|
HC VENOUS M-THROMBECTOMY ADD-ON
|
Facility
|
OP
|
$18,970.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
909081847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,433.57 |
| Max. Negotiated Rate |
$14,227.50 |
| Rate for Payer: Adventist Health Commercial |
$3,794.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,723.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$8,536.50
|
| Rate for Payer: Cash Price |
$8,536.50
|
| Rate for Payer: Cash Price |
$8,536.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,330.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,742.43
|
| Rate for Payer: Heritage Provider Network Senior |
$4,995.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,715.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,433.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,742.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$14,227.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,467.15
|
| Rate for Payer: TriValley Medical Group Senior |
$4,467.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC VENOUS SAMPLING
|
Facility
|
OP
|
$9,087.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,644.75 |
| Max. Negotiated Rate |
$10,735.29 |
| Rate for Payer: Adventist Health Commercial |
$1,817.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,615.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,404.04
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$4,089.15
|
| Rate for Payer: Cash Price |
$4,089.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,906.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,361.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,156.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,624.85
|
| Rate for Payer: Heritage Provider Network Senior |
$5,624.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,334.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,644.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,230.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,271.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$6,815.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,156.86
|
| Rate for Payer: TriValley Medical Group Senior |
$7,156.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC VENOUS SAMPLING
|
Facility
|
IP
|
$9,087.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,644.75 |
| Max. Negotiated Rate |
$6,815.25 |
| Rate for Payer: Adventist Health Commercial |
$1,817.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,852.03
|
| Rate for Payer: Cash Price |
$4,089.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,151.90
|
| Rate for Payer: Heritage Provider Network Senior |
$6,151.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,644.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,271.75
|
| Rate for Payer: Multiplan Commercial |
$6,815.25
|
|
|
HC VENOUS THROMBUS SCAN
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$209.96 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Adventist Health Commercial |
$232.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$747.04
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$785.32
|
| Rate for Payer: Heritage Provider Network Senior |
$785.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$209.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.00
|
| Rate for Payer: Multiplan Commercial |
$870.00
|
|
|
HC VENOUS THROMBUS SCAN
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$209.96 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Adventist Health Commercial |
$232.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$716.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$580.23
|
| Rate for Payer: Blue Shield of California Commercial |
$846.38
|
| Rate for Payer: Blue Shield of California EPN |
$680.63
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$754.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$754.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$718.04
|
| Rate for Payer: Heritage Provider Network Senior |
$718.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$553.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$209.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$870.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$580.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$580.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
|
IP
|
$3,740.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$676.94 |
| Max. Negotiated Rate |
$2,805.00 |
| Rate for Payer: Adventist Health Commercial |
$748.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,408.56
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,531.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,531.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$676.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.00
|
| Rate for Payer: Multiplan Commercial |
$2,805.00
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
|
OP
|
$3,740.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$2,805.00 |
| Rate for Payer: Adventist Health Commercial |
$748.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,311.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$794.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,431.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$794.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,431.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$794.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,315.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2,315.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$794.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,783.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$676.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$913.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,064.74
|
| Rate for Payer: Multiplan Commercial |
$2,805.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Vantage Medical Group Senior |
$794.58
|
|
|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
|
IP
|
$3,400.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$615.40 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Adventist Health Commercial |
$680.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,189.60
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,301.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2,301.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$615.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$850.00
|
| Rate for Payer: Multiplan Commercial |
$2,550.00
|
|
|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
|
OP
|
$3,400.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Adventist Health Commercial |
$680.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,101.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$794.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$794.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,210.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$794.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,104.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,104.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$794.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,621.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$615.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$913.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$850.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,064.74
|
| Rate for Payer: Multiplan Commercial |
$2,550.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Vantage Medical Group Senior |
$794.58
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
IP
|
$1,806.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$326.89 |
| Max. Negotiated Rate |
$1,354.50 |
| Rate for Payer: Adventist Health Commercial |
$361.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,163.06
|
| Rate for Payer: Cash Price |
$812.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,222.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,222.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.50
|
| Rate for Payer: Multiplan Commercial |
$1,354.50
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
OP
|
$1,806.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$326.89 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$361.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,116.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$857.85
|
| Rate for Payer: Blue Shield of California EPN |
$682.67
|
| Rate for Payer: Cash Price |
$812.70
|
| Rate for Payer: Cash Price |
$812.70
|
| Rate for Payer: Cash Price |
$812.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,173.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,173.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,222.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,222.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$861.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$1,354.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,083.60
|
| Rate for Payer: TriValley Medical Group Senior |
$1,083.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC VENT TUBE
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
909081809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.06
|
| Rate for Payer: Blue Shield of California Commercial |
$183.00
|
| Rate for Payer: Blue Shield of California EPN |
$146.40
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$195.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$185.70
|
| Rate for Payer: Heritage Provider Network Senior |
$185.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$143.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC VENT TUBE
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
909081809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.10
|
| Rate for Payer: Heritage Provider Network Senior |
$203.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
|
|
HC VERTEBRAL UNI
|
Facility
|
OP
|
$17,590.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
909020149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,183.79 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$3,518.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,870.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$7,915.50
|
| Rate for Payer: Cash Price |
$7,915.50
|
| Rate for Payer: Cash Price |
$7,915.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,433.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,156.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,888.21
|
| Rate for Payer: Heritage Provider Network Senior |
$8,802.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,598.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,183.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,230.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,397.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$13,192.50
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,872.55
|
| Rate for Payer: TriValley Medical Group Senior |
$7,872.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC VERTEBRAL UNI
|
Facility
|
IP
|
$17,590.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
909020149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,183.79 |
| Max. Negotiated Rate |
$13,192.50 |
| Rate for Payer: Adventist Health Commercial |
$3,518.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,327.96
|
| Rate for Payer: Cash Price |
$7,915.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,908.43
|
| Rate for Payer: Heritage Provider Network Senior |
$11,908.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,183.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,397.50
|
| Rate for Payer: Multiplan Commercial |
$13,192.50
|
|
|
HC VERTEBROPLASTY ADDL INJECT
|
Facility
|
IP
|
$12,258.00
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
909022512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,218.70 |
| Max. Negotiated Rate |
$9,193.50 |
| Rate for Payer: Adventist Health Commercial |
$2,451.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,894.15
|
| Rate for Payer: Cash Price |
$5,516.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,298.67
|
| Rate for Payer: Heritage Provider Network Senior |
$8,298.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,218.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,064.50
|
| Rate for Payer: Multiplan Commercial |
$9,193.50
|
|
|
HC VERTEBROPLASTY ADDL INJECT
|
Facility
|
OP
|
$12,258.00
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
909022512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$10,829.24 |
| Rate for Payer: Adventist Health Commercial |
$2,451.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,575.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,419.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,741.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,193.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$5,516.10
|
| Rate for Payer: Cash Price |
$5,516.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,967.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,419.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,419.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,419.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,587.70
|
| Rate for Payer: Heritage Provider Network Senior |
$7,587.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,847.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,218.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,064.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,580.60
|
| Rate for Payer: Multiplan Commercial |
$9,193.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,419.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,419.30
|
| Rate for Payer: Vantage Medical Group Senior |
$10,419.30
|
|
|
HC VESTIBULE OF MOUTH
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
900501785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$316.93 |
| Max. Negotiated Rate |
$1,313.25 |
| Rate for Payer: Adventist Health Commercial |
$350.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,127.64
|
| Rate for Payer: Cash Price |
$787.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,185.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,185.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$316.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.75
|
| Rate for Payer: Multiplan Commercial |
$1,313.25
|
|
|
HC VESTIBULE OF MOUTH
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
900501785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$316.93 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$350.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,082.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$831.73
|
| Rate for Payer: Blue Shield of California EPN |
$661.88
|
| Rate for Payer: Cash Price |
$787.95
|
| Rate for Payer: Cash Price |
$787.95
|
| Rate for Payer: Cash Price |
$787.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,138.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$693.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,185.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,185.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$835.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$316.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$797.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$1,313.25
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,050.60
|
| Rate for Payer: TriValley Medical Group Senior |
$1,050.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC VES V 1 (COMMON WASP), IGE
|
Facility
|
OP
|
$19.66
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913747
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$3.93
|
| Rate for Payer: Adventist Health Commercial |
$3.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.17
|
| Rate for Payer: Heritage Provider Network Senior |
$10.14
|
| Rate for Payer: Heritage Provider Network Senior |
$12.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$14.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC VES V 1 (COMMON WASP), IGE
|
Facility
|
IP
|
$19.66
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913747
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: Adventist Health Commercial |
$3.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.66
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.31
|
| Rate for Payer: Heritage Provider Network Senior |
$13.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$14.74
|
|
|
HC VES V 5 (COMMON WASP), IGE
|
Facility
|
OP
|
$19.66
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913748
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$3.93
|
| Rate for Payer: Adventist Health Commercial |
$3.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.17
|
| Rate for Payer: Heritage Provider Network Senior |
$10.14
|
| Rate for Payer: Heritage Provider Network Senior |
$12.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$14.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC VES V 5 (COMMON WASP), IGE
|
Facility
|
IP
|
$19.66
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913748
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: Adventist Health Commercial |
$3.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.66
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.31
|
| Rate for Payer: Heritage Provider Network Senior |
$13.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$14.74
|
|
|
HC VISCOELASTIC TEST
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 85396
|
| Hospital Charge Code |
900912037
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$152.26 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$100.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.26
|
| Rate for Payer: Blue Shield of California Commercial |
$38.11
|
| Rate for Payer: Blue Shield of California Commercial |
$38.11
|
| Rate for Payer: Blue Shield of California EPN |
$30.65
|
| Rate for Payer: Blue Shield of California EPN |
$30.65
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.42
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$59.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$45.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$93.80
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.60
|
| Rate for Payer: Vantage Medical Group Senior |
$113.90
|
| Rate for Payer: Vantage Medical Group Senior |
$81.60
|
|
|
HC VISCOELASTIC TEST
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 85396
|
| Hospital Charge Code |
900912037
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
