|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
IP
|
$54,354.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906813412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,838.07 |
| Max. Negotiated Rate |
$40,765.50 |
| Rate for Payer: Adventist Health Commercial |
$10,870.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35,003.98
|
| Rate for Payer: Cash Price |
$24,459.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,797.66
|
| Rate for Payer: Heritage Provider Network Senior |
$36,797.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,838.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,588.50
|
| Rate for Payer: Multiplan Commercial |
$40,765.50
|
|
|
HC TAVR W PROS VALVE PERC FMRL
|
Facility
|
IP
|
$48,473.00
|
|
|
Service Code
|
CPT 33361
|
| Hospital Charge Code |
906813408
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,773.61 |
| Max. Negotiated Rate |
$36,354.75 |
| Rate for Payer: Adventist Health Commercial |
$9,694.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31,216.61
|
| Rate for Payer: Cash Price |
$21,812.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$32,816.22
|
| Rate for Payer: Heritage Provider Network Senior |
$32,816.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,773.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,118.25
|
| Rate for Payer: Multiplan Commercial |
$36,354.75
|
|
|
HC TAVR W PROS VALVE PERC FMRL
|
Facility
|
OP
|
$48,473.00
|
|
|
Service Code
|
CPT 33361
|
| Hospital Charge Code |
906813408
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$41,202.05 |
| Rate for Payer: Adventist Health Commercial |
$9,694.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29,956.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,202.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,660.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,354.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,108.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$21,812.85
|
| Rate for Payer: Cash Price |
$21,812.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31,507.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,202.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,202.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41,202.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,004.79
|
| Rate for Payer: Heritage Provider Network Senior |
$30,004.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23,121.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,773.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,118.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,931.10
|
| Rate for Payer: Multiplan Commercial |
$36,354.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41,202.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,202.05
|
| Rate for Payer: Vantage Medical Group Senior |
$41,202.05
|
|
|
HC TAVR W PROS VALVE TRNSAORTIC
|
Facility
|
IP
|
$57,267.00
|
|
|
Service Code
|
CPT 33365
|
| Hospital Charge Code |
906813413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,365.33 |
| Max. Negotiated Rate |
$42,950.25 |
| Rate for Payer: Adventist Health Commercial |
$11,453.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,879.95
|
| Rate for Payer: Cash Price |
$25,770.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$38,769.76
|
| Rate for Payer: Heritage Provider Network Senior |
$38,769.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,365.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,316.75
|
| Rate for Payer: Multiplan Commercial |
$42,950.25
|
|
|
HC TAVR W PROS VALVE TRNSAORTIC
|
Facility
|
OP
|
$57,267.00
|
|
|
Service Code
|
CPT 33365
|
| Hospital Charge Code |
906813413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$48,676.95 |
| Rate for Payer: Adventist Health Commercial |
$11,453.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35,391.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48,676.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,496.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42,950.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$25,770.15
|
| Rate for Payer: Cash Price |
$25,770.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37,223.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48,676.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$48,676.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48,676.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,448.27
|
| Rate for Payer: Heritage Provider Network Senior |
$35,448.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$27,316.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,365.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,316.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$40,086.90
|
| Rate for Payer: Multiplan Commercial |
$42,950.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48,676.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48,676.95
|
| Rate for Payer: Vantage Medical Group Senior |
$48,676.95
|
|
|
HC TAVR W PROS VALVE TRNSAPICAL
|
Facility
|
IP
|
$52,480.00
|
|
|
Service Code
|
CPT 33366
|
| Hospital Charge Code |
906813415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,498.88 |
| Max. Negotiated Rate |
$39,360.00 |
| Rate for Payer: Adventist Health Commercial |
$10,496.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,797.12
|
| Rate for Payer: Cash Price |
$23,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,528.96
|
| Rate for Payer: Heritage Provider Network Senior |
$35,528.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,498.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,120.00
|
| Rate for Payer: Multiplan Commercial |
$39,360.00
|
|
|
HC TAVR W PROS VALVE TRNSAPICAL
|
Facility
|
OP
|
$52,480.00
|
|
|
Service Code
|
CPT 33366
|
| Hospital Charge Code |
906813415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$44,608.00 |
| Rate for Payer: Adventist Health Commercial |
$10,496.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32,432.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44,608.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28,864.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39,360.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,108.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$23,616.00
|
| Rate for Payer: Cash Price |
$23,616.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34,112.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44,608.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,608.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44,608.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$32,485.12
|
| Rate for Payer: Heritage Provider Network Senior |
$32,485.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25,032.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,498.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36,736.00
|
| Rate for Payer: Multiplan Commercial |
$39,360.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44,608.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,608.00
|
| Rate for Payer: Vantage Medical Group Senior |
$44,608.00
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
900501583
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$67.57 |
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.57
|
| Rate for Payer: Blue Shield of California Commercial |
$55.39
|
| Rate for Payer: Blue Shield of California EPN |
$44.54
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
900501583
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.88
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
|
HC TC-99 ARCITUMOMAB/CEA TO 45MCI
|
Facility
|
OP
|
$5,382.00
|
|
|
Service Code
|
CPT A9568
|
| Hospital Charge Code |
909301539
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$974.14 |
| Max. Negotiated Rate |
$4,574.70 |
| Rate for Payer: Adventist Health Commercial |
$1,076.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,574.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,960.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,036.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,283.02
|
| Rate for Payer: Blue Shield of California EPN |
$2,626.42
|
| Rate for Payer: Cash Price |
$2,421.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,498.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,574.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,574.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,574.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,444.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,331.46
|
| Rate for Payer: Heritage Provider Network Senior |
$3,331.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,567.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$974.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,345.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,767.40
|
| Rate for Payer: Multiplan Commercial |
$4,036.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,152.80
|
| Rate for Payer: TriValley Medical Group Senior |
$2,152.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,691.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,691.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,574.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,574.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,574.70
|
|
|
HC TC-99 ARCITUMOMAB/CEA TO 45MCI
|
Facility
|
IP
|
$5,382.00
|
|
|
Service Code
|
CPT A9568
|
| Hospital Charge Code |
909301539
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$974.14 |
| Max. Negotiated Rate |
$4,036.50 |
| Rate for Payer: Adventist Health Commercial |
$1,076.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,466.01
|
| Rate for Payer: Cash Price |
$2,421.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,906.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,643.61
|
| Rate for Payer: Heritage Provider Network Senior |
$3,643.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$974.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,345.50
|
| Rate for Payer: Multiplan Commercial |
$4,036.50
|
|
|
HC TC-99 BICISTAE/NUEROLITE LT 25MCI
|
Facility
|
IP
|
$4,978.00
|
|
|
Service Code
|
CPT A9557
|
| Hospital Charge Code |
909301541
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$901.02 |
| Max. Negotiated Rate |
$3,733.50 |
| Rate for Payer: Adventist Health Commercial |
$995.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,205.83
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,289.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,688.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,304.81
|
| Rate for Payer: Heritage Provider Network Senior |
$2,304.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$901.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,244.50
|
| Rate for Payer: Multiplan Commercial |
$3,733.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,798.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,648.22
|
|
|
HC TC-99 BICISTAE/NUEROLITE LT 25MCI
|
Facility
|
OP
|
$4,978.00
|
|
|
Service Code
|
CPT A9557
|
| Hospital Charge Code |
909301541
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$775.52 |
| Max. Negotiated Rate |
$3,733.50 |
| Rate for Payer: Adventist Health Commercial |
$995.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$969.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$853.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$853.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$859.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3,036.58
|
| Rate for Payer: Blue Shield of California EPN |
$2,429.26
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,289.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$969.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$853.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$853.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,185.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$775.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,304.81
|
| Rate for Payer: Heritage Provider Network Senior |
$2,304.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$775.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,374.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$901.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$891.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,244.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,039.20
|
| Rate for Payer: Multiplan Commercial |
$3,733.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,991.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1,991.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,798.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,648.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$969.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$853.07
|
| Rate for Payer: Vantage Medical Group Senior |
$853.07
|
|
|
HC TC-99 CERETEC UP TO 25 MCI
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
CPT A9521
|
| Hospital Charge Code |
909301535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$816.67 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,905.73
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,075.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,436.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,089.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2,089.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$816.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,128.00
|
| Rate for Payer: Multiplan Commercial |
$3,384.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,630.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,493.92
|
|
|
HC TC-99 CERETEC UP TO 25 MCI
|
Facility
|
OP
|
$4,512.00
|
|
|
Service Code
|
CPT A9521
|
| Hospital Charge Code |
909301535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$816.67 |
| Max. Negotiated Rate |
$3,835.20 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,481.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,384.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,893.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,752.32
|
| Rate for Payer: Blue Shield of California EPN |
$2,201.86
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,075.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,835.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,887.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,089.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2,089.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,152.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$816.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,128.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,158.40
|
| Rate for Payer: Multiplan Commercial |
$3,384.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,804.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,804.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,630.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,493.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,835.20
|
|
|
HC TC-99 GHT UP TO 25 MCI
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT A9550
|
| Hospital Charge Code |
909301509
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.34 |
| Max. Negotiated Rate |
$217.60 |
| Rate for Payer: Adventist Health Commercial |
$51.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$217.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.00
|
| Rate for Payer: Blue Shield of California Commercial |
$156.16
|
| Rate for Payer: Blue Shield of California EPN |
$124.93
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$217.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$217.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.53
|
| Rate for Payer: Heritage Provider Network Senior |
$118.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$122.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$179.20
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$102.40
|
| Rate for Payer: TriValley Medical Group Senior |
$102.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$92.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$84.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$217.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$217.60
|
| Rate for Payer: Vantage Medical Group Senior |
$217.60
|
|
|
HC TC-99 GHT UP TO 25 MCI
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT A9550
|
| Hospital Charge Code |
909301509
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.34 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Adventist Health Commercial |
$51.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.86
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.53
|
| Rate for Payer: Heritage Provider Network Senior |
$118.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.00
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$92.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$84.76
|
|
|
HC TC-99 HEPATOLITE UP TO 15 MCI
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
CPT A9510
|
| Hospital Charge Code |
909301505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.71 |
| Max. Negotiated Rate |
$299.20 |
| Rate for Payer: Adventist Health Commercial |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$299.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$193.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$264.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.21
|
| Rate for Payer: Blue Shield of California Commercial |
$214.72
|
| Rate for Payer: Blue Shield of California EPN |
$171.78
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$161.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$299.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$299.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.98
|
| Rate for Payer: Heritage Provider Network Senior |
$162.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$167.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$246.40
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$140.80
|
| Rate for Payer: TriValley Medical Group Senior |
$140.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$127.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$116.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$299.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$299.20
|
| Rate for Payer: Vantage Medical Group Senior |
$299.20
|
|
|
HC TC-99 HEPATOLITE UP TO 15 MCI
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
CPT A9510
|
| Hospital Charge Code |
909301505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.71 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Adventist Health Commercial |
$70.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$226.69
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$161.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.98
|
| Rate for Payer: Heritage Provider Network Senior |
$162.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.00
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$127.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$116.55
|
|
|
HC TC-99 MAA UP TO 10 MCI
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT A9540
|
| Hospital Charge Code |
909301506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.02 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$84.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$270.48
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.46
|
| Rate for Payer: Heritage Provider Network Senior |
$194.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$151.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$139.06
|
|
|
HC TC-99 MAA UP TO 10 MCI
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT A9540
|
| Hospital Charge Code |
909301506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Adventist Health Commercial |
$84.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$357.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$231.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$315.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.33
|
| Rate for Payer: Blue Shield of California Commercial |
$256.20
|
| Rate for Payer: Blue Shield of California EPN |
$204.96
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$357.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$357.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.46
|
| Rate for Payer: Heritage Provider Network Senior |
$194.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$200.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$294.00
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$151.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$139.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$357.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.00
|
| Rate for Payer: Vantage Medical Group Senior |
$357.00
|
|
|
HC TC-99M APCITIDE/ACCUTEC LT 20MCI
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
CPT A9504
|
| Hospital Charge Code |
909301540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$349.87 |
| Max. Negotiated Rate |
$1,643.05 |
| Rate for Payer: Adventist Health Commercial |
$386.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,643.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,063.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,449.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,010.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,179.13
|
| Rate for Payer: Blue Shield of California EPN |
$943.30
|
| Rate for Payer: Cash Price |
$869.85
|
| Rate for Payer: Cash Price |
$869.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$889.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,643.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,643.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,643.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,237.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$894.98
|
| Rate for Payer: Heritage Provider Network Senior |
$894.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$922.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$349.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$483.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,353.10
|
| Rate for Payer: Multiplan Commercial |
$1,449.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$773.20
|
| Rate for Payer: TriValley Medical Group Senior |
$773.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$698.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$640.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,643.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,643.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,643.05
|
|
|
HC TC-99M APCITIDE/ACCUTEC LT 20MCI
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
CPT A9504
|
| Hospital Charge Code |
909301540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$349.87 |
| Max. Negotiated Rate |
$1,449.75 |
| Rate for Payer: Adventist Health Commercial |
$386.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,244.85
|
| Rate for Payer: Cash Price |
$869.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$889.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,043.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$894.98
|
| Rate for Payer: Heritage Provider Network Senior |
$894.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$349.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$483.25
|
| Rate for Payer: Multiplan Commercial |
$1,449.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$698.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$640.02
|
|
|
HC TC-99M DEPREOTID NEOTEC LT 35MCI
|
Facility
|
OP
|
$2,398.00
|
|
|
Service Code
|
CPT A9536
|
| Hospital Charge Code |
909301542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$434.04 |
| Max. Negotiated Rate |
$2,038.30 |
| Rate for Payer: Adventist Health Commercial |
$479.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,038.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,318.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,798.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,705.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,462.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,170.22
|
| Rate for Payer: Cash Price |
$1,079.10
|
| Rate for Payer: Cash Price |
$1,079.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,103.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,038.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,038.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,534.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,110.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1,110.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,143.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$434.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,678.60
|
| Rate for Payer: Multiplan Commercial |
$1,798.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$959.20
|
| Rate for Payer: TriValley Medical Group Senior |
$959.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$866.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$793.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,038.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,038.30
|
|
|
HC TC-99M DEPREOTID NEOTEC LT 35MCI
|
Facility
|
IP
|
$2,398.00
|
|
|
Service Code
|
CPT A9536
|
| Hospital Charge Code |
909301542
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$434.04 |
| Max. Negotiated Rate |
$1,798.50 |
| Rate for Payer: Adventist Health Commercial |
$479.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,544.31
|
| Rate for Payer: Cash Price |
$1,079.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,103.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,294.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,110.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1,110.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$434.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.50
|
| Rate for Payer: Multiplan Commercial |
$1,798.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$866.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$793.98
|
|
