|
HC TIPS CATHETER SET
|
Facility
IP
|
$1,062.00
|
|
| Hospital Charge Code |
909081222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.22 |
| Max. Negotiated Rate |
$796.50 |
| Rate for Payer: Adventist Health Commercial |
$212.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$729.59
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$718.97
|
| Rate for Payer: Heritage Provider Network Senior |
$718.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.50
|
| Rate for Payer: Multiplan Commercial |
$796.50
|
|
|
HC TIPS CATHETER SET
|
Facility
OP
|
$1,062.00
|
|
| Hospital Charge Code |
909081222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.22 |
| Max. Negotiated Rate |
$902.70 |
| Rate for Payer: Adventist Health Commercial |
$212.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$567.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$729.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$902.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$584.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$796.50
|
| Rate for Payer: Blue Shield of California Commercial |
$659.50
|
| Rate for Payer: Blue Shield of California EPN |
$623.39
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$690.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$902.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$902.70
|
| Rate for Payer: Dignity Health Senior |
$902.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.38
|
| Rate for Payer: Heritage Provider Network Senior |
$657.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$511.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.50
|
| Rate for Payer: Multiplan Commercial |
$796.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$902.70
|
| Rate for Payer: Vantage Medical Group Senior |
$902.70
|
|
|
HC T.I.P.S. (PORTOCAVAL SHUNT)
|
Facility
IP
|
$21,677.00
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
909081331
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,923.54 |
| Max. Negotiated Rate |
$16,257.75 |
| Rate for Payer: Adventist Health Commercial |
$4,335.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,892.10
|
| Rate for Payer: Cash Price |
$9,754.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,675.33
|
| Rate for Payer: Heritage Provider Network Senior |
$14,675.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,923.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,419.25
|
| Rate for Payer: Multiplan Commercial |
$16,257.75
|
|
|
HC T.I.P.S. (PORTOCAVAL SHUNT)
|
Facility
OP
|
$21,677.00
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
909081331
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.01 |
| Max. Negotiated Rate |
$18,425.45 |
| Rate for Payer: Adventist Health Commercial |
$4,335.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,995.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,892.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18,425.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11,922.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16,257.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| 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 |
$9,754.65
|
| Rate for Payer: Cash Price |
$9,754.65
|
| Rate for Payer: Cash Price |
$9,754.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,090.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,425.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,425.45
|
| Rate for Payer: Dignity Health Senior |
$18,425.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,418.06
|
| Rate for Payer: Heritage Provider Network Senior |
$13,418.06
|
| Rate for Payer: IEHP Medi-Cal |
$170.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,448.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,923.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,419.25
|
| Rate for Payer: Multiplan Commercial |
$16,257.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,425.45
|
| Rate for Payer: Vantage Medical Group Senior |
$18,425.45
|
|
|
HC TIPS TX SHEATH
|
Facility
IP
|
$291.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.67 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$199.92
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.01
|
| Rate for Payer: Heritage Provider Network Senior |
$197.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.75
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
|
|
HC TIPS TX SHEATH
|
Facility
OP
|
$291.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.67 |
| Max. Negotiated Rate |
$247.35 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$199.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$247.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$160.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$218.25
|
| Rate for Payer: Blue Shield of California Commercial |
$180.71
|
| Rate for Payer: Blue Shield of California EPN |
$170.82
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$189.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$247.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$247.35
|
| Rate for Payer: Dignity Health Senior |
$247.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.13
|
| Rate for Payer: Heritage Provider Network Senior |
$180.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$140.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.75
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$247.35
|
| Rate for Payer: Vantage Medical Group Senior |
$247.35
|
|
|
HC TISS CUL NEO BONE MARROW BLD
|
Facility
IP
|
$412.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900918003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.57 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: Adventist Health Commercial |
$82.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$283.04
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.92
|
| Rate for Payer: Heritage Provider Network Senior |
$278.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.00
|
| Rate for Payer: Multiplan Commercial |
$309.00
|
|
|
HC TISS CUL NEO BONE MARROW BLD
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900918003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$986.47 |
| Rate for Payer: Adventist Health Commercial |
$59.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$367.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$897.50
|
| Rate for Payer: Blue Shield of California Commercial |
$986.47
|
| Rate for Payer: Blue Shield of California EPN |
$771.17
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Senior |
$143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$143.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.84
|
| Rate for Payer: Heritage Provider Network Senior |
$183.84
|
| Rate for Payer: Humana Medicare |
$143.75
|
| Rate for Payer: IEHP Medi-Cal |
$155.44
|
| Rate for Payer: IEHP Medicare Advantage |
$143.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$273.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.12
|
| Rate for Payer: Multiplan Commercial |
$222.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$143.75
|
| Rate for Payer: TriValley Medical Group Senior |
$143.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$155.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$155.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
|
|
HC TISS CUL NEO SOLID TUMOR
|
Facility
OP
|
$302.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900918002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$54.66 |
| Max. Negotiated Rate |
$1,194.87 |
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$429.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$207.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,194.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,152.21
|
| Rate for Payer: Blue Shield of California EPN |
$900.74
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$196.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Senior |
$147.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$147.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.94
|
| Rate for Payer: Heritage Provider Network Senior |
$186.94
|
| Rate for Payer: Humana Medicare |
$147.52
|
| Rate for Payer: IEHP Medi-Cal |
$204.55
|
| Rate for Payer: IEHP Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$280.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.88
|
| Rate for Payer: Multiplan Commercial |
$226.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.52
|
| Rate for Payer: TriValley Medical Group Senior |
$147.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$159.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC TISS CUL NEO SOLID TUMOR
|
Facility
IP
|
$419.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900918002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$75.84 |
| Max. Negotiated Rate |
$314.25 |
| Rate for Payer: Adventist Health Commercial |
$83.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$287.85
|
| Rate for Payer: Cash Price |
$188.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$283.66
|
| Rate for Payer: Heritage Provider Network Senior |
$283.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.75
|
| Rate for Payer: Multiplan Commercial |
$314.25
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900918004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$1,150.09 |
| Rate for Payer: Adventist Health Commercial |
$59.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$428.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$924.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,150.09
|
| Rate for Payer: Blue Shield of California EPN |
$899.08
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Senior |
$150.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$150.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.84
|
| Rate for Payer: Heritage Provider Network Senior |
$183.84
|
| Rate for Payer: Humana Medicare |
$150.30
|
| Rate for Payer: IEHP Medi-Cal |
$117.05
|
| Rate for Payer: IEHP Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$285.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.38
|
| Rate for Payer: Multiplan Commercial |
$222.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$150.30
|
| Rate for Payer: TriValley Medical Group Senior |
$150.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$162.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
IP
|
$412.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900918004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.57 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: Adventist Health Commercial |
$82.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$283.04
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.92
|
| Rate for Payer: Heritage Provider Network Senior |
$278.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.00
|
| Rate for Payer: Multiplan Commercial |
$309.00
|
|
|
HC TISS CUL NON-NEO LYMPHOCYTE
|
Facility
IP
|
$412.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900918006
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.57 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: Adventist Health Commercial |
$82.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$283.04
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.92
|
| Rate for Payer: Heritage Provider Network Senior |
$278.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.00
|
| Rate for Payer: Multiplan Commercial |
$309.00
|
|
|
HC TISS CUL NON-NEO LYMPHOCYTE
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900918006
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$909.88 |
| Rate for Payer: Adventist Health Commercial |
$59.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$338.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$827.85
|
| Rate for Payer: Blue Shield of California Commercial |
$909.88
|
| Rate for Payer: Blue Shield of California EPN |
$711.30
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Senior |
$116.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$116.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.84
|
| Rate for Payer: Heritage Provider Network Senior |
$183.84
|
| Rate for Payer: Humana Medicare |
$116.49
|
| Rate for Payer: IEHP Medi-Cal |
$157.53
|
| Rate for Payer: IEHP Medicare Advantage |
$116.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$221.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$146.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$146.78
|
| Rate for Payer: Multiplan Commercial |
$222.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$116.49
|
| Rate for Payer: TriValley Medical Group Senior |
$116.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$125.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
|
|
HC TISS CUL NON-NEO SKN/OTH BX
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$1,099.16 |
| Rate for Payer: Adventist Health Commercial |
$59.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$409.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$211.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$999.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,099.16
|
| Rate for Payer: Blue Shield of California EPN |
$859.27
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Senior |
$140.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$140.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.84
|
| Rate for Payer: Heritage Provider Network Senior |
$183.84
|
| Rate for Payer: Humana Medicare |
$140.73
|
| Rate for Payer: IEHP Medi-Cal |
$195.12
|
| Rate for Payer: IEHP Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$267.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$177.32
|
| Rate for Payer: Multiplan Commercial |
$222.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$140.73
|
| Rate for Payer: TriValley Medical Group Senior |
$140.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$151.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$151.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC TISS CUL NON-NEO SKN/OTH BX
|
Facility
IP
|
$412.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.57 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: Adventist Health Commercial |
$82.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$283.04
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.92
|
| Rate for Payer: Heritage Provider Network Senior |
$278.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.00
|
| Rate for Payer: Multiplan Commercial |
$309.00
|
|
|
HC TISSEEL FIBRIN SEALANT/CATH
|
Facility
OP
|
$2,194.00
|
|
|
Service Code
|
CPT C2615
|
| Hospital Charge Code |
900803520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.80 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$438.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,053.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,507.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,864.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,206.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,645.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,362.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,287.88
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,009.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,864.90
|
| Rate for Payer: Dignity Health Senior |
$1,864.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,015.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,015.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,097.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,097.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.50
|
| Rate for Payer: Multiplan Commercial |
$1,645.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$799.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$733.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,864.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,864.90
|
|
|
HC TISSEEL FIBRIN SEALANT/CATH
|
Facility
IP
|
$2,194.00
|
|
|
Service Code
|
CPT C2615
|
| Hospital Charge Code |
900803520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.80 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$438.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,053.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,507.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,009.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,485.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,485.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,097.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,097.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.50
|
| Rate for Payer: Multiplan Commercial |
$1,645.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$799.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$733.02
|
|
|
HC TISSUE HOMOGENIZATION, CULTR
|
Facility
IP
|
$129.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
900911804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$96.75 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.62
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.33
|
| Rate for Payer: Heritage Provider Network Senior |
$87.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.25
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
|
|
HC TISSUE HOMOGENIZATION, CULTR
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
900911804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$49.25 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.25
|
| Rate for Payer: Blue Shield of California Commercial |
$45.95
|
| Rate for Payer: Blue Shield of California EPN |
$35.92
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.47
|
| Rate for Payer: Dignity Health Senior |
$5.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Humana Medicare |
$5.88
|
| Rate for Payer: IEHP Medi-Cal |
$8.16
|
| Rate for Payer: IEHP Medicare Advantage |
$5.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.41
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.88
|
| Rate for Payer: TriValley Medical Group Senior |
$5.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$5.88
|
|
|
HC TISSUE MARKER 11 GA
|
Facility
OP
|
$429.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$205.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$294.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$235.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$321.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$266.41
|
| Rate for Payer: Blue Shield of California EPN |
$251.82
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$197.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$364.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$364.65
|
| Rate for Payer: Dignity Health Senior |
$364.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$198.63
|
| Rate for Payer: Heritage Provider Network Senior |
$198.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.25
|
| Rate for Payer: Multiplan Commercial |
$321.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$156.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$143.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$364.65
|
| Rate for Payer: Vantage Medical Group Senior |
$364.65
|
|
|
HC TISSUE MARKER 11 GA
|
Facility
IP
|
$429.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$205.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$294.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$197.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$231.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$290.43
|
| Rate for Payer: Heritage Provider Network Senior |
$290.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.25
|
| Rate for Payer: Multiplan Commercial |
$321.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$156.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$143.33
|
|
|
HC TISSUE MARKER 18GA
|
Facility
OP
|
$1,227.20
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.44 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$245.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$589.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$843.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,043.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$674.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$920.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$762.09
|
| Rate for Payer: Blue Shield of California EPN |
$720.37
|
| Rate for Payer: Cash Price |
$552.24
|
| Rate for Payer: Cash Price |
$552.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$564.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,043.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,043.12
|
| Rate for Payer: Dignity Health Senior |
$1,043.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$568.19
|
| Rate for Payer: Heritage Provider Network Senior |
$568.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$613.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$613.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.80
|
| Rate for Payer: Multiplan Commercial |
$920.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$447.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$410.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,043.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,043.12
|
|
|
HC TISSUE MARKER 18GA
|
Facility
IP
|
$1,227.20
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.44 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$245.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$589.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$843.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$552.24
|
| Rate for Payer: Cash Price |
$552.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$564.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$830.81
|
| Rate for Payer: Heritage Provider Network Senior |
$830.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$613.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$613.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.80
|
| Rate for Payer: Multiplan Commercial |
$920.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$447.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$410.01
|
|
|
HC TISSUE MARKER 8 GA
|
Facility
IP
|
$407.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$81.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$195.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$279.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$275.54
|
| Rate for Payer: Heritage Provider Network Senior |
$275.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$203.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$203.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.75
|
| Rate for Payer: Multiplan Commercial |
$305.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$148.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$135.98
|
|
