|
HC COLONOSCOPY W/TUMOR SNARE RMVL
|
Facility
|
OP
|
$4,152.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
906745385
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$830.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,852.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,698.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,570.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$648.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,980.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$751.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,038.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$3,114.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC COLONOSCOPY W/TUMOR SNARE RMVL
|
Facility
|
IP
|
$4,152.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
906745385
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$751.51 |
| Max. Negotiated Rate |
$3,114.00 |
| Rate for Payer: Adventist Health Commercial |
$830.40
|
| Rate for Payer: Cash Price |
$2,283.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,810.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,810.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$751.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,038.00
|
| Rate for Payer: Multiplan Commercial |
$3,114.00
|
|
|
HC COLONOSCPY FLX ABLATION TUMOR POLYP/OTHER LES
|
Facility
|
IP
|
$3,686.00
|
|
|
Service Code
|
CPT 45388
|
| Hospital Charge Code |
950442411
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$667.17 |
| Max. Negotiated Rate |
$2,764.50 |
| Rate for Payer: Adventist Health Commercial |
$737.20
|
| Rate for Payer: Cash Price |
$2,027.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,495.42
|
| Rate for Payer: Heritage Provider Network Senior |
$2,495.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$667.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$921.50
|
| Rate for Payer: Multiplan Commercial |
$2,764.50
|
|
|
HC COLONOSCPY FLX ABLATION TUMOR POLYP/OTHER LES
|
Facility
|
OP
|
$3,686.00
|
|
|
Service Code
|
CPT 45388
|
| Hospital Charge Code |
950442411
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$737.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,532.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,027.30
|
| Rate for Payer: Cash Price |
$2,027.30
|
| Rate for Payer: Cash Price |
$2,027.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,395.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,281.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,758.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$667.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$921.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$2,764.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC COLONSCOPY STOMA W RMVL
|
Facility
|
IP
|
$1,681.00
|
|
|
Service Code
|
CPT 44394
|
| Hospital Charge Code |
906744394
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$304.26 |
| Max. Negotiated Rate |
$1,260.75 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,138.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,138.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.25
|
| Rate for Payer: Multiplan Commercial |
$1,260.75
|
|
|
HC COLONSCOPY STOMA W RMVL
|
Facility
|
OP
|
$1,681.00
|
|
|
Service Code
|
CPT 44394
|
| Hospital Charge Code |
906744394
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,154.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,092.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,040.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$503.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$801.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$1,260.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC COLON VIA STOMA W FB REMOVAL
|
Facility
|
OP
|
$1,681.00
|
|
|
Service Code
|
CPT 44390
|
| Hospital Charge Code |
906744390
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,154.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,092.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Senior |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,158.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,040.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,424.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$284.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$801.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,332.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,459.61
|
| Rate for Payer: Multiplan Commercial |
$1,260.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC COLON VIA STOMA W FB REMOVAL
|
Facility
|
IP
|
$1,681.00
|
|
|
Service Code
|
CPT 44390
|
| Hospital Charge Code |
906744390
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$304.26 |
| Max. Negotiated Rate |
$1,260.75 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,138.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,138.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.25
|
| Rate for Payer: Multiplan Commercial |
$1,260.75
|
|
|
HC COLON W SNGL CONTRAST ENEMA
|
Facility
|
OP
|
$1,279.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
909001806
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.09 |
| Max. Negotiated Rate |
$959.25 |
| Rate for Payer: Adventist Health Commercial |
$255.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$683.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$878.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$432.76
|
| Rate for Payer: Blue Shield of California Commercial |
$361.30
|
| Rate for Payer: Blue Shield of California EPN |
$290.54
|
| Rate for Payer: Cash Price |
$703.45
|
| Rate for Payer: Cash Price |
$703.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$831.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$831.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$791.70
|
| Rate for Payer: Heritage Provider Network Senior |
$791.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$610.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$319.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$959.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$226.19
|
| Rate for Payer: TriValley Medical Group Senior |
$226.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC COLON W SNGL CONTRAST ENEMA
|
Facility
|
IP
|
$1,279.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
909001806
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.50 |
| Max. Negotiated Rate |
$959.25 |
| Rate for Payer: Adventist Health Commercial |
$255.80
|
| Rate for Payer: Cash Price |
$703.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$865.88
|
| Rate for Payer: Heritage Provider Network Senior |
$865.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$319.75
|
| Rate for Payer: Multiplan Commercial |
$959.25
|
|
|
HC COLORCTL CNCR SCRN NON HGH RSK
|
Facility
|
OP
|
$1,869.00
|
|
|
Service Code
|
CPT G0121
|
| Hospital Charge Code |
900100676
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$373.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,284.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,027.95
|
| Rate for Payer: Cash Price |
$1,027.95
|
| Rate for Payer: Cash Price |
$1,027.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,214.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Senior |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,121.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,158.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,156.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,424.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$891.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,332.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,459.61
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC COLORCTL CNCR SCRN NON HGH RSK
|
Facility
|
IP
|
$1,869.00
|
|
|
Service Code
|
CPT G0121
|
| Hospital Charge Code |
900100676
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$338.29 |
| Max. Negotiated Rate |
$1,401.75 |
| Rate for Payer: Adventist Health Commercial |
$373.80
|
| Rate for Payer: Cash Price |
$1,027.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,265.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,265.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.25
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
|
|
HC COLORECTAL CANCER SCRN FLXBL SGMDSCPY
|
Facility
|
IP
|
$2,302.00
|
|
|
Service Code
|
CPT G0104
|
| Hospital Charge Code |
900100230
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$416.66 |
| Max. Negotiated Rate |
$1,726.50 |
| Rate for Payer: Adventist Health Commercial |
$460.40
|
| Rate for Payer: Cash Price |
$1,266.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,558.45
|
| Rate for Payer: Heritage Provider Network Senior |
$1,558.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$575.50
|
| Rate for Payer: Multiplan Commercial |
$1,726.50
|
|
|
HC COLORECTAL CANCER SCRN FLXBL SGMDSCPY
|
Facility
|
OP
|
$2,302.00
|
|
|
Service Code
|
CPT G0104
|
| Hospital Charge Code |
900100230
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$460.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,581.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,266.10
|
| Rate for Payer: Cash Price |
$1,266.10
|
| Rate for Payer: Cash Price |
$1,266.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,496.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Senior |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,381.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,158.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,424.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1,424.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,098.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,332.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$575.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,459.61
|
| Rate for Payer: Multiplan Commercial |
$1,726.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC COLORECTAL CANCER SCRN HIGH RISK
|
Facility
|
OP
|
$1,869.00
|
|
|
Service Code
|
CPT G0105
|
| Hospital Charge Code |
900100675
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$373.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,284.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,027.95
|
| Rate for Payer: Cash Price |
$1,027.95
|
| Rate for Payer: Cash Price |
$1,027.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,214.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Senior |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,121.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,158.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,156.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,424.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$891.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,332.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,459.61
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC COLORECTAL CANCER SCRN HIGH RISK
|
Facility
|
IP
|
$1,869.00
|
|
|
Service Code
|
CPT G0105
|
| Hospital Charge Code |
900100675
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$338.29 |
| Max. Negotiated Rate |
$1,401.75 |
| Rate for Payer: Adventist Health Commercial |
$373.80
|
| Rate for Payer: Cash Price |
$1,027.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,265.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,265.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.25
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
|
|
HC COLPORRHAPHY
|
Facility
|
OP
|
$8,771.00
|
|
|
Service Code
|
CPT 57200
|
| Hospital Charge Code |
900501301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,754.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,025.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$4,824.05
|
| Rate for Payer: Cash Price |
$4,824.05
|
| Rate for Payer: Cash Price |
$4,824.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,701.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Senior |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,039.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,937.97
|
| Rate for Payer: Heritage Provider Network Senior |
$5,937.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,183.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,587.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,645.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,192.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,090.29
|
| Rate for Payer: Multiplan Commercial |
$6,578.25
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,155.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,904.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC COLPORRHAPHY
|
Facility
|
IP
|
$8,771.00
|
|
|
Service Code
|
CPT 57200
|
| Hospital Charge Code |
900501301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,587.55 |
| Max. Negotiated Rate |
$6,578.25 |
| Rate for Payer: Adventist Health Commercial |
$1,754.20
|
| Rate for Payer: Cash Price |
$4,824.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,937.97
|
| Rate for Payer: Heritage Provider Network Senior |
$5,937.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,587.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,192.75
|
| Rate for Payer: Multiplan Commercial |
$6,578.25
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$695.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$657.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Senior |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$386.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$626.43
|
| Rate for Payer: Heritage Provider Network Senior |
$475.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$482.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.99
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$183.17 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$685.12
|
| Rate for Payer: Heritage Provider Network Senior |
$685.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$695.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$657.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Senior |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$386.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$685.12
|
| Rate for Payer: Heritage Provider Network Senior |
$685.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$482.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.99
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$364.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$335.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$183.17 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$685.12
|
| Rate for Payer: Heritage Provider Network Senior |
$685.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
|
|
HC COMMON CAROTID HEAD UNI
|
Facility
|
OP
|
$9,868.00
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
906820221
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$1,973.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,779.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$5,427.40
|
| Rate for Payer: Cash Price |
$5,427.40
|
| Rate for Payer: Cash Price |
$5,427.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,414.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Senior |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,868.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,108.29
|
| Rate for Payer: Heritage Provider Network Senior |
$8,448.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$416.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,050.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,786.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,467.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,654.28
|
| Rate for Payer: Multiplan Commercial |
$7,401.00
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,555.33
|
| Rate for Payer: TriValley Medical Group Senior |
$7,555.33
|
| 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 |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC COMMON CAROTID HEAD UNI
|
Facility
|
IP
|
$10,153.00
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
909020146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,837.69 |
| Max. Negotiated Rate |
$7,614.75 |
| Rate for Payer: Adventist Health Commercial |
$2,030.60
|
| Rate for Payer: Cash Price |
$5,584.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,873.58
|
| Rate for Payer: Heritage Provider Network Senior |
$6,873.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,837.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,538.25
|
| Rate for Payer: Multiplan Commercial |
$7,614.75
|
|
|
HC COMMON CAROTID HEAD UNI
|
Facility
|
OP
|
$10,153.00
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
909020146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,030.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,975.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$5,584.15
|
| Rate for Payer: Cash Price |
$5,584.15
|
| Rate for Payer: Cash Price |
$5,584.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,599.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Senior |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,868.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,284.71
|
| Rate for Payer: Heritage Provider Network Senior |
$8,448.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$416.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,050.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,837.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,538.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,654.28
|
| Rate for Payer: Multiplan Commercial |
$7,614.75
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,555.33
|
| Rate for Payer: TriValley Medical Group Senior |
$7,555.33
|
| 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 |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
