|
HC COLONSCOPY STOMA W RMVL
|
Facility
|
OP
|
$3,793.00
|
|
|
Service Code
|
CPT 44394
|
| Hospital Charge Code |
906744394
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$758.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,605.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,706.85
|
| Rate for Payer: Cash Price |
$1,706.85
|
| Rate for Payer: Cash Price |
$1,706.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,465.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: Dignity Health Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,474.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,347.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,813.54
|
| Rate for Payer: Humana Medicare |
$1,474.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$484.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,801.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$686.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$948.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,857.77
|
| Rate for Payer: Multiplan Commercial |
$2,844.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC COLONSCOPY STOMA W RMVL
|
Facility
|
IP
|
$1,769.00
|
|
|
Service Code
|
CPT 44394
|
| Hospital Charge Code |
906744394
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$320.19 |
| Max. Negotiated Rate |
$1,326.75 |
| Rate for Payer: Adventist Health Commercial |
$353.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,215.30
|
| Rate for Payer: Cash Price |
$796.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,197.61
|
| Rate for Payer: Heritage Provider Network Senior |
$1,197.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.25
|
| Rate for Payer: Multiplan Commercial |
$1,326.75
|
|
|
HC COLON VIA STOMA W FB REMOVAL
|
Facility
|
OP
|
$1,769.00
|
|
|
Service Code
|
CPT 44390
|
| Hospital Charge Code |
906744390
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$274.14 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$353.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,215.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$796.05
|
| Rate for Payer: Cash Price |
$796.05
|
| Rate for Payer: Cash Price |
$796.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,149.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,095.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,404.57
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$274.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$1,326.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC COLON VIA STOMA W FB REMOVAL
|
Facility
|
IP
|
$1,769.00
|
|
|
Service Code
|
CPT 44390
|
| Hospital Charge Code |
906744390
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$320.19 |
| Max. Negotiated Rate |
$1,326.75 |
| Rate for Payer: Adventist Health Commercial |
$353.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,215.30
|
| Rate for Payer: Cash Price |
$796.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,197.61
|
| Rate for Payer: Heritage Provider Network Senior |
$1,197.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.25
|
| Rate for Payer: Multiplan Commercial |
$1,326.75
|
|
|
HC COLON W SNGL CONTRAST ENEMA
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
909001806
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$211.77 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$803.79
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$792.09
|
| Rate for Payer: Heritage Provider Network Senior |
$792.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
|
|
HC COLON W SNGL CONTRAST ENEMA
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
909001806
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$193.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$803.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$396.77
|
| Rate for Payer: Blue Shield of California Commercial |
$350.76
|
| Rate for Payer: Blue Shield of California EPN |
$199.47
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$760.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.23
|
| Rate for Payer: Heritage Provider Network Senior |
$724.23
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC COLORCTL CNCR SCRN NON HGH RSK
|
Facility
|
IP
|
$1,967.00
|
|
|
Service Code
|
CPT G0121
|
| Hospital Charge Code |
900100676
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$356.03 |
| Max. Negotiated Rate |
$1,475.25 |
| Rate for Payer: Adventist Health Commercial |
$393.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,351.33
|
| Rate for Payer: Cash Price |
$885.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,331.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,331.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.75
|
| Rate for Payer: Multiplan Commercial |
$1,475.25
|
|
|
HC COLORCTL CNCR SCRN NON HGH RSK
|
Facility
|
OP
|
$1,967.00
|
|
|
Service Code
|
CPT G0121
|
| Hospital Charge Code |
900100676
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$356.03 |
| Max. Negotiated Rate |
$4,706.95 |
| Rate for Payer: Adventist Health Commercial |
$393.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,351.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$885.15
|
| Rate for Payer: Cash Price |
$885.15
|
| Rate for Payer: Cash Price |
$885.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,278.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,180.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,217.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1,404.57
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$1,475.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC COLORECTAL CANCER SCRN FLXBL SGMDSCPY
|
Facility
|
IP
|
$2,423.00
|
|
|
Service Code
|
CPT G0104
|
| Hospital Charge Code |
900100230
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$438.56 |
| Max. Negotiated Rate |
$1,817.25 |
| Rate for Payer: Adventist Health Commercial |
$484.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,664.60
|
| Rate for Payer: Cash Price |
$1,090.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,640.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,640.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$605.75
|
| Rate for Payer: Multiplan Commercial |
$1,817.25
|
|
|
HC COLORECTAL CANCER SCRN FLXBL SGMDSCPY
|
Facility
|
OP
|
$2,423.00
|
|
|
Service Code
|
CPT G0104
|
| Hospital Charge Code |
900100230
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$484.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,664.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,090.35
|
| Rate for Payer: Cash Price |
$1,090.35
|
| Rate for Payer: Cash Price |
$1,090.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,574.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,453.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,499.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,404.57
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$605.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$1,817.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC COLORECTAL CANCER SCRN HIGH RISK
|
Facility
|
OP
|
$1,967.00
|
|
|
Service Code
|
CPT G0105
|
| Hospital Charge Code |
900100675
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$356.03 |
| Max. Negotiated Rate |
$4,706.95 |
| Rate for Payer: Adventist Health Commercial |
$393.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,351.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$885.15
|
| Rate for Payer: Cash Price |
$885.15
|
| Rate for Payer: Cash Price |
$885.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,278.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,180.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,217.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1,404.57
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$1,475.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC COLORECTAL CANCER SCRN HIGH RISK
|
Facility
|
IP
|
$1,967.00
|
|
|
Service Code
|
CPT G0105
|
| Hospital Charge Code |
900100675
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$356.03 |
| Max. Negotiated Rate |
$1,475.25 |
| Rate for Payer: Adventist Health Commercial |
$393.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,351.33
|
| Rate for Payer: Cash Price |
$885.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,331.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,331.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.75
|
| Rate for Payer: Multiplan Commercial |
$1,475.25
|
|
|
HC COLPORRHAPHY
|
Facility
|
IP
|
$6,732.00
|
|
|
Service Code
|
CPT 57200
|
| Hospital Charge Code |
900501301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,218.49 |
| Max. Negotiated Rate |
$5,049.00 |
| Rate for Payer: Adventist Health Commercial |
$1,346.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,624.88
|
| Rate for Payer: Cash Price |
$3,029.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,557.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4,557.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,218.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,683.00
|
| Rate for Payer: Multiplan Commercial |
$5,049.00
|
|
|
HC COLPORRHAPHY
|
Facility
|
OP
|
$6,732.00
|
|
|
Service Code
|
CPT 57200
|
| Hospital Charge Code |
900501301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,346.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,624.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$3,029.40
|
| Rate for Payer: Cash Price |
$3,029.40
|
| Rate for Payer: Cash Price |
$3,029.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,375.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: Dignity Health Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,557.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4,557.56
|
| Rate for Payer: Humana Medicare |
$3,906.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,244.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,218.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,609.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,683.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,921.79
|
| Rate for Payer: Multiplan Commercial |
$5,049.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,444.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,249.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
IP
|
$926.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$167.61 |
| Max. Negotiated Rate |
$694.50 |
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$636.16
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$626.90
|
| Rate for Payer: Heritage Provider Network Senior |
$626.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.50
|
| Rate for Payer: Multiplan Commercial |
$694.50
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
OP
|
$727.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$145.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$499.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| 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 |
$327.15
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$472.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: Dignity Health Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$400.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.01
|
| Rate for Payer: Heritage Provider Network Senior |
$493.01
|
| Rate for Payer: Humana Medicare |
$400.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$212.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$761.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$505.03
|
| Rate for Payer: Multiplan Commercial |
$545.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| 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 Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
IP
|
$926.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.61 |
| Max. Negotiated Rate |
$694.50 |
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$636.16
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$626.90
|
| Rate for Payer: Heritage Provider Network Senior |
$626.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.50
|
| Rate for Payer: Multiplan Commercial |
$694.50
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
OP
|
$727.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$145.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$499.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$472.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: Dignity Health Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$400.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$492.18
|
| Rate for Payer: Heritage Provider Network Senior |
$492.18
|
| Rate for Payer: Humana Medicare |
$400.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$350.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$505.03
|
| Rate for Payer: Multiplan Commercial |
$545.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$263.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$242.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC COMMON CAROTID HEAD UNI
|
Facility
|
OP
|
$16,274.00
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
909020146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$400.75 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$3,254.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,180.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$7,323.30
|
| Rate for Payer: Cash Price |
$7,323.30
|
| Rate for Payer: Cash Price |
$7,323.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,578.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,073.61
|
| Rate for Payer: Heritage Provider Network Senior |
$8,445.27
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$400.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,945.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,068.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$12,205.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,552.68
|
| Rate for Payer: TriValley Medical Group Senior |
$7,552.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC COMMON CAROTID HEAD UNI
|
Facility
|
IP
|
$10,387.00
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
906820221
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,880.05 |
| Max. Negotiated Rate |
$7,790.25 |
| Rate for Payer: Adventist Health Commercial |
$2,077.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,135.87
|
| Rate for Payer: Cash Price |
$4,674.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,032.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,032.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,880.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,596.75
|
| Rate for Payer: Multiplan Commercial |
$7,790.25
|
|
|
HC COMMON CAROTID HEAD UNI
|
Facility
|
OP
|
$10,387.00
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
906820221
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$400.75 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$2,077.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,135.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$4,674.15
|
| Rate for Payer: Cash Price |
$4,674.15
|
| Rate for Payer: Cash Price |
$4,674.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,751.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,429.55
|
| Rate for Payer: Heritage Provider Network Senior |
$8,445.27
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$400.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,880.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,596.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$7,790.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,552.68
|
| Rate for Payer: TriValley Medical Group Senior |
$7,552.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC COMMON CAROTID HEAD UNI
|
Facility
|
IP
|
$16,274.00
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
909020146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,945.59 |
| Max. Negotiated Rate |
$12,205.50 |
| Rate for Payer: Adventist Health Commercial |
$3,254.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,180.24
|
| Rate for Payer: Cash Price |
$7,323.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,017.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11,017.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,945.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,068.50
|
| Rate for Payer: Multiplan Commercial |
$12,205.50
|
|
|
HC COMMON CAROTID NECK UNI
|
Facility
|
OP
|
$9,868.00
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
906820220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$371.12 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,973.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,779.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,414.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,108.29
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,786.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,467.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$7,401.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC COMMON CAROTID NECK UNI
|
Facility
|
IP
|
$16,274.00
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
909020145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,945.59 |
| Max. Negotiated Rate |
$12,205.50 |
| Rate for Payer: Adventist Health Commercial |
$3,254.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,180.24
|
| Rate for Payer: Cash Price |
$7,323.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,017.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11,017.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,945.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,068.50
|
| Rate for Payer: Multiplan Commercial |
$12,205.50
|
|
|
HC COMMON CAROTID NECK UNI
|
Facility
|
IP
|
$9,868.00
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
906820220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,786.11 |
| Max. Negotiated Rate |
$7,401.00 |
| Rate for Payer: Adventist Health Commercial |
$1,973.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,779.32
|
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,680.64
|
| Rate for Payer: Heritage Provider Network Senior |
$6,680.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,786.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,467.00
|
| Rate for Payer: Multiplan Commercial |
$7,401.00
|
|
