|
HC CROSSMATCH COMP
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
900904766
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.86
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.98
|
| Rate for Payer: Heritage Provider Network Senior |
$194.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
|
|
HC CROSSMATCH IS
|
Facility
|
OP
|
$734.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
900904577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.25 |
| Max. Negotiated Rate |
$550.50 |
| Rate for Payer: Adventist Health Commercial |
$146.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$504.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.25
|
| Rate for Payer: Blue Shield of California Commercial |
$455.81
|
| Rate for Payer: Blue Shield of California EPN |
$430.86
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$477.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$477.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$454.35
|
| Rate for Payer: Heritage Provider Network Senior |
$454.35
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$550.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$213.41
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC CROSSMATCH IS
|
Facility
|
IP
|
$734.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
900904577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.85 |
| Max. Negotiated Rate |
$550.50 |
| Rate for Payer: Adventist Health Commercial |
$146.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$504.26
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$496.92
|
| Rate for Payer: Heritage Provider Network Senior |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.50
|
| Rate for Payer: Multiplan Commercial |
$550.50
|
|
|
HC CROSSMATCH XM
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.04 |
| Max. Negotiated Rate |
$610.50 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$559.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.25
|
| Rate for Payer: Blue Shield of California Commercial |
$505.49
|
| Rate for Payer: Blue Shield of California EPN |
$477.82
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$529.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.87
|
| Rate for Payer: Heritage Provider Network Senior |
$503.87
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$213.41
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC CROSSMATCH XM
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.33 |
| Max. Negotiated Rate |
$610.50 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$559.22
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$551.08
|
| Rate for Payer: Heritage Provider Network Senior |
$551.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.50
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
|
|
HC CRYABLATION BONE
|
Facility
|
IP
|
$7,197.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,302.66 |
| Max. Negotiated Rate |
$5,397.75 |
| Rate for Payer: Adventist Health Commercial |
$1,439.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,944.34
|
| Rate for Payer: Cash Price |
$3,238.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,872.37
|
| Rate for Payer: Heritage Provider Network Senior |
$4,872.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,302.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,799.25
|
| Rate for Payer: Multiplan Commercial |
$5,397.75
|
|
|
HC CRYABLATION BONE
|
Facility
|
OP
|
$7,197.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,439.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,944.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$3,238.65
|
| Rate for Payer: Cash Price |
$3,238.65
|
| Rate for Payer: Cash Price |
$3,238.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,678.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,872.37
|
| Rate for Payer: Heritage Provider Network Senior |
$4,872.37
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,468.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,302.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,799.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$5,397.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,613.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,404.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CRYABLATION BONE
|
Facility
|
IP
|
$7,197.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,302.66 |
| Max. Negotiated Rate |
$5,397.75 |
| Rate for Payer: Adventist Health Commercial |
$1,439.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,944.34
|
| Rate for Payer: Cash Price |
$3,238.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,872.37
|
| Rate for Payer: Heritage Provider Network Senior |
$4,872.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,302.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,799.25
|
| Rate for Payer: Multiplan Commercial |
$5,397.75
|
|
|
HC CRYABLATION BONE
|
Facility
|
OP
|
$7,197.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,439.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,944.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$3,238.65
|
| Rate for Payer: Cash Price |
$3,238.65
|
| Rate for Payer: Cash Price |
$3,238.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,678.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,454.94
|
| Rate for Payer: Heritage Provider Network Senior |
$362.41
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$559.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,302.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,799.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$5,397.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$324.10
|
| Rate for Payer: TriValley Medical Group Senior |
$324.10
|
| 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 |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CRYO ABLATE BONE TUMOR(S) PERQ
|
Facility
|
OP
|
$17,328.00
|
|
|
Service Code
|
CPT 20983
|
| Hospital Charge Code |
909020983
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$534.91 |
| Max. Negotiated Rate |
$16,983.21 |
| Rate for Payer: Adventist Health Commercial |
$3,465.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,904.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$7,797.60
|
| Rate for Payer: Cash Price |
$7,797.60
|
| Rate for Payer: Cash Price |
$7,797.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,263.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,726.03
|
| Rate for Payer: Heritage Provider Network Senior |
$10,994.39
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$534.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,983.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,136.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,332.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: Multiplan Commercial |
$12,996.00
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,832.38
|
| Rate for Payer: TriValley Medical Group Senior |
$9,832.38
|
| 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 |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC CRYO ABLATE BONE TUMOR(S) PERQ
|
Facility
|
IP
|
$17,328.00
|
|
|
Service Code
|
CPT 20983
|
| Hospital Charge Code |
909020983
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,136.37 |
| Max. Negotiated Rate |
$12,996.00 |
| Rate for Payer: Adventist Health Commercial |
$3,465.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,904.34
|
| Rate for Payer: Cash Price |
$7,797.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,731.06
|
| Rate for Payer: Heritage Provider Network Senior |
$11,731.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,136.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,332.00
|
| Rate for Payer: Multiplan Commercial |
$12,996.00
|
|
|
HC CRYOABLATION-LUNG
|
Facility
|
OP
|
$12,226.00
|
|
|
Service Code
|
CPT 32994
|
| Hospital Charge Code |
909020150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,212.91 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Adventist Health Commercial |
$2,445.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,399.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| 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 |
$5,501.70
|
| Rate for Payer: Cash Price |
$5,501.70
|
| Rate for Payer: Cash Price |
$5,501.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,946.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,147.44
|
| Rate for Payer: Dignity Health Senior |
$12,861.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12,861.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,567.89
|
| Rate for Payer: Heritage Provider Network Senior |
$15,819.41
|
| Rate for Payer: Humana Medicare |
$12,861.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,983.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,861.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24,436.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,212.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,176.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,056.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,205.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,205.25
|
| Rate for Payer: Multiplan Commercial |
$9,169.50
|
| Rate for Payer: Multiplan WC |
$17,583.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,147.44
|
| Rate for Payer: TriValley Medical Group Senior |
$14,147.44
|
| 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 |
$19,291.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Vantage Medical Group Senior |
$12,861.31
|
|
|
HC CRYOABLATION-LUNG
|
Facility
|
IP
|
$12,226.00
|
|
|
Service Code
|
CPT 32994
|
| Hospital Charge Code |
909020150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,212.91 |
| Max. Negotiated Rate |
$9,169.50 |
| Rate for Payer: Adventist Health Commercial |
$2,445.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,399.26
|
| Rate for Payer: Cash Price |
$5,501.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,277.00
|
| Rate for Payer: Heritage Provider Network Senior |
$8,277.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,212.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,056.50
|
| Rate for Payer: Multiplan Commercial |
$9,169.50
|
|
|
HC CRYOABLATION PROBE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C2618
|
| Hospital Charge Code |
909020059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,794.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,421.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,289.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,535.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,414.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,414.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,879.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC CRYOABLATION PROBE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C2618
|
| Hospital Charge Code |
909020059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
|
|
HC CRYO ABLAT LIVER TUMOR
|
Facility
|
OP
|
$11,870.00
|
|
|
Service Code
|
CPT 47381
|
| Hospital Charge Code |
909000269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$287.49 |
| Max. Negotiated Rate |
$10,089.50 |
| Rate for Payer: Adventist Health Commercial |
$2,374.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,154.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,089.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,528.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,902.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| 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 |
$5,341.50
|
| Rate for Payer: Cash Price |
$5,341.50
|
| Rate for Payer: Cash Price |
$5,341.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,715.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,089.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,089.50
|
| Rate for Payer: Dignity Health Senior |
$10,089.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,347.53
|
| Rate for Payer: Heritage Provider Network Senior |
$7,347.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$287.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,721.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,148.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,967.50
|
| Rate for Payer: Multiplan Commercial |
$8,902.50
|
| 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 Medi-Cal |
$10,089.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,089.50
|
|
|
HC CRYO ABLAT LIVER TUMOR
|
Facility
|
IP
|
$11,870.00
|
|
|
Service Code
|
CPT 47381
|
| Hospital Charge Code |
909000269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,148.47 |
| Max. Negotiated Rate |
$8,902.50 |
| Rate for Payer: Adventist Health Commercial |
$2,374.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,154.69
|
| Rate for Payer: Cash Price |
$5,341.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,035.99
|
| Rate for Payer: Heritage Provider Network Senior |
$8,035.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,148.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,967.50
|
| Rate for Payer: Multiplan Commercial |
$8,902.50
|
|
|
HC CRYO ABLAT RENAL TUMOR
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
909000268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,161.32 |
| Max. Negotiated Rate |
$8,955.75 |
| Rate for Payer: Adventist Health Commercial |
$2,388.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,203.47
|
| Rate for Payer: Cash Price |
$5,373.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,084.06
|
| Rate for Payer: Heritage Provider Network Senior |
$8,084.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,161.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,985.25
|
| Rate for Payer: Multiplan Commercial |
$8,955.75
|
|
|
HC CRYO ABLAT RENAL TUMOR
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
909000268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,161.32 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Adventist Health Commercial |
$2,388.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,995.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,203.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$5,373.45
|
| Rate for Payer: Cash Price |
$5,373.45
|
| Rate for Payer: Cash Price |
$5,373.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,761.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,147.44
|
| Rate for Payer: Dignity Health Senior |
$12,861.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12,861.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,391.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15,819.41
|
| Rate for Payer: Humana Medicare |
$12,861.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,076.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,861.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24,436.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,161.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,176.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,985.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,205.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,205.25
|
| Rate for Payer: Multiplan Commercial |
$8,955.75
|
| Rate for Payer: Multiplan WC |
$17,583.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,147.44
|
| Rate for Payer: TriValley Medical Group Senior |
$14,147.44
|
| 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 |
$19,291.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Vantage Medical Group Senior |
$12,861.31
|
|
|
HC CRYOCAUTERY OF CERVIX
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
900501637
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.82 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$132.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$454.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$297.90
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$430.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$448.17
|
| Rate for Payer: Heritage Provider Network Senior |
$448.17
|
| 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 |
$319.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.50
|
| 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 |
$496.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$240.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$221.17
|
| 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 CRYOCAUTERY OF CERVIX
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
900501637
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.82 |
| Max. Negotiated Rate |
$496.50 |
| Rate for Payer: Adventist Health Commercial |
$132.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$454.79
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$448.17
|
| Rate for Payer: Heritage Provider Network Senior |
$448.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.50
|
| Rate for Payer: Multiplan Commercial |
$496.50
|
|
|
HC CRYOGLOBULINS QUAL
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900910978
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.81
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
|
HC CRYOGLOBULINS QUAL
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900910978
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.74
|
| Rate for Payer: Blue Shield of California Commercial |
$50.53
|
| Rate for Payer: Blue Shield of California EPN |
$39.50
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.00
|
| Rate for Payer: Heritage Provider Network Senior |
$13.00
|
| Rate for Payer: Humana Medicare |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CSF LEAKAGE
|
Facility
|
IP
|
$1,886.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
909301416
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$341.37 |
| Max. Negotiated Rate |
$1,414.50 |
| Rate for Payer: Adventist Health Commercial |
$377.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,295.68
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,276.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,276.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.50
|
| Rate for Payer: Multiplan Commercial |
$1,414.50
|
|
|
HC CSF LEAKAGE
|
Facility
|
OP
|
$1,886.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
909301416
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$230.80 |
| Max. Negotiated Rate |
$3,370.88 |
| Rate for Payer: Adventist Health Commercial |
$377.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$666.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,295.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Blue Shield of California Commercial |
$947.52
|
| Rate for Payer: Blue Shield of California EPN |
$538.82
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,225.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: Dignity Health Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,225.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,774.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,167.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,167.43
|
| Rate for Payer: Humana Medicare |
$1,774.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,370.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,093.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,235.43
|
| Rate for Payer: Multiplan Commercial |
$1,414.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,951.56
|
| Rate for Payer: TriValley Medical Group Senior |
$1,774.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
