|
HC DIALYSIS PERITONEAL/CCPD
|
Facility
|
IP
|
$1,259.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
944000100
|
|
Hospital Revenue Code
|
804
|
| Min. Negotiated Rate |
$227.88 |
| Max. Negotiated Rate |
$944.25 |
| Rate for Payer: Adventist Health Commercial |
$251.80
|
| Rate for Payer: Cash Price |
$692.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$679.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$852.34
|
| Rate for Payer: Heritage Provider Network Senior |
$852.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.75
|
| Rate for Payer: Multiplan Commercial |
$944.25
|
|
|
HC DIAPHRAGM/CAP FITTING
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 57170
|
| Hospital Charge Code |
910400024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.56 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$212.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$272.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Blue Shield of California Commercial |
$242.17
|
| Rate for Payer: Blue Shield of California EPN |
$193.74
|
| Rate for Payer: Cash Price |
$218.35
|
| Rate for Payer: Cash Price |
$218.35
|
| Rate for Payer: Cash Price |
$218.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Senior |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$255.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.74
|
| Rate for Payer: Heritage Provider Network Senior |
$245.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$189.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$322.07
|
| Rate for Payer: Multiplan Commercial |
$297.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$198.50
|
| Rate for Payer: TriValley Medical Group Senior |
$198.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$198.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$198.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC DIAPHRAGM/CAP FITTING
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 57170
|
| Hospital Charge Code |
910400024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.86 |
| Max. Negotiated Rate |
$297.75 |
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Cash Price |
$218.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.77
|
| Rate for Payer: Heritage Provider Network Senior |
$268.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.25
|
| Rate for Payer: Multiplan Commercial |
$297.75
|
|
|
HC DIFFERENTIAL LUNG SCAN
|
Facility
|
OP
|
$2,896.00
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
909301404
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$287.70 |
| Max. Negotiated Rate |
$2,172.00 |
| Rate for Payer: Adventist Health Commercial |
$579.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,547.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,989.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,226.25
|
| Rate for Payer: Blue Shield of California Commercial |
$962.35
|
| Rate for Payer: Blue Shield of California EPN |
$773.89
|
| Rate for Payer: Cash Price |
$1,592.80
|
| Rate for Payer: Cash Price |
$1,592.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,882.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,882.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,792.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,792.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$287.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,381.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$524.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$724.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$2,172.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,448.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,448.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC DIFFERENTIAL LUNG SCAN
|
Facility
|
IP
|
$2,896.00
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
909301404
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$524.18 |
| Max. Negotiated Rate |
$2,172.00 |
| Rate for Payer: Adventist Health Commercial |
$579.20
|
| Rate for Payer: Cash Price |
$1,592.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,960.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,960.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$524.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$724.00
|
| Rate for Payer: Multiplan Commercial |
$2,172.00
|
|
|
HC DIGITAL-SCREENING MAMMO, BILAT
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
909002010
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$521.25 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$470.51
|
| Rate for Payer: Heritage Provider Network Senior |
$470.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.75
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
|
|
HC DIGITAL-SCREENING MAMMO, BILAT
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
909002010
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$618.29 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$371.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$477.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$382.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$521.25
|
| Rate for Payer: Blue Shield of California Commercial |
$618.29
|
| Rate for Payer: Blue Shield of California EPN |
$497.21
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$451.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$590.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.75
|
| Rate for Payer: Dignity Health Senior |
$590.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$430.20
|
| Rate for Payer: Heritage Provider Network Senior |
$430.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$331.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.50
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$168.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$168.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.75
|
| Rate for Payer: Vantage Medical Group Senior |
$590.75
|
|
|
HC DIGOXIN
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
900910816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$143.25 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.31
|
| Rate for Payer: Heritage Provider Network Senior |
$129.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
|
|
HC DIGOXIN
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
900910816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$143.25 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.21
|
| Rate for Payer: Blue Shield of California Commercial |
$106.85
|
| Rate for Payer: Blue Shield of California EPN |
$85.70
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.61
|
| Rate for Payer: Dignity Health Senior |
$13.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.23
|
| Rate for Payer: Heritage Provider Network Senior |
$118.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$91.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.73
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.28
|
| Rate for Payer: TriValley Medical Group Senior |
$13.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: Vantage Medical Group Senior |
$13.28
|
|
|
HC DILAT ANAL SPHINC UNDER ANES
|
Facility
|
OP
|
$5,448.00
|
|
|
Service Code
|
CPT 45905
|
| Hospital Charge Code |
906745905
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,089.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,742.78
|
| 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 |
$2,996.40
|
| Rate for Payer: Cash Price |
$2,996.40
|
| Rate for Payer: Cash Price |
$2,996.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,541.20
|
| 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 |
$3,372.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$244.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,598.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$986.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,362.00
|
| 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 |
$4,086.00
|
| 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 DILAT ANAL SPHINC UNDER ANES
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
CPT 45905
|
| Hospital Charge Code |
906745905
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$986.09 |
| Max. Negotiated Rate |
$4,086.00 |
| Rate for Payer: Adventist Health Commercial |
$1,089.60
|
| Rate for Payer: Cash Price |
$2,996.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,688.30
|
| Rate for Payer: Heritage Provider Network Senior |
$3,688.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$986.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,362.00
|
| Rate for Payer: Multiplan Commercial |
$4,086.00
|
|
|
HC DILATE BILIARY OR AMPULLA PERC
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
909047542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$356.39 |
| Max. Negotiated Rate |
$1,476.75 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Cash Price |
$1,082.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,333.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,333.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.25
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
|
|
HC DILATE BILIARY OR AMPULLA PERC
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
909047542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,352.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,082.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,476.75
|
| 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 |
$1,082.95
|
| Rate for Payer: Cash Price |
$1,082.95
|
| Rate for Payer: Cash Price |
$1,082.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,279.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,673.65
|
| Rate for Payer: Dignity Health Senior |
$1,673.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,218.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,218.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$760.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$939.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,378.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,378.30
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
| 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 |
$1,673.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,673.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,673.65
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$308.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,059.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$848.10
|
| Rate for Payer: Cash Price |
$848.10
|
| Rate for Payer: Cash Price |
$848.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,002.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,043.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,043.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$735.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$1,156.50
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$554.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$510.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$279.10 |
| Max. Negotiated Rate |
$1,156.50 |
| Rate for Payer: Adventist Health Commercial |
$308.40
|
| Rate for Payer: Cash Price |
$848.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,043.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,043.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$1,156.50
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$308.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,059.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| 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 |
$848.10
|
| Rate for Payer: Cash Price |
$848.10
|
| Rate for Payer: Cash Price |
$848.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,002.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$954.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$735.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$1,156.50
|
| 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 |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$279.10 |
| Max. Negotiated Rate |
$1,156.50 |
| Rate for Payer: Adventist Health Commercial |
$308.40
|
| Rate for Payer: Cash Price |
$848.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,043.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,043.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$1,156.50
|
|
|
HC DILAT ESOPH OVER GUIDE WIRE
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
906743453
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$308.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,059.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| 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 |
$848.10
|
| Rate for Payer: Cash Price |
$848.10
|
| Rate for Payer: Cash Price |
$848.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,002.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$954.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2,964.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$162.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$735.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$1,156.50
|
| 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 |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC DILAT ESOPH OVER GUIDE WIRE
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
906743453
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$279.10 |
| Max. Negotiated Rate |
$1,156.50 |
| Rate for Payer: Adventist Health Commercial |
$308.40
|
| Rate for Payer: Cash Price |
$848.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,043.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,043.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$1,156.50
|
|
|
HC DILATE TEAR DUCT OPENING
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
900501698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.61 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$170.60
|
| Rate for Payer: Heritage Provider Network Senior |
$170.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
|
|
HC DILATE TEAR DUCT OPENING
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
900501698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.61 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$163.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Senior |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$170.60
|
| Rate for Payer: Heritage Provider Network Senior |
$170.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$120.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$638.85
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$90.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$83.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
|
OP
|
$4,386.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$877.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,013.18
|
| 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 |
$2,412.30
|
| Rate for Payer: Cash Price |
$2,412.30
|
| Rate for Payer: Cash Price |
$2,412.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,850.90
|
| 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 |
$2,969.32
|
| Rate for Payer: Heritage Provider Network Senior |
$2,969.32
|
| 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 |
$2,092.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$793.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,645.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,096.50
|
| 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 |
$3,289.50
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,578.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,452.20
|
| 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 DILATION OF CERVICAL CANAL
|
Facility
|
IP
|
$4,386.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$793.87 |
| Max. Negotiated Rate |
$3,289.50 |
| Rate for Payer: Adventist Health Commercial |
$877.20
|
| Rate for Payer: Cash Price |
$2,412.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,969.32
|
| Rate for Payer: Heritage Provider Network Senior |
$2,969.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$793.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,096.50
|
| Rate for Payer: Multiplan Commercial |
$3,289.50
|
|
|
HC DILATION OF NEPHROSTOMY
|
Facility
|
OP
|
$11,641.00
|
|
|
Service Code
|
CPT 50436
|
| Hospital Charge Code |
909000168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,328.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,997.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| 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 |
$6,402.55
|
| Rate for Payer: Cash Price |
$6,402.55
|
| Rate for Payer: Cash Price |
$6,402.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,566.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Senior |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,382.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,205.78
|
| Rate for Payer: Heritage Provider Network Senior |
$5,390.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$212.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,326.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,107.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,039.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,910.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.65
|
| Rate for Payer: Multiplan Commercial |
$8,730.75
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,820.49
|
| Rate for Payer: TriValley Medical Group Senior |
$4,820.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC DILATION OF NEPHROSTOMY
|
Facility
|
IP
|
$11,641.00
|
|
|
Service Code
|
CPT 50436
|
| Hospital Charge Code |
909000168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,107.02 |
| Max. Negotiated Rate |
$8,730.75 |
| Rate for Payer: Adventist Health Commercial |
$2,328.20
|
| Rate for Payer: Cash Price |
$6,402.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,880.96
|
| Rate for Payer: Heritage Provider Network Senior |
$7,880.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,107.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,910.25
|
| Rate for Payer: Multiplan Commercial |
$8,730.75
|
|
