|
HC BK VIRUS DNA DETECTION BY PCR
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913628
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$65.70 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Cash Price |
$199.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.75
|
| Rate for Payer: Heritage Provider Network Senior |
$245.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.75
|
| Rate for Payer: Multiplan Commercial |
$272.25
|
|
|
HC BK VIRUS DNA DETECTION BY PCR
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913628
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$194.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$249.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| 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 |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$199.65
|
| Rate for Payer: Cash Price |
$199.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$235.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$235.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.70
|
| Rate for Payer: Heritage Provider Network Senior |
$224.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$173.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.75
|
| 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 |
$272.25
|
| 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 |
$52.63
|
| 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
|
$332.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913625
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$344.74 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$177.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.08
|
| 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 |
$236.20
|
| Rate for Payer: Blue Shield of California Commercial |
$344.74
|
| Rate for Payer: Blue Shield of California EPN |
$276.51
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| 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 |
$215.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| 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 |
$249.00
|
| 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
|
$332.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913625
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$165.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$566.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$503.25
|
| Rate for Payer: Blue Shield of California EPN |
$402.60
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$536.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Senior |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$309.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$510.68
|
| Rate for Payer: Heritage Provider Network Senior |
$510.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$393.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.37
|
| Rate for Payer: Multiplan Commercial |
$618.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$339.92
|
| Rate for Payer: TriValley Medical Group Senior |
$309.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$412.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$412.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
OP
|
$723.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
906551700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$144.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$496.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| 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 |
$397.65
|
| Rate for Payer: Cash Price |
$397.65
|
| Rate for Payer: Cash Price |
$397.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$469.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Senior |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$309.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$447.54
|
| Rate for Payer: Heritage Provider Network Senior |
$380.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$587.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.37
|
| Rate for Payer: Multiplan Commercial |
$542.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$339.92
|
| Rate for Payer: TriValley Medical Group Senior |
$339.92
|
| 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 |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
IP
|
$723.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
906551700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.86 |
| Max. Negotiated Rate |
$542.25 |
| Rate for Payer: Adventist Health Commercial |
$144.60
|
| Rate for Payer: Cash Price |
$397.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$489.47
|
| Rate for Payer: Heritage Provider Network Senior |
$489.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.75
|
| Rate for Payer: Multiplan Commercial |
$542.25
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$165.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$566.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$536.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Senior |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$309.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$558.52
|
| Rate for Payer: Heritage Provider Network Senior |
$558.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$393.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.37
|
| Rate for Payer: Multiplan Commercial |
$618.75
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$296.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$273.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.32 |
| Max. Negotiated Rate |
$618.75 |
| Rate for Payer: Adventist Health Commercial |
$165.00
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$558.52
|
| Rate for Payer: Heritage Provider Network Senior |
$558.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.25
|
| Rate for Payer: Multiplan Commercial |
$618.75
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$149.32 |
| Max. Negotiated Rate |
$618.75 |
| Rate for Payer: Adventist Health Commercial |
$165.00
|
| Rate for Payer: Cash Price |
$453.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$558.52
|
| Rate for Payer: Heritage Provider Network Senior |
$558.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.25
|
| Rate for Payer: Multiplan Commercial |
$618.75
|
|
|
HC BLEEDING TIME TEMPLATE
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
900910065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$251.25 |
| Rate for Payer: Adventist Health Commercial |
$67.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$179.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$230.15
|
| 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 |
$41.18
|
| Rate for Payer: Blue Shield of California Commercial |
$36.23
|
| Rate for Payer: Blue Shield of California EPN |
$29.06
|
| Rate for Payer: Cash Price |
$184.25
|
| Rate for Payer: Cash Price |
$184.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$217.75
|
| 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 |
$217.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$207.37
|
| Rate for Payer: Heritage Provider Network Senior |
$207.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$159.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.75
|
| 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 |
$251.25
|
| 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
|
$335.00
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
900910065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$60.63 |
| Max. Negotiated Rate |
$251.25 |
| Rate for Payer: Adventist Health Commercial |
$67.00
|
| Rate for Payer: Cash Price |
$184.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$226.79
|
| Rate for Payer: Heritage Provider Network Senior |
$226.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.75
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.10 |
| Max. Negotiated Rate |
$659.25 |
| Rate for Payer: Adventist Health Commercial |
$175.80
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$595.08
|
| Rate for Payer: Heritage Provider Network Senior |
$595.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.75
|
| Rate for Payer: Multiplan Commercial |
$659.25
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$175.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$603.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$571.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Senior |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$379.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$595.08
|
| Rate for Payer: Heritage Provider Network Senior |
$595.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$419.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.57
|
| Rate for Payer: Multiplan Commercial |
$659.25
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$316.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$291.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC BLLN ANGIO CNTRL DIALYSIS SEG
|
Facility
|
OP
|
$6,886.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
909036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,730.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,853.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,787.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,164.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$3,787.30
|
| Rate for Payer: Cash Price |
$3,787.30
|
| Rate for Payer: Cash Price |
$3,787.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,475.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,853.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,853.10
|
| Rate for Payer: Dignity Health Senior |
$5,853.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,262.43
|
| Rate for Payer: Heritage Provider Network Senior |
$4,262.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,078.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,284.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,246.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,721.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,820.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,820.20
|
| Rate for Payer: Multiplan Commercial |
$5,164.50
|
| 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 |
$5,853.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,853.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5,853.10
|
|
|
HC BLLN ANGIO CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$6,886.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
909036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,246.37 |
| Max. Negotiated Rate |
$5,164.50 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Cash Price |
$3,787.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,661.82
|
| Rate for Payer: Heritage Provider Network Senior |
$4,661.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,246.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,721.50
|
| Rate for Payer: Multiplan Commercial |
$5,164.50
|
|
|
HC BLLN ANGIOPLASTY, PULM, ADD'L
|
Facility
|
IP
|
$14,548.00
|
|
|
Service Code
|
CPT 92998
|
| Hospital Charge Code |
906820076
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,633.19 |
| Max. Negotiated Rate |
$10,911.00 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| 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 |
$2,633.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,637.00
|
| Rate for Payer: Multiplan Commercial |
$10,911.00
|
|
|
HC BLLN ANGIOPLASTY, PULM, ADD'L
|
Facility
|
OP
|
$14,548.00
|
|
|
Service Code
|
CPT 92998
|
| Hospital Charge Code |
906820076
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$459.61 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,994.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,001.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,911.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,456.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,365.80
|
| Rate for Payer: Dignity Health Senior |
$12,365.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,005.21
|
| Rate for Payer: Heritage Provider Network Senior |
$9,005.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$459.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,939.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,633.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,637.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,183.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,183.60
|
| Rate for Payer: Multiplan Commercial |
$10,911.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Senior |
$12,365.80
|
|
|
HC BLLN ANGIOPLASTY, PULM, INIT
|
Facility
|
OP
|
$14,548.00
|
|
|
Service Code
|
CPT 92997
|
| Hospital Charge Code |
906820075
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,994.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,456.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,005.21
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$882.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,633.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,637.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$10,911.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$14,409.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC BLLN ANGIOPLASTY, PULM, INIT
|
Facility
|
IP
|
$14,548.00
|
|
|
Service Code
|
CPT 92997
|
| Hospital Charge Code |
906820075
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,633.19 |
| Max. Negotiated Rate |
$10,911.00 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| 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 |
$2,633.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,637.00
|
| Rate for Payer: Multiplan Commercial |
$10,911.00
|
|
|
HC BLLN DILATION URETERAL STRCTR
|
Facility
|
OP
|
$6,462.00
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
909050706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,292.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,439.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,492.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,554.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,846.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$3,554.10
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,200.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,492.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,492.70
|
| Rate for Payer: Dignity Health Senior |
$5,492.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,999.98
|
| Rate for Payer: Heritage Provider Network Senior |
$3,999.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,133.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,082.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,169.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,615.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,523.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,523.40
|
| Rate for Payer: Multiplan Commercial |
$4,846.50
|
| 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 |
$5,492.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,492.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5,492.70
|
|
|
HC BLLN DILATION URETERAL STRCTR
|
Facility
|
IP
|
$6,462.00
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
909050706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,169.62 |
| Max. Negotiated Rate |
$4,846.50 |
| Rate for Payer: Adventist Health Commercial |
$1,292.40
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,374.77
|
| Rate for Payer: Heritage Provider Network Senior |
$4,374.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,169.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,615.50
|
| Rate for Payer: Multiplan Commercial |
$4,846.50
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
901200031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.04 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.91
|
| Rate for Payer: Heritage Provider Network Senior |
$190.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.50
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
901200031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.04 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.91
|
| Rate for Payer: Heritage Provider Network Senior |
$190.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.50
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
901200031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.04 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$150.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.45
|
| Rate for Payer: Blue Shield of California Commercial |
$172.02
|
| Rate for Payer: Blue Shield of California EPN |
$137.62
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$183.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Senior |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.56
|
| Rate for Payer: Heritage Provider Network Senior |
$174.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$134.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.36
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$163.78
|
| Rate for Payer: TriValley Medical Group Senior |
$163.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$141.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$141.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
