|
HC ALT SINGLE
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
900910510
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.67
|
| Rate for Payer: Blue Shield of California Commercial |
$42.62
|
| Rate for Payer: Blue Shield of California Commercial |
$42.62
|
| Rate for Payer: Blue Shield of California EPN |
$34.19
|
| Rate for Payer: Blue Shield of California EPN |
$34.19
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.10
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.30
|
| Rate for Payer: TriValley Medical Group Senior |
$5.30
|
| Rate for Payer: TriValley Medical Group Senior |
$5.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.83
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
|
|
HC ALT SINGLE
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
900910510
|
|
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: Aetna of CA Non-Gatekeeper |
$63.11
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC AMIKACIN
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
900910405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.77
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.44
|
| Rate for Payer: Heritage Provider Network Senior |
$116.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
|
|
HC AMIKACIN
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
900910405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$143.12 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.12
|
| Rate for Payer: Blue Shield of California Commercial |
$121.31
|
| Rate for Payer: Blue Shield of California Commercial |
$121.31
|
| Rate for Payer: Blue Shield of California EPN |
$97.30
|
| Rate for Payer: Blue Shield of California EPN |
$97.30
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.57
|
| Rate for Payer: Heritage Provider Network Senior |
$106.47
|
| Rate for Payer: Heritage Provider Network Senior |
$31.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$82.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.08
|
| Rate for Payer: TriValley Medical Group Senior |
$15.08
|
| Rate for Payer: TriValley Medical Group Senior |
$15.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Vantage Medical Group Senior |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$15.08
|
|
|
HC AMMONIA
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
900910276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$336.75 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$277.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.39
|
| Rate for Payer: Blue Shield of California Commercial |
$117.27
|
| Rate for Payer: Blue Shield of California Commercial |
$117.27
|
| Rate for Payer: Blue Shield of California EPN |
$94.06
|
| Rate for Payer: Blue Shield of California EPN |
$94.06
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$277.93
|
| Rate for Payer: Heritage Provider Network Senior |
$76.76
|
| Rate for Payer: Heritage Provider Network Senior |
$277.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$59.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$214.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.52
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.57
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.57
|
| Rate for Payer: TriValley Medical Group Senior |
$14.57
|
| Rate for Payer: TriValley Medical Group Senior |
$14.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Vantage Medical Group Senior |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$14.57
|
|
|
HC AMMONIA
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
900910276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.27 |
| Max. Negotiated Rate |
$336.75 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$289.16
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$303.97
|
| Rate for Payer: Heritage Provider Network Senior |
$303.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.25
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
|
|
HC AMNIOBAND MTF 10MM MEMBRANE AG MTX DISK
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.86 |
| Max. Negotiated Rate |
$463.50 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.12
|
| Rate for Payer: Blue Shield of California Commercial |
$376.98
|
| Rate for Payer: Blue Shield of California EPN |
$301.58
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$284.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$395.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$286.13
|
| Rate for Payer: Heritage Provider Network Senior |
$286.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$294.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$463.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$247.20
|
| Rate for Payer: TriValley Medical Group Senior |
$247.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$223.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$204.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC AMNIOBAND MTF 10MM MEMBRANE AG MTX DISK
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.86 |
| Max. Negotiated Rate |
$463.50 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$397.99
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$284.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$286.13
|
| Rate for Payer: Heritage Provider Network Senior |
$286.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.50
|
| Rate for Payer: Multiplan Commercial |
$463.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$223.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$204.62
|
|
|
HC AMNIOBAND MTF 14MM MEMBRANE AG MTX DISK
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$579.60
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$416.70
|
| Rate for Payer: Heritage Provider Network Senior |
$416.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$325.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$297.99
|
|
|
HC AMNIOBAND MTF 14MM MEMBRANE AG MTX DISK
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$556.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$450.18
|
| Rate for Payer: Blue Shield of California Commercial |
$549.00
|
| Rate for Payer: Blue Shield of California EPN |
$439.20
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$416.70
|
| Rate for Payer: Heritage Provider Network Senior |
$416.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$429.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$360.00
|
| Rate for Payer: TriValley Medical Group Senior |
$360.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$325.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$297.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC AMNIOBAND MTF 16MM MEMBRANE AG MTX DISK
|
Facility
|
IP
|
$1,157.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$209.42 |
| Max. Negotiated Rate |
$867.75 |
| Rate for Payer: Adventist Health Commercial |
$231.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$745.11
|
| Rate for Payer: Cash Price |
$520.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$532.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$535.69
|
| Rate for Payer: Heritage Provider Network Senior |
$535.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$209.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$867.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$418.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$383.08
|
|
|
HC AMNIOBAND MTF 16MM MEMBRANE AG MTX DISK
|
Facility
|
OP
|
$1,157.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$867.75 |
| Rate for Payer: Adventist Health Commercial |
$231.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$715.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$578.73
|
| Rate for Payer: Blue Shield of California Commercial |
$705.77
|
| Rate for Payer: Blue Shield of California EPN |
$564.62
|
| Rate for Payer: Cash Price |
$520.65
|
| Rate for Payer: Cash Price |
$520.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$532.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$535.69
|
| Rate for Payer: Heritage Provider Network Senior |
$535.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$551.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$209.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$867.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$462.80
|
| Rate for Payer: TriValley Medical Group Senior |
$462.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$418.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$383.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC AMNIOBAND MTF 18MM MEMBRANE AG MTX DISK
|
Facility
|
IP
|
$937.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.60 |
| Max. Negotiated Rate |
$702.75 |
| Rate for Payer: Adventist Health Commercial |
$187.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$603.43
|
| Rate for Payer: Cash Price |
$421.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$431.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.83
|
| Rate for Payer: Heritage Provider Network Senior |
$433.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.25
|
| Rate for Payer: Multiplan Commercial |
$702.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$338.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$310.24
|
|
|
HC AMNIOBAND MTF 18MM MEMBRANE AG MTX DISK
|
Facility
|
OP
|
$937.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$702.75 |
| Rate for Payer: Adventist Health Commercial |
$187.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$579.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$468.69
|
| Rate for Payer: Blue Shield of California Commercial |
$571.57
|
| Rate for Payer: Blue Shield of California EPN |
$457.26
|
| Rate for Payer: Cash Price |
$421.65
|
| Rate for Payer: Cash Price |
$421.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$431.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$599.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.83
|
| Rate for Payer: Heritage Provider Network Senior |
$433.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$446.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$702.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$374.80
|
| Rate for Payer: TriValley Medical Group Senior |
$374.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$338.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$310.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC AMNIOBAND MTF 2CMX2CM MEMBRANE AG MTX
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.86 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$607.94
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$434.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$509.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.07
|
| Rate for Payer: Heritage Provider Network Senior |
$437.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.00
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$341.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.56
|
|
|
HC AMNIOBAND MTF 2CMX2CM MEMBRANE AG MTX
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$583.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$472.19
|
| Rate for Payer: Blue Shield of California Commercial |
$575.84
|
| Rate for Payer: Blue Shield of California EPN |
$460.67
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$434.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$604.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.07
|
| Rate for Payer: Heritage Provider Network Senior |
$437.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$450.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$377.60
|
| Rate for Payer: TriValley Medical Group Senior |
$377.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$341.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC AMNIOBAND MTF 2CMX3CM MEMBRANE AG MTX
|
Facility
|
IP
|
$658.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$493.50 |
| Rate for Payer: Adventist Health Commercial |
$131.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.75
|
| Rate for Payer: Cash Price |
$296.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$302.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$355.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$304.65
|
| Rate for Payer: Heritage Provider Network Senior |
$304.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.50
|
| Rate for Payer: Multiplan Commercial |
$493.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$237.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$217.86
|
|
|
HC AMNIOBAND MTF 2CMX3CM MEMBRANE AG MTX
|
Facility
|
OP
|
$658.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$493.50 |
| Rate for Payer: Adventist Health Commercial |
$131.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$406.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$329.13
|
| Rate for Payer: Blue Shield of California Commercial |
$401.38
|
| Rate for Payer: Blue Shield of California EPN |
$321.10
|
| Rate for Payer: Cash Price |
$296.10
|
| Rate for Payer: Cash Price |
$296.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$302.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$304.65
|
| Rate for Payer: Heritage Provider Network Senior |
$304.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$313.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$493.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$263.20
|
| Rate for Payer: TriValley Medical Group Senior |
$263.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$237.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$217.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC AMNIOBAND MTF 2CMX4CM MEMBRANE AG MTX
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.39 |
| Max. Negotiated Rate |
$395.25 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$339.39
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$242.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$244.00
|
| Rate for Payer: Heritage Provider Network Senior |
$244.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.75
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$190.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$174.49
|
|
|
HC AMNIOBAND MTF 2CMX4CM MEMBRANE AG MTX
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.39 |
| Max. Negotiated Rate |
$395.25 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$325.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.61
|
| Rate for Payer: Blue Shield of California Commercial |
$321.47
|
| Rate for Payer: Blue Shield of California EPN |
$257.18
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$242.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$244.00
|
| Rate for Payer: Heritage Provider Network Senior |
$244.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$251.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$210.80
|
| Rate for Payer: TriValley Medical Group Senior |
$210.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$190.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$174.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC AMNIOBAND MTF 3CMX4CM MEMBRANE AG MTX
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.56 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.79
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.23
|
| Rate for Payer: Heritage Provider Network Senior |
$147.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.50
|
| Rate for Payer: Multiplan Commercial |
$238.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$114.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$105.29
|
|
|
HC AMNIOBAND MTF 3CMX4CM MEMBRANE AG MTX
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
CPT Q4151
|
| Hospital Charge Code |
900104033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.56 |
| Max. Negotiated Rate |
$240.09 |
| Rate for Payer: Adventist Health Commercial |
$63.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$196.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.06
|
| Rate for Payer: Blue Shield of California Commercial |
$193.98
|
| Rate for Payer: Blue Shield of California EPN |
$155.18
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.23
|
| Rate for Payer: Heritage Provider Network Senior |
$147.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$151.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$238.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$114.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$105.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC
|
Facility
|
IP
|
$1,178.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
910400080
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$213.22 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Adventist Health Commercial |
$235.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$758.63
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$797.51
|
| Rate for Payer: Heritage Provider Network Senior |
$797.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$213.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.50
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC
|
Facility
|
OP
|
$1,178.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
910400080
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$213.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$235.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$728.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,184.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$718.58
|
| Rate for Payer: Blue Shield of California EPN |
$574.86
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$765.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,303.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,184.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,184.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$729.18
|
| Rate for Payer: Heritage Provider Network Senior |
$729.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,184.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$561.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$213.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,362.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,587.39
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$589.00
|
| Rate for Payer: TriValley Medical Group Senior |
$589.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$589.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$589.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,184.62
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC ADDL FETUS
|
Facility
|
OP
|
$1,178.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
910400081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$213.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$235.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$728.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,184.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$718.58
|
| Rate for Payer: Blue Shield of California EPN |
$574.86
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$765.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,303.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,184.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,184.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$729.18
|
| Rate for Payer: Heritage Provider Network Senior |
$729.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,184.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$561.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$213.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,362.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,587.39
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$589.00
|
| Rate for Payer: TriValley Medical Group Senior |
$589.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$589.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$589.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,184.62
|
|
