|
HC BILIARY ENDOPROSTHESIS
|
Facility
|
OP
|
$2,611.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909001046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.20 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$522.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,253.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,793.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,219.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,436.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,958.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,049.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,049.62
|
| Rate for Payer: Cash Price |
$1,436.05
|
| Rate for Payer: Cash Price |
$1,436.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,201.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,219.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,219.35
|
| Rate for Payer: Dignity Health Senior |
$2,219.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,671.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,208.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,208.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,305.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,305.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,305.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,827.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,827.70
|
| Rate for Payer: Multiplan Commercial |
$1,958.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$943.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,219.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,219.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,219.35
|
|
|
HC BILIARY ENDOPROSTHESIS
|
Facility
|
IP
|
$2,611.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909001046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.20 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$522.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,253.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,049.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,049.62
|
| Rate for Payer: Cash Price |
$1,436.05
|
| Rate for Payer: Cash Price |
$1,436.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,201.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,409.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,208.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,208.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,305.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,305.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,305.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.75
|
| Rate for Payer: Multiplan Commercial |
$1,958.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$943.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.50
|
|
|
HC BILIARY ENDOPROTHESIS
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909001066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$218.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$312.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$341.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$182.91
|
| Rate for Payer: Blue Shield of California EPN |
$182.91
|
| Rate for Payer: Cash Price |
$250.25
|
| Rate for Payer: Cash Price |
$250.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$209.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.75
|
| Rate for Payer: Dignity Health Senior |
$386.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$210.66
|
| Rate for Payer: Heritage Provider Network Senior |
$210.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$227.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.50
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$150.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.75
|
| Rate for Payer: Vantage Medical Group Senior |
$386.75
|
|
|
HC BILIARY ENDOPROTHESIS
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909001066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$218.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$182.91
|
| Rate for Payer: Blue Shield of California EPN |
$182.91
|
| Rate for Payer: Cash Price |
$250.25
|
| Rate for Payer: Cash Price |
$250.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$209.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$210.66
|
| Rate for Payer: Heritage Provider Network Senior |
$210.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$227.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.75
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$150.65
|
|
|
HC BILIARY STNT PLCMNT EXT ACCESS
|
Facility
|
IP
|
$20,499.00
|
|
|
Service Code
|
CPT 47538
|
| Hospital Charge Code |
909047538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,710.32 |
| Max. Negotiated Rate |
$15,374.25 |
| Rate for Payer: Adventist Health Commercial |
$4,099.80
|
| Rate for Payer: Cash Price |
$11,274.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,877.82
|
| Rate for Payer: Heritage Provider Network Senior |
$13,877.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,710.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,124.75
|
| Rate for Payer: Multiplan Commercial |
$15,374.25
|
|
|
HC BILIARY STNT PLCMNT EXT ACCESS
|
Facility
|
OP
|
$20,499.00
|
|
|
Service Code
|
CPT 47538
|
| Hospital Charge Code |
909047538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$15,374.25 |
| Rate for Payer: Adventist Health Commercial |
$4,099.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,082.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,413.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$11,274.45
|
| Rate for Payer: Cash Price |
$11,274.45
|
| Rate for Payer: Cash Price |
$11,274.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,324.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,154.45
|
| Rate for Payer: Dignity Health Senior |
$7,413.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,413.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,688.88
|
| Rate for Payer: Heritage Provider Network Senior |
$9,118.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,786.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,413.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14,084.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,710.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,525.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,124.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,340.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,340.56
|
| Rate for Payer: Multiplan Commercial |
$15,374.25
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,154.45
|
| Rate for Payer: TriValley Medical Group Senior |
$8,154.45
|
| 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 |
$11,119.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,413.14
|
|
|
HC BILIARY STONE REMVL T-TUBE
|
Facility
|
IP
|
$5,202.00
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
909000151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$941.56 |
| Max. Negotiated Rate |
$3,901.50 |
| Rate for Payer: Adventist Health Commercial |
$1,040.40
|
| Rate for Payer: Cash Price |
$2,861.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,521.75
|
| Rate for Payer: Heritage Provider Network Senior |
$3,521.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$941.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.50
|
| Rate for Payer: Multiplan Commercial |
$3,901.50
|
|
|
HC BILIARY STONE REMVL T-TUBE
|
Facility
|
OP
|
$5,202.00
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
909000151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,040.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,573.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,421.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,861.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,901.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| 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 |
$2,861.10
|
| Rate for Payer: Cash Price |
$2,861.10
|
| Rate for Payer: Cash Price |
$2,861.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,381.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,421.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,421.70
|
| Rate for Payer: Dignity Health Senior |
$4,421.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,220.04
|
| Rate for Payer: Heritage Provider Network Senior |
$3,220.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,206.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,481.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$941.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,641.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,641.40
|
| Rate for Payer: Multiplan Commercial |
$3,901.50
|
| 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 |
$4,421.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,421.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,421.70
|
|
|
HC BILIARY TRACT CELLVIZIO
|
Facility
|
IP
|
$12,026.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
906747999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,176.71 |
| Max. Negotiated Rate |
$9,019.50 |
| Rate for Payer: Adventist Health Commercial |
$2,405.20
|
| Rate for Payer: Cash Price |
$6,614.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,141.60
|
| Rate for Payer: Heritage Provider Network Senior |
$8,141.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,176.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,006.50
|
| Rate for Payer: Multiplan Commercial |
$9,019.50
|
|
|
HC BILIARY TRACT CELLVIZIO
|
Facility
|
OP
|
$12,026.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
906747999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,405.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,427.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,261.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| 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 |
$6,614.30
|
| Rate for Payer: Cash Price |
$6,614.30
|
| Rate for Payer: Cash Price |
$6,614.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,816.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,444.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,736.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,176.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,006.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$9,019.50
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC BILIARY TUBE CK-CHOLANGIO
|
Facility
|
OP
|
$3,991.00
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
909000144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$798.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,741.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,484.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$2,195.05
|
| Rate for Payer: Cash Price |
$2,195.05
|
| Rate for Payer: Cash Price |
$2,195.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,594.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,932.42
|
| Rate for Payer: Dignity Health Senior |
$4,484.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,484.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,470.43
|
| Rate for Payer: Heritage Provider Network Senior |
$5,515.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,213.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,519.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,156.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,649.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,649.87
|
| Rate for Payer: Multiplan Commercial |
$2,993.25
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,932.42
|
| Rate for Payer: TriValley Medical Group Senior |
$4,932.42
|
| 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 |
$6,726.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4,484.02
|
|
|
HC BILIARY TUBE CK-CHOLANGIO
|
Facility
|
IP
|
$3,991.00
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
909000144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$722.37 |
| Max. Negotiated Rate |
$2,993.25 |
| Rate for Payer: Adventist Health Commercial |
$798.20
|
| Rate for Payer: Cash Price |
$2,195.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.91
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.75
|
| Rate for Payer: Multiplan Commercial |
$2,993.25
|
|
|
HC BILI DUCT DILITATION PERC
|
Facility
|
OP
|
$4,354.00
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
909001856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$214.12 |
| Max. Negotiated Rate |
$3,700.90 |
| Rate for Payer: Adventist Health Commercial |
$870.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,327.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,991.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,700.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,394.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,265.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,585.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,283.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,032.47
|
| Rate for Payer: Cash Price |
$2,394.70
|
| Rate for Payer: Cash Price |
$2,394.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,830.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,700.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,700.90
|
| Rate for Payer: Dignity Health Senior |
$3,700.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,830.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,695.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2,695.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$214.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,076.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,088.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,047.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,047.80
|
| Rate for Payer: Multiplan Commercial |
$3,265.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,177.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,177.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,700.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,700.90
|
| Rate for Payer: Vantage Medical Group Senior |
$3,700.90
|
|
|
HC BILI DUCT DILITATION PERC
|
Facility
|
IP
|
$4,354.00
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
909001856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$788.07 |
| Max. Negotiated Rate |
$3,265.50 |
| Rate for Payer: Adventist Health Commercial |
$870.80
|
| Rate for Payer: Cash Price |
$2,394.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,947.66
|
| Rate for Payer: Heritage Provider Network Senior |
$2,947.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,088.50
|
| Rate for Payer: Multiplan Commercial |
$3,265.50
|
|
|
HC BILIRUBIN DIRECT
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
900910504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC BILIRUBIN DIRECT
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
900910504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.67
|
| Rate for Payer: Blue Shield of California Commercial |
$40.44
|
| Rate for Payer: Blue Shield of California EPN |
$32.43
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Senior |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.33
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN ICTOTEST
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910181
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.45
|
| Rate for Payer: Heritage Provider Network Senior |
$51.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
|
|
HC BILIRUBIN ICTOTEST
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910181
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.70
|
| Rate for Payer: Blue Shield of California Commercial |
$20.56
|
| Rate for Payer: Blue Shield of California EPN |
$16.49
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Senior |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.04
|
| Rate for Payer: Heritage Provider Network Senior |
$47.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.48
|
| Rate for Payer: TriValley Medical Group Senior |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC BILIRUBIN TOTAL
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.67
|
| Rate for Payer: Blue Shield of California Commercial |
$40.44
|
| Rate for Payer: Blue Shield of California EPN |
$32.43
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Senior |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.33
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN TOTAL
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.64
|
| Rate for Payer: Heritage Provider Network Senior |
$63.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
|
|
HC BILIRUBIN TOTAL CH
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900912177
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Heritage Provider Network Senior |
$57.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
|
|
HC BILIRUBIN TOTAL CH
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900912177
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.67
|
| Rate for Payer: Blue Shield of California Commercial |
$40.44
|
| Rate for Payer: Blue Shield of California EPN |
$32.43
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Senior |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.62
|
| Rate for Payer: Heritage Provider Network Senior |
$52.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.33
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN TOTAL INDIVIDUAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910499
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC BILIRUBIN TOTAL INDIVIDUAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910499
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$45.67 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.67
|
| Rate for Payer: Blue Shield of California Commercial |
$40.44
|
| Rate for Payer: Blue Shield of California EPN |
$32.43
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Senior |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.33
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN TRANSCUTANEOUS
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
900912154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$76.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.73
|
| Rate for Payer: Blue Shield of California Commercial |
$42.22
|
| Rate for Payer: Blue Shield of California EPN |
$33.86
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$93.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Senior |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.14
|
| Rate for Payer: Heritage Provider Network Senior |
$89.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$68.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.33
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
