|
HC TUBE TRACH BIVONA FLEXTEND NEO
|
Facility
OP
|
$350.00
|
|
| Hospital Charge Code |
900800711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Blue Shield of California Commercial |
$217.35
|
| Rate for Payer: Blue Shield of California EPN |
$205.45
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Senior |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$168.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TUBE TRACH BIVONA FLEXTEND NEO
|
Facility
IP
|
$350.00
|
|
| Hospital Charge Code |
900800711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC TUBE TRACH BIVONA FLEXTEND PED
|
Facility
OP
|
$350.00
|
|
| Hospital Charge Code |
900800710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Blue Shield of California Commercial |
$217.35
|
| Rate for Payer: Blue Shield of California EPN |
$205.45
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Senior |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$168.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TUBE TRACH BIVONA FLEXTEND PED
|
Facility
IP
|
$350.00
|
|
| Hospital Charge Code |
900800710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC TUBE TRACH PORTEX DIC
|
Facility
IP
|
$178.00
|
|
| Hospital Charge Code |
900800712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.29
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.51
|
| Rate for Payer: Heritage Provider Network Senior |
$120.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
|
|
HC TUBE TRACH PORTEX DIC
|
Facility
OP
|
$178.00
|
|
| Hospital Charge Code |
900800712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$95.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$133.50
|
| Rate for Payer: Blue Shield of California Commercial |
$110.54
|
| Rate for Payer: Blue Shield of California EPN |
$104.49
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: Dignity Health Senior |
$151.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.18
|
| Rate for Payer: Heritage Provider Network Senior |
$110.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$85.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC TUMOR LOCAL I-111 ZEVALIN DIAGNOSTIC
|
Facility
OP
|
$5,762.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
909301340
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$295.93 |
| Max. Negotiated Rate |
$4,321.50 |
| Rate for Payer: Adventist Health Commercial |
$1,152.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,175.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,958.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Blue Shield of California Commercial |
$883.35
|
| Rate for Payer: Blue Shield of California EPN |
$502.33
|
| Rate for Payer: Cash Price |
$2,592.90
|
| Rate for Payer: Cash Price |
$2,592.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,745.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: Dignity Health Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,745.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,774.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,566.68
|
| Rate for Payer: Heritage Provider Network Senior |
$3,566.68
|
| Rate for Payer: Humana Medicare |
$1,774.15
|
| Rate for Payer: IEHP Medi-Cal |
$295.93
|
| Rate for Payer: IEHP Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,370.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,042.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,093.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,440.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,235.43
|
| Rate for Payer: Multiplan Commercial |
$4,321.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,951.56
|
| Rate for Payer: TriValley Medical Group Senior |
$1,774.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC TUMOR LOCAL I-111 ZEVALIN DIAGNOSTIC
|
Facility
IP
|
$5,762.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
909301340
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,042.92 |
| Max. Negotiated Rate |
$4,321.50 |
| Rate for Payer: Adventist Health Commercial |
$1,152.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,958.49
|
| Rate for Payer: Cash Price |
$2,592.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,900.87
|
| Rate for Payer: Heritage Provider Network Senior |
$3,900.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,042.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,440.50
|
| Rate for Payer: Multiplan Commercial |
$4,321.50
|
|
|
HC TUMOR LOCLIZATN SPECT SNGL DAY
|
Facility
IP
|
$2,764.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
909301254
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$500.28 |
| Max. Negotiated Rate |
$2,073.00 |
| Rate for Payer: Adventist Health Commercial |
$552.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,898.87
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,871.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,871.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$500.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.00
|
| Rate for Payer: Multiplan Commercial |
$2,073.00
|
|
|
HC TUMOR LOCLIZATN SPECT SNGL DAY
|
Facility
OP
|
$2,764.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
909301254
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$500.28 |
| Max. Negotiated Rate |
$3,370.88 |
| Rate for Payer: Adventist Health Commercial |
$552.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$663.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,898.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,339.47
|
| Rate for Payer: Blue Shield of California EPN |
$761.72
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,796.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: Dignity Health Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,796.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,774.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,710.92
|
| Rate for Payer: Heritage Provider Network Senior |
$1,710.92
|
| Rate for Payer: Humana Medicare |
$1,774.15
|
| Rate for Payer: IEHP Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,370.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$500.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,093.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,235.43
|
| Rate for Payer: Multiplan Commercial |
$2,073.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,951.56
|
| Rate for Payer: TriValley Medical Group Senior |
$1,774.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC TURBO TRACKER 2-TIP
|
Facility
OP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$803.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$643.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$877.50
|
| Rate for Payer: Blue Shield of California Commercial |
$726.57
|
| Rate for Payer: Blue Shield of California EPN |
$686.79
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$760.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$994.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$994.50
|
| Rate for Payer: Dignity Health Senior |
$994.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.23
|
| Rate for Payer: Heritage Provider Network Senior |
$724.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$563.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$994.50
|
| Rate for Payer: Vantage Medical Group Senior |
$994.50
|
|
|
HC TURBO TRACKER 2-TIP
|
Facility
IP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.77 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$803.79
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$792.09
|
| Rate for Payer: Heritage Provider Network Senior |
$792.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
|
|
HC TVSWG VARIABLESTIFFNESS(TAD/II
|
Facility
OP
|
$93.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$157.10 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$79.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$51.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$69.75
|
| Rate for Payer: Blue Shield of California Commercial |
$57.75
|
| Rate for Payer: Blue Shield of California EPN |
$54.59
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.05
|
| Rate for Payer: Dignity Health Senior |
$79.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.57
|
| Rate for Payer: Heritage Provider Network Senior |
$57.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.05
|
| Rate for Payer: Vantage Medical Group Senior |
$79.05
|
|
|
HC TVSWG VARIABLESTIFFNESS(TAD/II
|
Facility
IP
|
$93.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.89
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.96
|
| Rate for Payer: Heritage Provider Network Senior |
$62.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
|
|
HC T-WAVE ALTERNANS
|
Facility
OP
|
$1,592.00
|
|
|
Service Code
|
CPT 93025
|
| Hospital Charge Code |
900200153
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$318.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$370.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,093.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| 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 |
$716.40
|
| Rate for Payer: Cash Price |
$716.40
|
| Rate for Payer: Cash Price |
$716.40
|
| Rate for Payer: Cash Price |
$716.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,034.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,034.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$985.45
|
| Rate for Payer: Heritage Provider Network Senior |
$240.06
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: IEHP Medi-Cal |
$363.92
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$1,194.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC T-WAVE ALTERNANS
|
Facility
IP
|
$1,592.00
|
|
|
Service Code
|
CPT 93025
|
| Hospital Charge Code |
900200153
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$288.15 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$318.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,093.70
|
| Rate for Payer: Cash Price |
$716.40
|
| Rate for Payer: Cash Price |
$716.40
|
| 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 |
$288.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.00
|
| Rate for Payer: Multiplan Commercial |
$1,194.00
|
|
|
HC U1RNP AUTO AB
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913524
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$140.09 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.47
|
| Rate for Payer: Blue Shield of California Commercial |
$140.09
|
| Rate for Payer: Blue Shield of California EPN |
$109.51
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: IEHP Medi-Cal |
$22.76
|
| Rate for Payer: IEHP Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.59
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC U1RNP AUTO AB
|
Facility
IP
|
$162.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913524
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.29
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.67
|
| Rate for Payer: Heritage Provider Network Senior |
$109.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
|
|
HC UGI AIR DBL CONTRAST
|
Facility
IP
|
$1,026.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$185.71 |
| Max. Negotiated Rate |
$769.50 |
| Rate for Payer: Adventist Health Commercial |
$205.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$704.86
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$694.60
|
| Rate for Payer: Heritage Provider Network Senior |
$694.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.50
|
| Rate for Payer: Multiplan Commercial |
$769.50
|
|
|
HC UGI AIR DBL CONTRAST
|
Facility
OP
|
$1,026.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.33 |
| Max. Negotiated Rate |
$769.50 |
| Rate for Payer: Adventist Health Commercial |
$205.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$192.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$704.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$396.03
|
| Rate for Payer: Blue Shield of California Commercial |
$337.62
|
| Rate for Payer: Blue Shield of California EPN |
$191.99
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$666.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$666.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$635.09
|
| Rate for Payer: Heritage Provider Network Senior |
$635.09
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: IEHP Medi-Cal |
$179.79
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$769.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
IP
|
$891.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$161.27 |
| Max. Negotiated Rate |
$668.25 |
| Rate for Payer: Adventist Health Commercial |
$178.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$612.12
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$603.21
|
| Rate for Payer: Heritage Provider Network Senior |
$603.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.75
|
| Rate for Payer: Multiplan Commercial |
$668.25
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
OP
|
$891.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$757.35 |
| Rate for Payer: Adventist Health Commercial |
$178.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$612.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$757.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$490.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$668.25
|
| Rate for Payer: Blue Shield of California Commercial |
$224.71
|
| Rate for Payer: Blue Shield of California EPN |
$127.78
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$579.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$757.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$757.35
|
| Rate for Payer: Dignity Health Senior |
$757.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$551.53
|
| Rate for Payer: Heritage Provider Network Senior |
$551.53
|
| Rate for Payer: IEHP Medi-Cal |
$88.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$429.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.75
|
| Rate for Payer: Multiplan Commercial |
$668.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$757.35
|
| Rate for Payer: Vantage Medical Group Senior |
$757.35
|
|
|
HC ULTRASND OB LT 14 WK SNGL FETUS
|
Facility
IP
|
$1,611.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
906601314
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$291.59 |
| Max. Negotiated Rate |
$1,208.25 |
| Rate for Payer: Adventist Health Commercial |
$322.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,106.76
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,090.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,090.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.75
|
| Rate for Payer: Multiplan Commercial |
$1,208.25
|
|
|
HC ULTRASND OB LT 14 WK SNGL FETUS
|
Facility
OP
|
$1,611.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
906601314
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$122.34 |
| Max. Negotiated Rate |
$1,208.25 |
| Rate for Payer: Adventist Health Commercial |
$322.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$182.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,106.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$428.67
|
| Rate for Payer: Blue Shield of California EPN |
$243.77
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,047.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,047.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$997.21
|
| Rate for Payer: Heritage Provider Network Senior |
$997.21
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$122.34
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,208.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
IP
|
$1,797.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$325.26 |
| Max. Negotiated Rate |
$1,347.75 |
| Rate for Payer: Adventist Health Commercial |
$359.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,234.54
|
| Rate for Payer: Cash Price |
$808.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,216.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1,216.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.25
|
| Rate for Payer: Multiplan Commercial |
$1,347.75
|
|
