|
HC CYCLOSPORINE A (EMIT)
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
900910933
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$175.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$225.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.84
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$180.40
|
| Rate for Payer: Cash Price |
$180.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$213.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.86
|
| Rate for Payer: Dignity Health Senior |
$18.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.03
|
| Rate for Payer: Heritage Provider Network Senior |
$203.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$156.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.74
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.05
|
| Rate for Payer: TriValley Medical Group Senior |
$18.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.86
|
| Rate for Payer: Vantage Medical Group Senior |
$18.05
|
|
|
HC CYCLOSPORINE A (EMIT)
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
900910933
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.37 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Cash Price |
$180.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$222.06
|
| Rate for Payer: Heritage Provider Network Senior |
$222.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
|
|
HC CYSTOGRAM, INJECTION
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
909000171
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.47 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$284.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$366.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$453.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$399.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$325.13
|
| Rate for Payer: Blue Shield of California EPN |
$260.10
|
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$346.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$453.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$453.05
|
| Rate for Payer: Dignity Health Senior |
$453.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.93
|
| Rate for Payer: Heritage Provider Network Senior |
$329.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$416.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$254.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$373.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$373.10
|
| Rate for Payer: Multiplan Commercial |
$399.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$266.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$266.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$453.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$453.05
|
| Rate for Payer: Vantage Medical Group Senior |
$453.05
|
|
|
HC CYSTOGRAM, INJECTION
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
909000171
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.47 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$360.84
|
| Rate for Payer: Heritage Provider Network Senior |
$360.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.25
|
| Rate for Payer: Multiplan Commercial |
$399.75
|
|
|
HC CYSTOGRAPH MIN 3 VIEWS
|
Facility
|
IP
|
$1,389.00
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
909001901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.41 |
| Max. Negotiated Rate |
$1,041.75 |
| Rate for Payer: Adventist Health Commercial |
$277.80
|
| Rate for Payer: Cash Price |
$763.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$940.35
|
| Rate for Payer: Heritage Provider Network Senior |
$940.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.25
|
| Rate for Payer: Multiplan Commercial |
$1,041.75
|
|
|
HC CYSTOGRAPH MIN 3 VIEWS
|
Facility
|
OP
|
$1,389.00
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
909001901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.72 |
| Max. Negotiated Rate |
$1,041.75 |
| Rate for Payer: Adventist Health Commercial |
$277.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$742.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$954.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$274.19
|
| Rate for Payer: Blue Shield of California Commercial |
$222.77
|
| Rate for Payer: Blue Shield of California EPN |
$179.14
|
| Rate for Payer: Cash Price |
$763.95
|
| Rate for Payer: Cash Price |
$763.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$902.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$902.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$859.79
|
| Rate for Payer: Heritage Provider Network Senior |
$859.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$662.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$1,041.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$453.77
|
| Rate for Payer: TriValley Medical Group Senior |
$453.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC CYSTOSTOMY TUBE CHG SIMPLE
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
900501165
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$517.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Senior |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$309.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$538.89
|
| Rate for Payer: Heritage Provider Network Senior |
$538.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$379.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.37
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$286.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$263.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC CYSTOSTOMY TUBE CHG SIMPLE
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
900501165
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.08 |
| Max. Negotiated Rate |
$597.00 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$538.89
|
| Rate for Payer: Heritage Provider Network Senior |
$538.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
|
|
HC CYSTOSTOMY W DRAINAGE
|
Facility
|
OP
|
$8,556.00
|
|
|
Service Code
|
CPT 51040
|
| Hospital Charge Code |
900551040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,711.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,877.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Cash Price |
$4,705.80
|
| Rate for Payer: Cash Price |
$4,705.80
|
| Rate for Payer: Cash Price |
$4,705.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,561.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Senior |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,602.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,792.41
|
| Rate for Payer: Heritage Provider Network Senior |
$5,792.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,081.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,548.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,993.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,139.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,279.58
|
| Rate for Payer: Multiplan Commercial |
$6,417.00
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,078.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,832.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CYSTOSTOMY W DRAINAGE
|
Facility
|
IP
|
$8,556.00
|
|
|
Service Code
|
CPT 51040
|
| Hospital Charge Code |
900551040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,548.64 |
| Max. Negotiated Rate |
$6,417.00 |
| Rate for Payer: Adventist Health Commercial |
$1,711.20
|
| Rate for Payer: Cash Price |
$4,705.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,792.41
|
| Rate for Payer: Heritage Provider Network Senior |
$5,792.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,548.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,139.00
|
| Rate for Payer: Multiplan Commercial |
$6,417.00
|
|
|
HC CYSTOSTOMY W INSERTION CATH OR STNT
|
Facility
|
OP
|
$3,266.00
|
|
|
Service Code
|
CPT 51045
|
| Hospital Charge Code |
900551045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,243.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,122.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Senior |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,602.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,211.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,211.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,557.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$591.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,993.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$816.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,279.58
|
| Rate for Payer: Multiplan Commercial |
$2,449.50
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,175.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,081.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CYSTOSTOMY W INSERTION CATH OR STNT
|
Facility
|
IP
|
$3,266.00
|
|
|
Service Code
|
CPT 51045
|
| Hospital Charge Code |
900551045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$591.15 |
| Max. Negotiated Rate |
$2,449.50 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Cash Price |
$1,796.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,211.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,211.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$591.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$816.50
|
| Rate for Payer: Multiplan Commercial |
$2,449.50
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
IP
|
$4,959.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
900501353
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$897.58 |
| Max. Negotiated Rate |
$3,719.25 |
| Rate for Payer: Adventist Health Commercial |
$991.80
|
| Rate for Payer: Cash Price |
$2,727.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,357.24
|
| Rate for Payer: Heritage Provider Network Senior |
$3,357.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$897.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,239.75
|
| Rate for Payer: Multiplan Commercial |
$3,719.25
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
OP
|
$4,959.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
900501353
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$991.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,406.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$848.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,727.45
|
| Rate for Payer: Cash Price |
$2,727.45
|
| Rate for Payer: Cash Price |
$2,727.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,223.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$932.90
|
| Rate for Payer: Dignity Health Senior |
$848.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$848.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,357.24
|
| Rate for Payer: Heritage Provider Network Senior |
$3,357.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$848.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,365.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$897.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$975.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,239.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,068.59
|
| Rate for Payer: Multiplan Commercial |
$3,719.25
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,784.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,641.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Vantage Medical Group Senior |
$848.09
|
|
|
HC CYSTOURETHROSCOPY, W/DILATION
|
Facility
|
OP
|
$4,375.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
900501303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$875.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,005.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,843.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Senior |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,602.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,961.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,961.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,086.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$791.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,993.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,093.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,279.58
|
| Rate for Payer: Multiplan Commercial |
$3,281.25
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,574.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,448.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CYSTOURETHROSCOPY, W/DILATION
|
Facility
|
IP
|
$4,375.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
900501303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$791.88 |
| Max. Negotiated Rate |
$3,281.25 |
| Rate for Payer: Adventist Health Commercial |
$875.00
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,961.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,961.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$791.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,093.75
|
| Rate for Payer: Multiplan Commercial |
$3,281.25
|
|
|
HC CYSTOURETHROSCOPY W/RMVL F B
|
Facility
|
IP
|
$4,375.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
900501293
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$791.88 |
| Max. Negotiated Rate |
$3,281.25 |
| Rate for Payer: Adventist Health Commercial |
$875.00
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,961.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,961.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$791.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,093.75
|
| Rate for Payer: Multiplan Commercial |
$3,281.25
|
|
|
HC CYSTOURETHROSCOPY W/RMVL F B
|
Facility
|
OP
|
$4,375.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
900501293
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$875.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,005.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,843.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Senior |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,602.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,961.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,961.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,086.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$791.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,993.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,093.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,279.58
|
| Rate for Payer: Multiplan Commercial |
$3,281.25
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,574.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,448.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CYSTOURETHROSCOPY,W/UTERAL CAT
|
Facility
|
OP
|
$7,301.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
900501312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,460.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,015.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$4,015.55
|
| Rate for Payer: Cash Price |
$4,015.55
|
| Rate for Payer: Cash Price |
$4,015.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,745.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Senior |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,602.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,942.78
|
| Rate for Payer: Heritage Provider Network Senior |
$4,942.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,482.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,321.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,993.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,825.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,279.58
|
| Rate for Payer: Multiplan Commercial |
$5,475.75
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,626.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,417.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CYSTOURETHROSCOPY,W/UTERAL CAT
|
Facility
|
IP
|
$7,301.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
900501312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,321.48 |
| Max. Negotiated Rate |
$5,475.75 |
| Rate for Payer: Adventist Health Commercial |
$1,460.20
|
| Rate for Payer: Cash Price |
$4,015.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,942.78
|
| Rate for Payer: Heritage Provider Network Senior |
$4,942.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,321.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,825.25
|
| Rate for Payer: Multiplan Commercial |
$5,475.75
|
|
|
HC CYSTOURETHRO W LITHO INC STNT
|
Facility
|
IP
|
$17,383.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
900052356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,146.32 |
| Max. Negotiated Rate |
$13,037.25 |
| Rate for Payer: Adventist Health Commercial |
$3,476.60
|
| Rate for Payer: Cash Price |
$9,560.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,768.29
|
| Rate for Payer: Heritage Provider Network Senior |
$11,768.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,146.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,345.75
|
| Rate for Payer: Multiplan Commercial |
$13,037.25
|
|
|
HC CYSTOURETHRO W LITHO INC STNT
|
Facility
|
OP
|
$17,383.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
900052356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$13,037.25 |
| Rate for Payer: Adventist Health Commercial |
$3,476.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,942.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,688.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,105.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,459.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$9,560.65
|
| Rate for Payer: Cash Price |
$9,560.65
|
| Rate for Payer: Cash Price |
$9,560.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,298.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,688.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,105.18
|
| Rate for Payer: Dignity Health Senior |
$6,459.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,459.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,768.29
|
| Rate for Payer: Heritage Provider Network Senior |
$11,768.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,459.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,291.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,146.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,428.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,345.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,138.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,138.65
|
| Rate for Payer: Multiplan Commercial |
$13,037.25
|
| Rate for Payer: Multiplan WC |
$10,291.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,254.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,755.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,688.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,105.18
|
| Rate for Payer: Vantage Medical Group Senior |
$6,459.25
|
|
|
HC CYTO FNA EVAL, 1ST EA SITE
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800008
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$66.25 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.78
|
| Rate for Payer: Heritage Provider Network Senior |
$247.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.50
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
|
|
HC CYTO FNA EVAL, 1ST EA SITE
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800008
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$45.83 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$195.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$251.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.96
|
| Rate for Payer: Blue Shield of California Commercial |
$81.65
|
| Rate for Payer: Blue Shield of California EPN |
$65.66
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$237.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Senior |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$217.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$226.55
|
| Rate for Payer: Heritage Provider Network Senior |
$226.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$174.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$274.34
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$217.73
|
| Rate for Payer: TriValley Medical Group Senior |
$217.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC CYTO FNA EVAL,EA ADDL SAME SIT
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800180
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
