|
HC FMRI BRAIN BY PHYS/PSYCH
|
Facility
|
OP
|
$1,352.00
|
|
|
Service Code
|
CPT 70555
|
| Hospital Charge Code |
908801023
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$154.46 |
| Max. Negotiated Rate |
$1,075.00 |
| Rate for Payer: Adventist Health Commercial |
$270.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$928.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$839.59
|
| Rate for Payer: Blue Shield of California EPN |
$793.62
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$154.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,014.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC FMRI BRAIN BY TECH
|
Facility
|
IP
|
$4,508.00
|
|
|
Service Code
|
CPT 70554
|
| Hospital Charge Code |
908801022
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$815.95 |
| Max. Negotiated Rate |
$3,381.00 |
| Rate for Payer: Adventist Health Commercial |
$901.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,097.00
|
| Rate for Payer: Cash Price |
$2,028.60
|
| Rate for Payer: Cash Price |
$2,028.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,051.92
|
| Rate for Payer: Heritage Provider Network Senior |
$3,051.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$815.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,127.00
|
| Rate for Payer: Multiplan Commercial |
$3,381.00
|
|
|
HC FMRI BRAIN BY TECH
|
Facility
|
OP
|
$1,352.00
|
|
|
Service Code
|
CPT 70554
|
| Hospital Charge Code |
908801022
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$244.71 |
| Max. Negotiated Rate |
$2,642.83 |
| Rate for Payer: Adventist Health Commercial |
$270.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$928.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2,642.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,502.89
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$583.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,014.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC FNA BX W/CT GDN 1ST LESION
|
Facility
|
IP
|
$1,601.00
|
|
|
Service Code
|
CPT 10009
|
| Hospital Charge Code |
909010009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.78 |
| Max. Negotiated Rate |
$1,200.75 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.89
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,083.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,083.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
|
|
HC FNA BX W/CT GDN 1ST LESION
|
Facility
|
OP
|
$1,601.00
|
|
|
Service Code
|
CPT 10009
|
| Hospital Charge Code |
909010009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,040.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$991.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$668.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC FNA BX W/CT GDN EA ADDL LSN
|
Facility
|
IP
|
$801.00
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
909010010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.98 |
| Max. Negotiated Rate |
$600.75 |
| Rate for Payer: Adventist Health Commercial |
$160.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.29
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$542.28
|
| Rate for Payer: Heritage Provider Network Senior |
$542.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.25
|
| Rate for Payer: Multiplan Commercial |
$600.75
|
|
|
HC FNA BX W/CT GDN EA ADDL LSN
|
Facility
|
OP
|
$801.00
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
909010010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$160.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$600.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$520.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$680.85
|
| Rate for Payer: Dignity Health Senior |
$680.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$495.82
|
| Rate for Payer: Heritage Provider Network Senior |
$495.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$400.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$386.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.25
|
| Rate for Payer: Multiplan Commercial |
$600.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$680.85
|
| Rate for Payer: Vantage Medical Group Senior |
$680.85
|
|
|
HC FNA BX W/FLUOR GDN 1ST LESION
|
Facility
|
OP
|
$1,601.00
|
|
|
Service Code
|
CPT 10007
|
| Hospital Charge Code |
909010007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,040.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$991.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$404.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC FNA BX W/FLUOR GDN 1ST LESION
|
Facility
|
IP
|
$1,601.00
|
|
|
Service Code
|
CPT 10007
|
| Hospital Charge Code |
909010007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.78 |
| Max. Negotiated Rate |
$1,200.75 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.89
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,083.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,083.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
|
|
HC FNA BX W/FLUOR GDN EA ADDL LSN
|
Facility
|
OP
|
$801.00
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
909010008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$160.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$600.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$520.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$680.85
|
| Rate for Payer: Dignity Health Senior |
$680.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$495.82
|
| Rate for Payer: Heritage Provider Network Senior |
$495.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$386.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.25
|
| Rate for Payer: Multiplan Commercial |
$600.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$680.85
|
| Rate for Payer: Vantage Medical Group Senior |
$680.85
|
|
|
HC FNA BX W/FLUOR GDN EA ADDL LSN
|
Facility
|
IP
|
$801.00
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
909010008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.98 |
| Max. Negotiated Rate |
$600.75 |
| Rate for Payer: Adventist Health Commercial |
$160.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.29
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$542.28
|
| Rate for Payer: Heritage Provider Network Senior |
$542.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.25
|
| Rate for Payer: Multiplan Commercial |
$600.75
|
|
|
HC FNA BX W/MR GDN 1ST LESION
|
Facility
|
OP
|
$1,601.00
|
|
|
Service Code
|
CPT 10011
|
| Hospital Charge Code |
909010011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,040.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$991.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC FNA BX W/MR GDN 1ST LESION
|
Facility
|
IP
|
$1,601.00
|
|
|
Service Code
|
CPT 10011
|
| Hospital Charge Code |
909010011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.78 |
| Max. Negotiated Rate |
$1,200.75 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.89
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,083.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,083.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
|
|
HC FNA BX W/US GDN 1ST LESION
|
Facility
|
IP
|
$1,601.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
909010005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.78 |
| Max. Negotiated Rate |
$1,200.75 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.89
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,083.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,083.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
|
|
HC FNA BX W/US GDN 1ST LESION
|
Facility
|
OP
|
$1,601.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
909010005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,040.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$991.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$174.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC FNA BX W/US GDN EA ADDL LSN
|
Facility
|
IP
|
$801.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
909010006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.98 |
| Max. Negotiated Rate |
$600.75 |
| Rate for Payer: Adventist Health Commercial |
$160.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.29
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$542.28
|
| Rate for Payer: Heritage Provider Network Senior |
$542.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.25
|
| Rate for Payer: Multiplan Commercial |
$600.75
|
|
|
HC FNA BX W/US GDN EA ADDL LSN
|
Facility
|
OP
|
$801.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
909010006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$80.73 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$160.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$600.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$520.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$680.85
|
| Rate for Payer: Dignity Health Senior |
$680.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$495.82
|
| Rate for Payer: Heritage Provider Network Senior |
$495.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$386.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.25
|
| Rate for Payer: Multiplan Commercial |
$600.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$680.85
|
| Rate for Payer: Vantage Medical Group Senior |
$680.85
|
|
|
HC FO FINGER KNUCKLE BENDER PF
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905103948
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$74.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$178.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$254.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$170.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$251.17
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$185.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.75
|
| Rate for Payer: Multiplan Commercial |
$278.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$123.95
|
|
|
HC FO FINGER KNUCKLE BENDER PF
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905103948
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$74.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$178.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$254.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$315.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$204.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$278.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$230.39
|
| Rate for Payer: Blue Shield of California EPN |
$217.78
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$170.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$315.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$315.35
|
| Rate for Payer: Dignity Health Senior |
$315.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.77
|
| Rate for Payer: Heritage Provider Network Senior |
$171.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$185.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.75
|
| Rate for Payer: Multiplan Commercial |
$278.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$123.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$315.35
|
| Rate for Payer: Vantage Medical Group Senior |
$315.35
|
|
|
HC FOLIC ACID (SERUM)
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
900910817
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$123.07 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.07
|
| Rate for Payer: Blue Shield of California Commercial |
$114.82
|
| Rate for Payer: Blue Shield of California EPN |
$89.76
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.17
|
| Rate for Payer: Dignity Health Senior |
$14.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Humana Medicare |
$14.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.52
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.70
|
| Rate for Payer: TriValley Medical Group Senior |
$14.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Vantage Medical Group Senior |
$14.70
|
|
|
HC FOLIC ACID (SERUM)
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
900910817
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.63
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.19
|
| Rate for Payer: Heritage Provider Network Senior |
$165.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
|
|
HC FOLLOW-UP ANGIO-EXISTING CATH
|
Facility
|
OP
|
$2,243.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
909081647
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$448.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,540.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.77
|
| Rate for Payer: Blue Shield of California Commercial |
$216.27
|
| Rate for Payer: Blue Shield of California EPN |
$122.99
|
| Rate for Payer: Cash Price |
$1,009.35
|
| Rate for Payer: Cash Price |
$1,009.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,457.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,457.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,388.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,388.42
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$162.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$560.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$1,682.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC FOLLOW-UP ANGIO-EXISTING CATH
|
Facility
|
IP
|
$2,243.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
909081647
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$405.98 |
| Max. Negotiated Rate |
$1,682.25 |
| Rate for Payer: Adventist Health Commercial |
$448.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,540.94
|
| Rate for Payer: Cash Price |
$1,009.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,518.51
|
| Rate for Payer: Heritage Provider Network Senior |
$1,518.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$560.75
|
| Rate for Payer: Multiplan Commercial |
$1,682.25
|
|
|
HC FO MODIFIED PIN
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
901309136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$63.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.36
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.10
|
|
|
HC FO MODIFIED PIN
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
901309136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$63.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$81.97
|
| Rate for Payer: Blue Shield of California EPN |
$77.48
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Senior |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.12
|
| Rate for Payer: Heritage Provider Network Senior |
$61.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
