|
HC BILIARY DILATION W/O STENT
|
Facility
|
OP
|
$11,540.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
909000149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,088.74 |
| Max. Negotiated Rate |
$15,820.18 |
| Rate for Payer: Adventist Health Commercial |
$2,308.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,131.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,489.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,159.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,326.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$5,193.00
|
| Rate for Payer: Cash Price |
$5,193.00
|
| Rate for Payer: Cash Price |
$5,193.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,501.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,489.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,159.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,326.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,326.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,143.26
|
| Rate for Payer: Heritage Provider Network Senior |
$10,241.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,326.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15,820.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,088.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,575.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,885.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,157.39
|
| Rate for Payer: Multiplan Commercial |
$8,655.00
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,159.05
|
| Rate for Payer: TriValley Medical Group Senior |
$9,159.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,489.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,159.05
|
| Rate for Payer: Vantage Medical Group Senior |
$8,326.41
|
|
|
HC BILIARY DILATION W/O STENT
|
Facility
|
IP
|
$11,540.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
909000149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,088.74 |
| Max. Negotiated Rate |
$8,655.00 |
| Rate for Payer: Adventist Health Commercial |
$2,308.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,431.76
|
| Rate for Payer: Cash Price |
$5,193.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,812.58
|
| Rate for Payer: Heritage Provider Network Senior |
$7,812.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,088.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,885.00
|
| Rate for Payer: Multiplan Commercial |
$8,655.00
|
|
|
HC BILIARY DRAINAGE CATH CHANGE
|
Facility
|
IP
|
$9,577.00
|
|
|
Service Code
|
CPT 47536
|
| Hospital Charge Code |
909000147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,733.44 |
| Max. Negotiated Rate |
$7,182.75 |
| Rate for Payer: Adventist Health Commercial |
$1,915.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,167.59
|
| Rate for Payer: Cash Price |
$4,309.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,483.63
|
| Rate for Payer: Heritage Provider Network Senior |
$6,483.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,733.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,394.25
|
| Rate for Payer: Multiplan Commercial |
$7,182.75
|
|
|
HC BILIARY DRAINAGE CATH CHANGE
|
Facility
|
IP
|
$9,577.00
|
|
|
Service Code
|
CPT 47536
|
| Hospital Charge Code |
909000147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,733.44 |
| Max. Negotiated Rate |
$7,182.75 |
| Rate for Payer: Adventist Health Commercial |
$1,915.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,167.59
|
| Rate for Payer: Cash Price |
$4,309.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,483.63
|
| Rate for Payer: Heritage Provider Network Senior |
$6,483.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,733.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,394.25
|
| Rate for Payer: Multiplan Commercial |
$7,182.75
|
|
|
HC BILIARY DRAINAGE CATH CHANGE
|
Facility
|
OP
|
$9,577.00
|
|
|
Service Code
|
CPT 47536
|
| Hospital Charge Code |
909000147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,733.44 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$1,915.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,918.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$4,309.65
|
| Rate for Payer: Cash Price |
$4,309.65
|
| Rate for Payer: Cash Price |
$4,309.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,225.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,604.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,928.16
|
| Rate for Payer: Heritage Provider Network Senior |
$5,664.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,749.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,733.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,295.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,394.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,170.69
|
| Rate for Payer: Multiplan Commercial |
$7,182.75
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,065.49
|
| Rate for Payer: TriValley Medical Group Senior |
$5,065.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
HC BILIARY DRAINAGE CATH CHANGE
|
Facility
|
OP
|
$9,577.00
|
|
|
Service Code
|
CPT 47536
|
| Hospital Charge Code |
909000147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,733.44 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,915.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,918.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,549.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,620.11
|
| Rate for Payer: Cash Price |
$4,309.65
|
| Rate for Payer: Cash Price |
$4,309.65
|
| Rate for Payer: Cash Price |
$4,309.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,225.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,604.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,483.63
|
| Rate for Payer: Heritage Provider Network Senior |
$6,483.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,568.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,733.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,295.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,394.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,170.69
|
| Rate for Payer: Multiplan Commercial |
$7,182.75
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,746.20
|
| Rate for Payer: TriValley Medical Group Senior |
$5,746.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
HC BILIARY ENDOPROSTHESIS
|
Facility
|
IP
|
$2,611.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909001046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.20 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$522.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,681.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,049.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,049.62
|
| Rate for Payer: Cash Price |
$1,174.95
|
| Rate for Payer: Cash Price |
$1,174.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,201.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,409.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,208.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,208.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,305.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,305.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,305.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.75
|
| Rate for Payer: Multiplan Commercial |
$1,958.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$943.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.50
|
|
|
HC BILIARY ENDOPROSTHESIS
|
Facility
|
OP
|
$2,611.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909001046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.20 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$522.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,613.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,219.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,436.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,958.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,049.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,049.62
|
| Rate for Payer: Cash Price |
$1,174.95
|
| Rate for Payer: Cash Price |
$1,174.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,201.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,219.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,219.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,219.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,671.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,208.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,208.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,305.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,305.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,305.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,827.70
|
| Rate for Payer: Multiplan Commercial |
$1,958.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$943.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,219.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,219.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,219.35
|
|
|
HC BILIARY ENDOPROTHESIS
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909001066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$281.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$341.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$182.91
|
| Rate for Payer: Blue Shield of California EPN |
$182.91
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$209.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$210.66
|
| Rate for Payer: Heritage Provider Network Senior |
$210.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$227.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$318.50
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$150.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.75
|
| Rate for Payer: Vantage Medical Group Senior |
$386.75
|
|
|
HC BILIARY ENDOPROTHESIS
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909001066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$293.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$182.91
|
| Rate for Payer: Blue Shield of California EPN |
$182.91
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$209.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$210.66
|
| Rate for Payer: Heritage Provider Network Senior |
$210.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$227.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.75
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$150.65
|
|
|
HC BILIARY STNT PLCMNT EXT ACCESS
|
Facility
|
IP
|
$20,499.00
|
|
|
Service Code
|
CPT 47538
|
| Hospital Charge Code |
909047538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,710.32 |
| Max. Negotiated Rate |
$15,374.25 |
| Rate for Payer: Adventist Health Commercial |
$4,099.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,201.36
|
| Rate for Payer: Cash Price |
$9,224.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,877.82
|
| Rate for Payer: Heritage Provider Network Senior |
$13,877.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,710.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,124.75
|
| Rate for Payer: Multiplan Commercial |
$15,374.25
|
|
|
HC BILIARY STNT PLCMNT EXT ACCESS
|
Facility
|
OP
|
$20,499.00
|
|
|
Service Code
|
CPT 47538
|
| Hospital Charge Code |
909047538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,672.00 |
| Max. Negotiated Rate |
$15,374.25 |
| Rate for Payer: Adventist Health Commercial |
$4,099.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,668.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$9,224.55
|
| Rate for Payer: Cash Price |
$9,224.55
|
| Rate for Payer: Cash Price |
$9,224.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,324.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,775.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,688.88
|
| Rate for Payer: Heritage Provider Network Senior |
$9,563.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,773.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,710.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,941.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,124.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,419.25
|
| Rate for Payer: Multiplan Commercial |
$15,374.25
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,553.12
|
| Rate for Payer: TriValley Medical Group Senior |
$8,553.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
HC BILIARY STONE REMVL T-TUBE
|
Facility
|
IP
|
$5,202.00
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
909000151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$941.56 |
| Max. Negotiated Rate |
$3,901.50 |
| Rate for Payer: Adventist Health Commercial |
$1,040.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,350.09
|
| Rate for Payer: Cash Price |
$2,340.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,521.75
|
| Rate for Payer: Heritage Provider Network Senior |
$3,521.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$941.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.50
|
| Rate for Payer: Multiplan Commercial |
$3,901.50
|
|
|
HC BILIARY STONE REMVL T-TUBE
|
Facility
|
OP
|
$5,202.00
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
909000151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,040.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,214.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,421.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,861.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,901.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,340.90
|
| Rate for Payer: Cash Price |
$2,340.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,381.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,421.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,421.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,421.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,220.04
|
| Rate for Payer: Heritage Provider Network Senior |
$3,220.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,481.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$941.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,641.40
|
| Rate for Payer: Multiplan Commercial |
$3,901.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,421.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,421.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,421.70
|
|
|
HC BILIARY TRACT CELLVIZIO
|
Facility
|
OP
|
$7,965.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
906747999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,593.00
|
| Rate for Payer: Adventist Health Commercial |
$2,405.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,432.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,922.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,984.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,015.41
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| 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: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,584.25
|
| Rate for Payer: Cash Price |
$5,411.70
|
| Rate for Payer: Cash Price |
$5,411.70
|
| Rate for Payer: Cash Price |
$3,584.25
|
| Rate for Payer: Cash Price |
$5,411.70
|
| Rate for Payer: Cash Price |
$3,584.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,816.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,177.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,930.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,444.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,736.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,799.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,441.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,176.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,006.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,991.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$5,973.75
|
| Rate for Payer: Multiplan Commercial |
$9,019.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC BILIARY TRACT CELLVIZIO
|
Facility
|
IP
|
$12,026.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
906747999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,176.71 |
| Max. Negotiated Rate |
$9,019.50 |
| Rate for Payer: Adventist Health Commercial |
$2,405.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,744.74
|
| Rate for Payer: Cash Price |
$5,411.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,141.60
|
| Rate for Payer: Heritage Provider Network Senior |
$8,141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,176.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,006.50
|
| Rate for Payer: Multiplan Commercial |
$9,019.50
|
|
|
HC BILIARY TUBE CK-CHOLANGIO
|
Facility
|
IP
|
$3,991.00
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
909000144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$722.37 |
| Max. Negotiated Rate |
$2,993.25 |
| Rate for Payer: Adventist Health Commercial |
$798.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,570.20
|
| Rate for Payer: Cash Price |
$1,795.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.91
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.75
|
| Rate for Payer: Multiplan Commercial |
$2,993.25
|
|
|
HC BILIARY TUBE CK-CHOLANGIO
|
Facility
|
OP
|
$3,991.00
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
909000144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$722.37 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$798.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,466.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$1,795.95
|
| Rate for Payer: Cash Price |
$1,795.95
|
| Rate for Payer: Cash Price |
$1,795.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,594.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,604.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,470.43
|
| Rate for Payer: Heritage Provider Network Senior |
$5,664.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,749.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,295.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,170.69
|
| Rate for Payer: Multiplan Commercial |
$2,993.25
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,065.49
|
| Rate for Payer: TriValley Medical Group Senior |
$5,065.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
HC BILI DUCT DILITATION PERC
|
Facility
|
IP
|
$4,354.00
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
909001856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$788.07 |
| Max. Negotiated Rate |
$3,265.50 |
| Rate for Payer: Adventist Health Commercial |
$870.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,803.98
|
| Rate for Payer: Cash Price |
$1,959.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,947.66
|
| Rate for Payer: Heritage Provider Network Senior |
$2,947.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$788.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,088.50
|
| Rate for Payer: Multiplan Commercial |
$3,265.50
|
|
|
HC BILI DUCT DILITATION PERC
|
Facility
|
OP
|
$4,354.00
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
909001856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$788.07 |
| Max. Negotiated Rate |
$3,700.90 |
| Rate for Payer: Adventist Health Commercial |
$870.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,690.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,700.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,394.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,265.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,648.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,283.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,032.47
|
| Rate for Payer: Cash Price |
$1,959.30
|
| Rate for Payer: Cash Price |
$1,959.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,830.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,700.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,700.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,700.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,568.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,695.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2,695.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,076.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$788.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,088.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,047.80
|
| Rate for Payer: Multiplan Commercial |
$3,265.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,177.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,177.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,700.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,700.90
|
| Rate for Payer: Vantage Medical Group Senior |
$3,700.90
|
|
|
HC BILIRUBIN DIRECT
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
900910504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: 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 BILIRUBIN DIRECT
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
900910504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.49
|
| Rate for Payer: Blue Shield of California Commercial |
$40.44
|
| Rate for Payer: Blue Shield of California Commercial |
$40.44
|
| Rate for Payer: Blue Shield of California EPN |
$32.43
|
| Rate for Payer: Blue Shield of California EPN |
$32.43
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN DIRECT INDIVIDUAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
900910539
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC BILIRUBIN DIRECT INDIVIDUAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
900910539
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$47.49 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.49
|
| Rate for Payer: Blue Shield of California Commercial |
$40.44
|
| Rate for Payer: Blue Shield of California EPN |
$32.43
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN ICTOTEST
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910181
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.56
|
| Rate for Payer: Blue Shield of California Commercial |
$20.56
|
| Rate for Payer: Blue Shield of California EPN |
$16.49
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.04
|
| Rate for Payer: Heritage Provider Network Senior |
$47.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.48
|
| Rate for Payer: TriValley Medical Group Senior |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
