT
|
Facility
OP
|
$184.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905104147
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Senior |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.90
|
| Rate for Payer: Heritage Provider Network Senior |
$113.90
|
| Rate for Payer: IEHP Medi-Cal |
$21.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$88.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC THERAPEUTIC PROCEDURE GRP OT
|
Facility
IP
|
$184.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905104147
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.41
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.57
|
| Rate for Payer: Heritage Provider Network Senior |
$124.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
|
|
HC THERAPEUTIC PROCEDURE GRP PT
|
Facility
IP
|
$184.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905103147
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.41
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.57
|
| Rate for Payer: Heritage Provider Network Senior |
$124.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
|
|
HC THERAPEUTIC PROCEDURE GRP PT
|
Facility
OP
|
$184.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905103147
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Senior |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.90
|
| Rate for Payer: Heritage Provider Network Senior |
$113.90
|
| Rate for Payer: IEHP Medi-Cal |
$21.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$88.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC THERAPEUTIC PROCEDURE GRP PT COMM MCARE
|
Facility
OP
|
$184.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900417151
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Senior |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.90
|
| Rate for Payer: Heritage Provider Network Senior |
$113.90
|
| Rate for Payer: IEHP Medi-Cal |
$21.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$88.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC THERAPEUTIC PROCEDURE GRP PT COMM MCARE
|
Facility
IP
|
$184.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900417151
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.41
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.57
|
| Rate for Payer: Heritage Provider Network Senior |
$124.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
|
|
HC THERAPUTIC BRONCH SUB
|
Facility
IP
|
$4,354.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
900803511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$788.07 |
| Max. Negotiated Rate |
$3,265.50 |
| Rate for Payer: Adventist Health Commercial |
$870.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,991.20
|
| Rate for Payer: Cash Price |
$1,959.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,947.66
|
| Rate for Payer: Heritage Provider Network Senior |
$2,947.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,088.50
|
| Rate for Payer: Multiplan Commercial |
$3,265.50
|
|
|
HC THERAPUTIC BRONCH SUB
|
Facility
OP
|
$4,354.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
900803511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.76 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$870.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,991.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$765.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$561.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$510.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,703.83
|
| Rate for Payer: Blue Shield of California EPN |
$2,555.80
|
| Rate for Payer: Cash Price |
$1,959.30
|
| Rate for Payer: Cash Price |
$1,959.30
|
| Rate for Payer: Cash Price |
$1,959.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,830.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.20
|
| Rate for Payer: Dignity Health Senior |
$510.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,695.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2,695.13
|
| Rate for Payer: Humana Medicare |
$510.18
|
| Rate for Payer: IEHP Medi-Cal |
$170.76
|
| Rate for Payer: IEHP Medicare Advantage |
$510.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$969.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,088.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$642.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$642.83
|
| Rate for Payer: Multiplan Commercial |
$3,265.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.20
|
| Rate for Payer: TriValley Medical Group Senior |
$561.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.20
|
| Rate for Payer: Vantage Medical Group Senior |
$510.18
|
|
|
HC THERMODILUTION CONG EVAL DEFECTS
|
Facility
IP
|
$3,517.00
|
|
|
Service Code
|
CPT 93598
|
| Hospital Charge Code |
906820098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$636.58 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$703.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,416.18
|
| Rate for Payer: Cash Price |
$1,582.65
|
| Rate for Payer: Cash Price |
$1,582.65
|
| 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 |
$636.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$879.25
|
| Rate for Payer: Multiplan Commercial |
$2,637.75
|
|
|
HC THERMODILUTION CONG EVAL DEFECTS
|
Facility
OP
|
$3,517.00
|
|
|
Service Code
|
CPT 93598
|
| Hospital Charge Code |
906820098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$636.58 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$703.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,879.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,416.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,989.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,934.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,637.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,582.65
|
| Rate for Payer: Cash Price |
$1,582.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,989.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,989.45
|
| Rate for Payer: Dignity Health Senior |
$2,989.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,286.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,177.02
|
| Rate for Payer: Heritage Provider Network Senior |
$2,177.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,695.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$636.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$879.25
|
| Rate for Payer: Multiplan Commercial |
$2,637.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,989.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,989.45
|
|
|
HC THIOCYANATE SERUM
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 84430
|
| Hospital Charge Code |
900910463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$97.37 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$33.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.37
|
| Rate for Payer: Blue Shield of California Commercial |
$90.89
|
| Rate for Payer: Blue Shield of California EPN |
$71.06
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.79
|
| Rate for Payer: Dignity Health Senior |
$11.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Humana Medicare |
$11.63
|
| Rate for Payer: IEHP Medi-Cal |
$16.13
|
| Rate for Payer: IEHP Medicare Advantage |
$11.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| 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 |
$33.75
|
| 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 |
$17.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Vantage Medical Group Senior |
$11.63
|
|
|
HC THIOCYANATE SERUM
|
Facility
IP
|
$460.00
|
|
|
Service Code
|
CPT 84430
|
| Hospital Charge Code |
900910463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$316.02
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$311.42
|
| Rate for Payer: Heritage Provider Network Senior |
$311.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
IP
|
$4,348.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
900200007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$786.99 |
| Max. Negotiated Rate |
$3,261.00 |
| Rate for Payer: Adventist Health Commercial |
$869.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,987.08
|
| Rate for Payer: Cash Price |
$1,956.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,943.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,943.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$786.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.00
|
| Rate for Payer: Multiplan Commercial |
$3,261.00
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
OP
|
$4,348.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
900200007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$869.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,987.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,956.60
|
| Rate for Payer: Cash Price |
$1,956.60
|
| Rate for Payer: Cash Price |
$1,956.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,826.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,691.41
|
| Rate for Payer: Heritage Provider Network Senior |
$965.43
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: IEHP Medi-Cal |
$144.03
|
| Rate for Payer: IEHP Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$786.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$3,261.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.39
|
| Rate for Payer: TriValley Medical Group Senior |
$863.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
OP
|
$4,348.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
909020158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$869.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,987.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,956.60
|
| Rate for Payer: Cash Price |
$1,956.60
|
| Rate for Payer: Cash Price |
$1,956.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,826.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,691.41
|
| Rate for Payer: Heritage Provider Network Senior |
$965.43
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: IEHP Medi-Cal |
$144.03
|
| Rate for Payer: IEHP Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$786.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$3,261.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.39
|
| Rate for Payer: TriValley Medical Group Senior |
$863.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
IP
|
$4,348.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
909020158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$786.99 |
| Max. Negotiated Rate |
$3,261.00 |
| Rate for Payer: Adventist Health Commercial |
$869.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,987.08
|
| Rate for Payer: Cash Price |
$1,956.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,943.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,943.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$786.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.00
|
| Rate for Payer: Multiplan Commercial |
$3,261.00
|
|
|
HC THORACENTESIS ASPIRATN WO GUID
|
Facility
IP
|
$2,291.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
901200036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$414.67 |
| Max. Negotiated Rate |
$1,718.25 |
| Rate for Payer: Adventist Health Commercial |
$458.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,573.92
|
| Rate for Payer: Cash Price |
$1,030.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,551.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,551.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.75
|
| Rate for Payer: Multiplan Commercial |
$1,718.25
|
|
|
HC THORACENTESIS ASPIRATN WO GUID
|
Facility
OP
|
$2,291.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
900800117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.58 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$458.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,573.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,030.95
|
| Rate for Payer: Cash Price |
$1,030.95
|
| Rate for Payer: Cash Price |
$1,030.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,489.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,418.13
|
| Rate for Payer: Heritage Provider Network Senior |
$965.43
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: IEHP Medi-Cal |
$115.58
|
| Rate for Payer: IEHP Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$1,718.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.39
|
| Rate for Payer: TriValley Medical Group Senior |
$863.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC THORACENTESIS ASPIRATN WO GUID
|
Facility
OP
|
$2,291.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
901200036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.58 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$458.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,573.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,030.95
|
| Rate for Payer: Cash Price |
$1,030.95
|
| Rate for Payer: Cash Price |
$1,030.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,489.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,418.13
|
| Rate for Payer: Heritage Provider Network Senior |
$965.43
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: IEHP Medi-Cal |
$115.58
|
| Rate for Payer: IEHP Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$1,718.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.39
|
| Rate for Payer: TriValley Medical Group Senior |
$863.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC THORACENTESIS ASPIRATN WO GUID
|
Facility
IP
|
$2,291.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
900800117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$414.67 |
| Max. Negotiated Rate |
$1,718.25 |
| Rate for Payer: Adventist Health Commercial |
$458.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,573.92
|
| Rate for Payer: Cash Price |
$1,030.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,551.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,551.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.75
|
| Rate for Payer: Multiplan Commercial |
$1,718.25
|
|
|
HC THORACENTESIS ASPIRATN WO GUID
|
Facility
OP
|
$2,291.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
900800117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$414.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$458.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,573.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,030.95
|
| Rate for Payer: Cash Price |
$1,030.95
|
| Rate for Payer: Cash Price |
$1,030.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,489.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,551.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,551.01
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,104.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$1,718.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$831.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$765.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC THORACENTESIS ASPIRATN WO GUID
|
Facility
IP
|
$2,291.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
900800117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$414.67 |
| Max. Negotiated Rate |
$1,718.25 |
| Rate for Payer: Adventist Health Commercial |
$458.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,573.92
|
| Rate for Payer: Cash Price |
$1,030.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,551.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,551.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.75
|
| Rate for Payer: Multiplan Commercial |
$1,718.25
|
|
|
HC THORACIC FACET JONT INJ,EA ADL
|
Facility
IP
|
$1,496.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
909000231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$270.78 |
| Max. Negotiated Rate |
$1,122.00 |
| Rate for Payer: Adventist Health Commercial |
$299.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,027.75
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,012.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,012.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.00
|
| Rate for Payer: Multiplan Commercial |
$1,122.00
|
|
