|
HC BIVONA PED TRACH UNCUFFED 5.5
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$270.31 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.60
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$244.00
|
| Rate for Payer: Heritage Provider Network Senior |
$244.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.10
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
|
|
HC BIVONA PED TRACH UNCUFFED 5.5
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$270.31
|
| Rate for Payer: Blue Shield of California Commercial |
$223.81
|
| Rate for Payer: Blue Shield of California EPN |
$211.56
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$234.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.35
|
| Rate for Payer: Dignity Health Senior |
$306.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$223.09
|
| Rate for Payer: Heritage Provider Network Senior |
$223.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$173.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.10
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT L5450
|
| Hospital Charge Code |
905355450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$130.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$313.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$448.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$489.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$405.51
|
| Rate for Payer: Blue Shield of California EPN |
$383.31
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$300.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.05
|
| Rate for Payer: Dignity Health Senior |
$555.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$302.34
|
| Rate for Payer: Heritage Provider Network Senior |
$302.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$206.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$326.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$326.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.25
|
| Rate for Payer: Multiplan Commercial |
$489.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$238.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$218.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.05
|
| Rate for Payer: Vantage Medical Group Senior |
$555.05
|
|
|
HC BK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT L5450
|
| Hospital Charge Code |
905355450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$130.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$313.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$448.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$300.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$442.08
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$326.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$326.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.25
|
| Rate for Payer: Multiplan Commercial |
$489.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$238.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$218.17
|
|
|
HC BK SHRINKER
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
905358440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.64
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.41
|
|
|
HC BK SHRINKER
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
905358440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$58.37
|
| Rate for Payer: Blue Shield of California EPN |
$55.18
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.90
|
| Rate for Payer: Dignity Health Senior |
$79.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.52
|
| Rate for Payer: Heritage Provider Network Senior |
$43.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.90
|
| Rate for Payer: Vantage Medical Group Senior |
$79.90
|
|
|
HC BK VIRUS DNA DETECTION BY PCR
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913628
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.10
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.41
|
| Rate for Payer: Heritage Provider Network Senior |
$114.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.25
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
|
|
HC BK VIRUS DNA DETECTION BY PCR
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913628
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.23
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.61
|
| Rate for Payer: Heritage Provider Network Senior |
$104.61
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC BK VIRUS DNA QUANT
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913625
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$334.56 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.56
|
| Rate for Payer: Blue Shield of California Commercial |
$334.56
|
| Rate for Payer: Blue Shield of California EPN |
$261.54
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.32
|
| Rate for Payer: Heritage Provider Network Senior |
$173.32
|
| Rate for Payer: Humana Medicare |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.98
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC BK VIRUS DNA QUANT
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913625
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.36 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$232.89
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$229.50
|
| Rate for Payer: Heritage Provider Network Senior |
$229.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.75
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
OP
|
$689.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$447.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: Dignity Health Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.45
|
| Rate for Payer: Heritage Provider Network Senior |
$466.45
|
| Rate for Payer: Humana Medicare |
$308.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$332.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$364.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.08
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$250.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$230.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
OP
|
$689.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$122.55 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.87
|
| Rate for Payer: Blue Shield of California EPN |
$404.44
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$447.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: Dignity Health Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$426.49
|
| Rate for Payer: Heritage Provider Network Senior |
$426.49
|
| Rate for Payer: Humana Medicare |
$308.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$122.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$586.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$364.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.08
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$339.67
|
| Rate for Payer: TriValley Medical Group Senior |
$308.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
IP
|
$689.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$516.75 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.45
|
| Rate for Payer: Heritage Provider Network Senior |
$466.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
906551700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.82 |
| Max. Negotiated Rate |
$496.50 |
| Rate for Payer: Adventist Health Commercial |
$132.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$454.79
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$448.17
|
| Rate for Payer: Heritage Provider Network Senior |
$448.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.50
|
| Rate for Payer: Multiplan Commercial |
$496.50
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
IP
|
$689.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$516.75 |
| Rate for Payer: Adventist Health Commercial |
$137.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.34
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.45
|
| Rate for Payer: Heritage Provider Network Senior |
$466.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.25
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
906551700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.82 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$132.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$454.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| 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 |
$297.90
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$430.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: Dignity Health Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$409.78
|
| Rate for Payer: Heritage Provider Network Senior |
$379.81
|
| Rate for Payer: Humana Medicare |
$308.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$122.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$586.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$364.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.08
|
| Rate for Payer: Multiplan Commercial |
$496.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$339.67
|
| Rate for Payer: TriValley Medical Group Senior |
$339.67
|
| 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 |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC BLEEDING TIME TEMPLATE
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
900910065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$37.76 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.76
|
| Rate for Payer: Blue Shield of California Commercial |
$35.16
|
| Rate for Payer: Blue Shield of California EPN |
$27.49
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: Dignity Health Senior |
$4.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$4.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.82
|
| Rate for Payer: TriValley Medical Group Senior |
$4.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4.82
|
|
|
HC BLEEDING TIME TEMPLATE
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
900910065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$63.89 |
| Max. Negotiated Rate |
$264.75 |
| Rate for Payer: Adventist Health Commercial |
$70.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$242.51
|
| Rate for Payer: Cash Price |
$158.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$238.98
|
| Rate for Payer: Heritage Provider Network Senior |
$238.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.25
|
| Rate for Payer: Multiplan Commercial |
$264.75
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
OP
|
$804.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.52 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$160.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$552.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$522.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: Dignity Health Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$363.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$544.31
|
| Rate for Payer: Heritage Provider Network Senior |
$544.31
|
| Rate for Payer: Humana Medicare |
$363.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$363.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$387.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$458.61
|
| Rate for Payer: Multiplan Commercial |
$603.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$291.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$268.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
IP
|
$804.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.52 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Adventist Health Commercial |
$160.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$552.35
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$544.31
|
| Rate for Payer: Heritage Provider Network Senior |
$544.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.00
|
| Rate for Payer: Multiplan Commercial |
$603.00
|
|
|
HC BLLN ANGIO CNTRL DIALYSIS SEG
|
Facility
|
OP
|
$10,324.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
909036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,064.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,092.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,775.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,678.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,743.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$4,645.80
|
| Rate for Payer: Cash Price |
$4,645.80
|
| Rate for Payer: Cash Price |
$4,645.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,710.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,775.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,775.40
|
| Rate for Payer: Dignity Health Senior |
$8,775.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,390.56
|
| Rate for Payer: Heritage Provider Network Senior |
$6,390.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,038.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,976.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,868.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,581.00
|
| Rate for Payer: Multiplan Commercial |
$7,743.00
|
| 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 Medi-Cal |
$8,775.40
|
| Rate for Payer: Vantage Medical Group Senior |
$8,775.40
|
|
|
HC BLLN ANGIO CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$10,324.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
909036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,868.64 |
| Max. Negotiated Rate |
$7,743.00 |
| Rate for Payer: Adventist Health Commercial |
$2,064.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,092.59
|
| Rate for Payer: Cash Price |
$4,645.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,989.35
|
| Rate for Payer: Heritage Provider Network Senior |
$6,989.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,868.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,581.00
|
| Rate for Payer: Multiplan Commercial |
$7,743.00
|
|
|
HC BLLN ANGIOPLASTY, PULM, ADD'L
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 92998
|
| Hospital Charge Code |
906820076
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,771.83 |
| Max. Negotiated Rate |
$11,485.50 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| 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 |
$2,771.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
|
|
HC BLLN ANGIOPLASTY, PULM, ADD'L
|
Facility
|
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 92998
|
| Hospital Charge Code |
906820076
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$442.59 |
| Max. Negotiated Rate |
$13,016.90 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,485.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,954.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,016.90
|
| Rate for Payer: Dignity Health Senior |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,479.37
|
| Rate for Payer: Heritage Provider Network Senior |
$9,479.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,381.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,771.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| 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 |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC BLLN ANGIOPLASTY, PULM, INIT
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 92997
|
| Hospital Charge Code |
906820075
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,771.83 |
| Max. Negotiated Rate |
$11,485.50 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| 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 |
$2,771.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
|
