|
HC US ULTRA GUIDE/PSEU.AVFISTULA
|
Facility
IP
|
$2,034.00
|
|
|
Service Code
|
CPT 76936
|
| Hospital Charge Code |
909001485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$368.15 |
| Max. Negotiated Rate |
$1,525.50 |
| Rate for Payer: Adventist Health Commercial |
$406.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,397.36
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,377.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,377.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.50
|
| Rate for Payer: Multiplan Commercial |
$1,525.50
|
|
|
HC US ULTRA GUIDE/PSEU.AVFISTULA
|
Facility
OP
|
$2,034.00
|
|
|
Service Code
|
CPT 76936
|
| Hospital Charge Code |
909001485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$170.66 |
| Max. Negotiated Rate |
$1,525.50 |
| Rate for Payer: Adventist Health Commercial |
$406.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$237.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,397.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,287.05
|
| Rate for Payer: Blue Shield of California EPN |
$731.90
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,322.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,322.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,259.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1,259.05
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$745.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$1,525.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$392.17
|
| Rate for Payer: TriValley Medical Group Senior |
$392.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$170.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$170.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC US URINE CAPACITY MEASURE
|
Facility
IP
|
$155.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
900501798
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Adventist Health Commercial |
$31.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.48
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.94
|
| Rate for Payer: Heritage Provider Network Senior |
$104.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.75
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
|
|
HC US URINE CAPACITY MEASURE
|
Facility
OP
|
$155.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
900501798
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$31.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.94
|
| Rate for Payer: Heritage Provider Network Senior |
$104.94
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$74.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$56.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC UTRAVERSE BALLOON
|
Facility
IP
|
$805.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909000018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$386.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$544.98
|
| Rate for Payer: Heritage Provider Network Senior |
$544.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$293.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$268.95
|
|
|
HC UTRAVERSE BALLOON
|
Facility
OP
|
$805.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909000018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$386.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$603.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$499.90
|
| Rate for Payer: Blue Shield of California EPN |
$472.54
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$370.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: Dignity Health Senior |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$515.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$372.72
|
| Rate for Payer: Heritage Provider Network Senior |
$372.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$293.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$268.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC VACCINE INFLUENZA VACCINE GT 3 YR
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
910400052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$45.75 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.91
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.30
|
| Rate for Payer: Heritage Provider Network Senior |
$41.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.25
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.38
|
|
|
HC VACCINE INFLUENZA VACCINE GT 3 YR
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
910400052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$51.85 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$45.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.95
|
| Rate for Payer: Blue Shield of California Commercial |
$17.69
|
| Rate for Payer: Blue Shield of California EPN |
$17.69
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.85
|
| Rate for Payer: Dignity Health Senior |
$51.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.24
|
| Rate for Payer: Heritage Provider Network Senior |
$28.24
|
| Rate for Payer: IEHP Medi-Cal |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.25
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC VACCINE TDAP 7 YRS OR OLDER
|
Facility
IP
|
$52.00
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
900090715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.72
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.20
|
| Rate for Payer: Heritage Provider Network Senior |
$35.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.37
|
|
|
HC VACCINE TDAP 7 YRS OR OLDER
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
900090715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$93.18 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$39.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.88
|
| Rate for Payer: Blue Shield of California Commercial |
$45.31
|
| Rate for Payer: Blue Shield of California EPN |
$45.31
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.20
|
| Rate for Payer: Dignity Health Senior |
$44.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.08
|
| Rate for Payer: Heritage Provider Network Senior |
$24.08
|
| Rate for Payer: IEHP Medi-Cal |
$66.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.20
|
| Rate for Payer: Vantage Medical Group Senior |
$44.20
|
|
|
HC VACCINIA VRS VAC 0.3 ML PERQ
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
CPT 90622
|
| Hospital Charge Code |
948000201
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.00
|
| Rate for Payer: Cash Price |
$0.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Senior |
$0.00
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: IEHP Medi-Cal |
$0.02
|
| Rate for Payer: IEHP Medicare Advantage |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC VACCINIA VRS VAC 0.3 ML PERQ
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
CPT 90622
|
| Hospital Charge Code |
948000201
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Cash Price |
$0.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
|
|
HC VAD ABIOMED IMPELLA CP CATH
|
Facility
IP
|
$37,500.00
|
|
| Hospital Charge Code |
906812480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,500.00 |
| Max. Negotiated Rate |
$28,125.00 |
| Rate for Payer: Adventist Health Commercial |
$7,500.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,762.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$16,875.00
|
| Rate for Payer: Cash Price |
$16,875.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,250.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,387.50
|
| Rate for Payer: Heritage Provider Network Senior |
$25,387.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,750.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,750.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,750.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,375.00
|
| Rate for Payer: Multiplan Commercial |
$28,125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,672.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12,528.75
|
|
|
HC VAD ABIOMED IMPELLA CP CATH
|
Facility
OP
|
$37,500.00
|
|
| Hospital Charge Code |
906812480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,500.00 |
| Max. Negotiated Rate |
$31,875.00 |
| Rate for Payer: Adventist Health Commercial |
$7,500.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,762.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31,875.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20,625.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$23,287.50
|
| Rate for Payer: Blue Shield of California EPN |
$22,012.50
|
| Rate for Payer: Cash Price |
$16,875.00
|
| Rate for Payer: Cash Price |
$16,875.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,250.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,875.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,875.00
|
| Rate for Payer: Dignity Health Senior |
$31,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,000.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,362.50
|
| Rate for Payer: Heritage Provider Network Senior |
$17,362.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,750.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,750.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,750.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,375.00
|
| Rate for Payer: Multiplan Commercial |
$28,125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,672.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12,528.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,875.00
|
| Rate for Payer: Vantage Medical Group Senior |
$31,875.00
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
IP
|
$1,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.81 |
| Max. Negotiated Rate |
$844.50 |
| Rate for Payer: Adventist Health Commercial |
$225.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$773.56
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$762.30
|
| Rate for Payer: Heritage Provider Network Senior |
$762.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.50
|
| Rate for Payer: Multiplan Commercial |
$844.50
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
IP
|
$1,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$203.81 |
| Max. Negotiated Rate |
$844.50 |
| Rate for Payer: Adventist Health Commercial |
$225.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$773.56
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$762.30
|
| Rate for Payer: Heritage Provider Network Senior |
$762.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.50
|
| Rate for Payer: Multiplan Commercial |
$844.50
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
OP
|
$1,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$52.28 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$225.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$773.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$731.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: Dignity Health Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$423.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$696.99
|
| Rate for Payer: Heritage Provider Network Senior |
$520.46
|
| Rate for Payer: Humana Medicare |
$423.14
|
| Rate for Payer: IEHP Medi-Cal |
$52.28
|
| Rate for Payer: IEHP Medicare Advantage |
$423.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$803.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$499.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$533.16
|
| Rate for Payer: Multiplan Commercial |
$844.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$465.45
|
| Rate for Payer: TriValley Medical Group Senior |
$465.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
OP
|
$1,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$203.81 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$225.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$773.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$731.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: Dignity Health Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$423.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$762.30
|
| Rate for Payer: Heritage Provider Network Senior |
$762.30
|
| Rate for Payer: Humana Medicare |
$423.14
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$423.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$542.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$499.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$533.16
|
| Rate for Payer: Multiplan Commercial |
$844.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$408.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$376.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC VAG DEL PLUS ANTE/POST PARTUM
|
Facility
IP
|
$2,816.00
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
902400310
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Adventist Health Commercial |
$563.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,934.59
|
| Rate for Payer: Cash Price |
$1,267.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,906.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,906.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$509.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.00
|
| Rate for Payer: Multiplan Commercial |
$2,112.00
|
|
|
HC VAG DEL PLUS ANTE/POST PARTUM
|
Facility
OP
|
$2,816.00
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
902400310
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$563.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,107.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,934.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,393.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,548.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,112.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,105.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,748.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,652.99
|
| Rate for Payer: Cash Price |
$1,267.20
|
| Rate for Payer: Cash Price |
$1,267.20
|
| Rate for Payer: Cash Price |
$1,267.20
|
| Rate for Payer: Cash Price |
$1,267.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,830.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,393.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,393.60
|
| Rate for Payer: Dignity Health Senior |
$2,393.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,743.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,743.10
|
| Rate for Payer: IEHP Medi-Cal |
$2,168.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,357.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$509.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.00
|
| Rate for Payer: Multiplan Commercial |
$2,112.00
|
| 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 Medi-Cal |
$2,393.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,393.60
|
|
|
HC VAGINAL DELIVERY ONLY
|
Facility
IP
|
$6,474.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
900501171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,171.79 |
| Max. Negotiated Rate |
$4,855.50 |
| Rate for Payer: Adventist Health Commercial |
$1,294.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,447.64
|
| Rate for Payer: Cash Price |
$2,913.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,382.90
|
| Rate for Payer: Heritage Provider Network Senior |
$4,382.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,171.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,618.50
|
| Rate for Payer: Multiplan Commercial |
$4,855.50
|
|
|
HC VAGINAL DELIVERY ONLY
|
Facility
OP
|
$6,474.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
900501171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,294.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,447.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,105.00
|
| Rate for Payer: Cash Price |
$2,913.30
|
| Rate for Payer: Cash Price |
$2,913.30
|
| Rate for Payer: Cash Price |
$2,913.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,208.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: Dignity Health Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,382.90
|
| Rate for Payer: Heritage Provider Network Senior |
$4,382.90
|
| Rate for Payer: Humana Medicare |
$3,906.18
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,120.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,171.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,609.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,618.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,921.79
|
| Rate for Payer: Multiplan Commercial |
$4,855.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,350.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,162.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC VALPROIC ACID (DEPAKENE)
|
Facility
IP
|
$223.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
900910927
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$167.25 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$153.20
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$150.97
|
| Rate for Payer: Heritage Provider Network Senior |
$150.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.75
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
|
|
HC VALPROIC ACID (DEPAKENE)
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
900910927
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$113.38 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.38
|
| Rate for Payer: Blue Shield of California Commercial |
$105.82
|
| Rate for Payer: Blue Shield of California EPN |
$82.72
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Senior |
$13.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Humana Medicare |
$13.54
|
| Rate for Payer: IEHP Medi-Cal |
$18.78
|
| Rate for Payer: IEHP Medicare Advantage |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.06
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.54
|
| Rate for Payer: TriValley Medical Group Senior |
$13.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
|
|
HC VALVULOPLASTY, AORTIC
|
Facility
IP
|
$19,142.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906820030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,464.70 |
| Max. Negotiated Rate |
$14,356.50 |
| Rate for Payer: Adventist Health Commercial |
$3,828.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,150.55
|
| Rate for Payer: Cash Price |
$8,613.90
|
| Rate for Payer: Cash Price |
$8,613.90
|
| 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 |
$3,464.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,785.50
|
| Rate for Payer: Multiplan Commercial |
$14,356.50
|
|
