|
HC XR RIBS UNI & PA CHEST
|
Facility
OP
|
$325.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
950463101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.42 |
| Max. Negotiated Rate |
$260.98 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$58.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$223.28
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$161.22
|
| Rate for Payer: Blue Shield of California Commercial |
$137.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.91
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$211.25
|
| 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 |
$211.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.18
|
| Rate for Payer: Heritage Provider Network Senior |
$201.18
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$50.42
|
| 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 |
$58.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.25
|
| 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 |
$243.75
|
| 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 |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| 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 XR RIBS UNI & PA CHEST
|
Facility
IP
|
$325.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
950463101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.82 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$223.28
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.02
|
| Rate for Payer: Heritage Provider Network Senior |
$220.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.25
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
|
|
HC XR RIBS W PA CXR
|
Facility
OP
|
$325.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
950463102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.82 |
| Max. Negotiated Rate |
$260.98 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$82.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$223.28
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$214.42
|
| Rate for Payer: Blue Shield of California Commercial |
$182.95
|
| Rate for Payer: Blue Shield of California EPN |
$104.04
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$211.25
|
| 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 |
$211.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.18
|
| Rate for Payer: Heritage Provider Network Senior |
$201.18
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$66.14
|
| 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 |
$58.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.25
|
| 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 |
$243.75
|
| 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 |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| 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 XR RIBS W PA CXR
|
Facility
IP
|
$325.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
950463102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.82 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$223.28
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.02
|
| Rate for Payer: Heritage Provider Network Senior |
$220.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.25
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
|
|
HC XR TEMP MANDIBULAR BILAT
|
Facility
IP
|
$916.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
909020170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.80 |
| Max. Negotiated Rate |
$687.00 |
| Rate for Payer: Adventist Health Commercial |
$183.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$629.29
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.13
|
| Rate for Payer: Heritage Provider Network Senior |
$620.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.00
|
| Rate for Payer: Multiplan Commercial |
$687.00
|
|
|
HC XR TEMP MANDIBULAR BILAT
|
Facility
OP
|
$916.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
909020170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.42 |
| Max. Negotiated Rate |
$687.00 |
| Rate for Payer: Adventist Health Commercial |
$183.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$80.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$629.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.10
|
| Rate for Payer: Blue Shield of California Commercial |
$173.72
|
| Rate for Payer: Blue Shield of California EPN |
$98.79
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$595.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$567.00
|
| Rate for Payer: Heritage Provider Network Senior |
$567.00
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$59.42
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$687.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC XYLOSE TOLERANCE BLD
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 84620
|
| Hospital Charge Code |
900910321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$99.12 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.12
|
| Rate for Payer: Blue Shield of California Commercial |
$92.51
|
| Rate for Payer: Blue Shield of California EPN |
$72.32
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.20
|
| Rate for Payer: Dignity Health Senior |
$12.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Humana Medicare |
$12.91
|
| Rate for Payer: IEHP Medi-Cal |
$16.43
|
| Rate for Payer: IEHP Medicare Advantage |
$12.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.27
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.91
|
| Rate for Payer: TriValley Medical Group Senior |
$12.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.91
|
|
|
HC XYLOSE TOLERANCE BLD
|
Facility
IP
|
$212.00
|
|
|
Service Code
|
CPT 84620
|
| Hospital Charge Code |
900910321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.64
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.52
|
| Rate for Payer: Heritage Provider Network Senior |
$143.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
|
|
HC Y90 MICROSPHERES
|
Facility
OP
|
$25,200.00
|
|
|
Service Code
|
CPT C2616
|
| Hospital Charge Code |
909301347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,040.00 |
| Max. Negotiated Rate |
$33,787.35 |
| Rate for Payer: Adventist Health Commercial |
$5,040.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,096.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,312.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33,787.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,777.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22,524.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15,649.20
|
| Rate for Payer: Blue Shield of California EPN |
$14,792.40
|
| Rate for Payer: Cash Price |
$11,340.00
|
| Rate for Payer: Cash Price |
$11,340.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,592.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,787.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,777.39
|
| Rate for Payer: Dignity Health Senior |
$22,524.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,128.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,524.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,667.60
|
| Rate for Payer: Heritage Provider Network Senior |
$11,667.60
|
| Rate for Payer: Humana Medicare |
$22,524.90
|
| Rate for Payer: IEHP Medicare Advantage |
$22,524.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,600.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,600.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,600.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,300.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,381.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,381.37
|
| Rate for Payer: Multiplan Commercial |
$18,900.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,777.39
|
| Rate for Payer: TriValley Medical Group Senior |
$22,524.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,187.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,419.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,787.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,777.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,524.90
|
|
|
HC Y90 MICROSPHERES
|
Facility
IP
|
$25,200.00
|
|
|
Service Code
|
CPT C2616
|
| Hospital Charge Code |
909301347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,040.00 |
| Max. Negotiated Rate |
$18,900.00 |
| Rate for Payer: Adventist Health Commercial |
$5,040.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,096.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,312.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$11,340.00
|
| Rate for Payer: Cash Price |
$11,340.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,592.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,608.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,060.40
|
| Rate for Payer: Heritage Provider Network Senior |
$17,060.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,600.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,600.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,600.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,300.00
|
| Rate for Payer: Multiplan Commercial |
$18,900.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,187.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,419.32
|
|
|
HC Y-90 ZEVALIN UP TO 40 MCI
|
Facility
IP
|
$93,735.00
|
|
|
Service Code
|
CPT A9543
|
| Hospital Charge Code |
909301343
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$16,966.04 |
| Max. Negotiated Rate |
$70,301.25 |
| Rate for Payer: Adventist Health Commercial |
$18,747.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64,395.94
|
| Rate for Payer: Cash Price |
$42,180.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,616.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$63,458.60
|
| Rate for Payer: Heritage Provider Network Senior |
$63,458.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,966.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23,433.75
|
| Rate for Payer: Multiplan Commercial |
$70,301.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34,175.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31,316.86
|
|
|
HC Y-90 ZEVALIN UP TO 40 MCI
|
Facility
OP
|
$93,735.00
|
|
|
Service Code
|
CPT A9543
|
| Hospital Charge Code |
909301343
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$16,966.04 |
| Max. Negotiated Rate |
$149,643.07 |
| Rate for Payer: Adventist Health Commercial |
$18,747.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149,643.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64,395.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$98,214.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$72,024.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65,476.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118,770.92
|
| Rate for Payer: Blue Shield of California Commercial |
$58,209.44
|
| Rate for Payer: Blue Shield of California EPN |
$55,022.44
|
| Rate for Payer: Cash Price |
$42,180.75
|
| Rate for Payer: Cash Price |
$42,180.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60,927.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98,214.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$72,024.24
|
| Rate for Payer: Dignity Health Senior |
$65,476.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$59,990.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$65,476.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$58,021.96
|
| Rate for Payer: Heritage Provider Network Senior |
$58,021.96
|
| Rate for Payer: Humana Medicare |
$65,476.58
|
| Rate for Payer: IEHP Medi-Cal |
$96,368.72
|
| Rate for Payer: IEHP Medicare Advantage |
$65,476.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$124,405.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,966.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77,262.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23,433.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82,500.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$82,500.49
|
| Rate for Payer: Multiplan Commercial |
$70,301.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$72,024.24
|
| Rate for Payer: TriValley Medical Group Senior |
$65,476.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34,175.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31,316.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98,214.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72,024.24
|
| Rate for Payer: Vantage Medical Group Senior |
$65,476.58
|
|
|
HC ZELANTE CATHETER
|
Facility
OP
|
$8,798.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909001757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,759.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$1,759.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,223.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,044.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,478.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,838.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,598.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,463.56
|
| Rate for Payer: Blue Shield of California EPN |
$5,164.43
|
| Rate for Payer: Cash Price |
$3,959.10
|
| Rate for Payer: Cash Price |
$3,959.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,047.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,478.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,478.30
|
| Rate for Payer: Dignity Health Senior |
$7,478.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,630.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,073.47
|
| Rate for Payer: Heritage Provider Network Senior |
$4,073.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,399.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,399.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,399.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,199.50
|
| Rate for Payer: Multiplan Commercial |
$6,598.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,207.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,939.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,478.30
|
| Rate for Payer: Vantage Medical Group Senior |
$7,478.30
|
|
|
HC ZELANTE CATHETER
|
Facility
IP
|
$8,798.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909001757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,759.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,759.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,223.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,044.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$3,959.10
|
| Rate for Payer: Cash Price |
$3,959.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,047.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,750.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,956.25
|
| Rate for Payer: Heritage Provider Network Senior |
$5,956.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,399.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,399.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,399.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,199.50
|
| Rate for Payer: Multiplan Commercial |
$6,598.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,207.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,939.41
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
IP
|
$20,575.45
|
|
|
Service Code
|
APR-DRG 0554
|
| Min. Negotiated Rate |
$20,575.45 |
| Max. Negotiated Rate |
$20,575.45 |
| Rate for Payer: IEHP Medi-Cal |
$20,575.45
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
IP
|
$7,771.13
|
|
|
Service Code
|
APR-DRG 0552
|
| Min. Negotiated Rate |
$7,771.13 |
| Max. Negotiated Rate |
$7,771.13 |
| Rate for Payer: IEHP Medi-Cal |
$7,771.13
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
IP
|
$5,516.69
|
|
|
Service Code
|
APR-DRG 0551
|
| Min. Negotiated Rate |
$5,516.69 |
| Max. Negotiated Rate |
$5,516.69 |
| Rate for Payer: IEHP Medi-Cal |
$5,516.69
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
IP
|
$11,645.26
|
|
|
Service Code
|
APR-DRG 0553
|
| Min. Negotiated Rate |
$11,645.26 |
| Max. Negotiated Rate |
$11,645.26 |
| Rate for Payer: IEHP Medi-Cal |
$11,645.26
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
IP
|
$79,835.43
|
|
|
Service Code
|
APR-DRG 0021
|
| Min. Negotiated Rate |
$79,835.43 |
| Max. Negotiated Rate |
$79,835.43 |
| Rate for Payer: IEHP Medi-Cal |
$79,835.43
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
IP
|
$93,128.24
|
|
|
Service Code
|
APR-DRG 0022
|
| Min. Negotiated Rate |
$93,128.24 |
| Max. Negotiated Rate |
$93,128.24 |
| Rate for Payer: IEHP Medi-Cal |
$93,128.24
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
IP
|
$125,491.20
|
|
|
Service Code
|
APR-DRG 0023
|
| Min. Negotiated Rate |
$125,491.20 |
| Max. Negotiated Rate |
$125,491.20 |
| Rate for Payer: IEHP Medi-Cal |
$125,491.20
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
IP
|
$202,933.91
|
|
|
Service Code
|
APR-DRG 0024
|
| Min. Negotiated Rate |
$202,933.91 |
| Max. Negotiated Rate |
$202,933.91 |
| Rate for Payer: IEHP Medi-Cal |
$202,933.91
|
|
|
HEART FAILURE
|
Facility
IP
|
$5,997.23
|
|
|
Service Code
|
APR-DRG 1942
|
| Min. Negotiated Rate |
$5,997.23 |
| Max. Negotiated Rate |
$5,997.23 |
| Rate for Payer: IEHP Medi-Cal |
$5,997.23
|
|
|
HEART FAILURE
|
Facility
IP
|
$8,295.45
|
|
|
Service Code
|
APR-DRG 1943
|
| Min. Negotiated Rate |
$8,295.45 |
| Max. Negotiated Rate |
$8,295.45 |
| Rate for Payer: IEHP Medi-Cal |
$8,295.45
|
|
|
HEART FAILURE
|
Facility
IP
|
$12,575.49
|
|
|
Service Code
|
APR-DRG 1944
|
| Min. Negotiated Rate |
$12,575.49 |
| Max. Negotiated Rate |
$12,575.49 |
| Rate for Payer: IEHP Medi-Cal |
$12,575.49
|
|
