|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
|
OP
|
$2,852.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906820131
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$2,424.20 |
| Rate for Payer: Adventist Health Commercial |
$570.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,959.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,424.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,568.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,139.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,771.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,674.12
|
| Rate for Payer: Cash Price |
$1,283.40
|
| Rate for Payer: Cash Price |
$1,283.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,853.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,424.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,424.20
|
| Rate for Payer: Dignity Health Senior |
$2,424.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,853.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,765.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,765.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,374.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$516.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.00
|
| Rate for Payer: Multiplan Commercial |
$2,139.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,424.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,424.20
|
|
|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
|
OP
|
$2,356.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811387
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$2,002.60 |
| Rate for Payer: Adventist Health Commercial |
$471.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,618.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,002.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,295.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,767.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,463.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,382.97
|
| Rate for Payer: Cash Price |
$1,060.20
|
| Rate for Payer: Cash Price |
$1,060.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,531.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,002.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,002.60
|
| Rate for Payer: Dignity Health Senior |
$2,002.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,531.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,458.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,458.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,135.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.00
|
| Rate for Payer: Multiplan Commercial |
$1,767.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,002.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,002.60
|
|
|
HC ILEOSCOPY STOMA W BX
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
CPT 44382
|
| Hospital Charge Code |
906744382
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$451.78 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Adventist Health Commercial |
$499.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,714.75
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,689.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,689.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
|
|
HC ILEOSCOPY STOMA W BX
|
Facility
|
OP
|
$4,558.00
|
|
|
Service Code
|
CPT 44382
|
| Hospital Charge Code |
906744382
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$170.16 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$911.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,131.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,962.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,821.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$170.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,139.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$3,418.50
|
| 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 |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
|
OP
|
$4,558.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$131.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$911.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,131.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,962.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,821.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,139.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$3,418.50
|
| 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 |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$451.78 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Adventist Health Commercial |
$499.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,714.75
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,689.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,689.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
|
OP
|
$4,558.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$911.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,131.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,962.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,085.77
|
| Rate for Payer: Heritage Provider Network Senior |
$3,085.77
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,196.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,139.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$3,418.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,655.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,522.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$451.78 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Adventist Health Commercial |
$499.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,714.75
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,689.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,689.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
|
|
HC ILEOSCOPY W/STNT PLCMNT
|
Facility
|
IP
|
$7,035.00
|
|
|
Service Code
|
CPT 44384
|
| Hospital Charge Code |
906744384
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,273.34 |
| Max. Negotiated Rate |
$5,276.25 |
| Rate for Payer: Adventist Health Commercial |
$1,407.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,833.04
|
| Rate for Payer: Cash Price |
$3,165.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,762.70
|
| Rate for Payer: Heritage Provider Network Senior |
$4,762.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,273.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,758.75
|
| Rate for Payer: Multiplan Commercial |
$5,276.25
|
|
|
HC ILEOSCOPY W/STNT PLCMNT
|
Facility
|
OP
|
$7,192.00
|
|
|
Service Code
|
CPT 44384
|
| Hospital Charge Code |
906744384
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,940.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,674.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,451.85
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| 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 |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, PERC
|
Facility
|
IP
|
$4,495.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
900100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$813.60 |
| Max. Negotiated Rate |
$3,371.25 |
| Rate for Payer: Adventist Health Commercial |
$899.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,088.06
|
| Rate for Payer: Cash Price |
$2,022.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,043.12
|
| Rate for Payer: Heritage Provider Network Senior |
$3,043.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$813.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,123.75
|
| Rate for Payer: Multiplan Commercial |
$3,371.25
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, PERC
|
Facility
|
OP
|
$4,495.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
900100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$287.49 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$899.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,088.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$2,022.75
|
| Rate for Payer: Cash Price |
$2,022.75
|
| Rate for Payer: Cash Price |
$2,022.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,921.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,782.40
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$287.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$813.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,123.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$3,371.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, TRANSVAG/TRANSREC
|
Facility
|
IP
|
$4,511.00
|
|
|
Service Code
|
CPT 49407
|
| Hospital Charge Code |
900100012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$816.49 |
| Max. Negotiated Rate |
$3,383.25 |
| Rate for Payer: Adventist Health Commercial |
$902.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,099.06
|
| Rate for Payer: Cash Price |
$2,029.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,053.95
|
| Rate for Payer: Heritage Provider Network Senior |
$3,053.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,127.75
|
| Rate for Payer: Multiplan Commercial |
$3,383.25
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, TRANSVAG/TRANSREC
|
Facility
|
OP
|
$4,511.00
|
|
|
Service Code
|
CPT 49407
|
| Hospital Charge Code |
900100012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$816.49 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$902.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,099.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$2,029.95
|
| Rate for Payer: Cash Price |
$2,029.95
|
| Rate for Payer: Cash Price |
$2,029.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,932.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,792.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$928.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,127.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$3,383.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH VISCERAL, PERC
|
Facility
|
IP
|
$3,420.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
900100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$619.02 |
| Max. Negotiated Rate |
$2,565.00 |
| Rate for Payer: Adventist Health Commercial |
$684.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,349.54
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,315.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2,315.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$619.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.00
|
| Rate for Payer: Multiplan Commercial |
$2,565.00
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH VISCERAL, PERC
|
Facility
|
OP
|
$3,420.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
900100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$286.92 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$684.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,349.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,223.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,116.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$619.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$2,565.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC IMIPENEM E TEST
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912423
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.88
|
| Rate for Payer: Blue Shield of California Commercial |
$22.47
|
| Rate for Payer: Blue Shield of California EPN |
$17.57
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Humana Medicare |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC IMIPENEM E TEST
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912423
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.14
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.08
|
| Rate for Payer: Heritage Provider Network Senior |
$71.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
900912028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.63
|
| Rate for Payer: Heritage Provider Network Senior |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
900912028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$224.95 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.95
|
| Rate for Payer: Blue Shield of California Commercial |
$209.12
|
| Rate for Payer: Blue Shield of California EPN |
$163.48
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.31
|
| Rate for Payer: Dignity Health Senior |
$35.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.95
|
| Rate for Payer: Heritage Provider Network Senior |
$17.95
|
| Rate for Payer: Humana Medicare |
$35.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$67.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.03
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.74
|
| Rate for Payer: TriValley Medical Group Senior |
$35.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Vantage Medical Group Senior |
$35.74
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 20"
|
Facility
|
IP
|
$131.04
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698369
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$26.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.71
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$65.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.76
|
| Rate for Payer: Multiplan Commercial |
$98.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.78
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 20"
|
Facility
|
OP
|
$131.04
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698369
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$26.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$81.38
|
| Rate for Payer: Blue Shield of California EPN |
$76.92
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.38
|
| Rate for Payer: Dignity Health Senior |
$111.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.67
|
| Rate for Payer: Heritage Provider Network Senior |
$60.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$109.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$65.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.76
|
| Rate for Payer: Multiplan Commercial |
$98.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.38
|
| Rate for Payer: Vantage Medical Group Senior |
$111.38
|
|
|
HC IMMUNE CELL LUMINESCENCE DET
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900912314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.28
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.34
|
| Rate for Payer: Heritage Provider Network Senior |
$131.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
|
|
HC IMMUNE CELL LUMINESCENCE DET
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900912314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.28
|
| Rate for Payer: Blue Shield of California Commercial |
$110.35
|
| Rate for Payer: Blue Shield of California EPN |
$86.26
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$104.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Senior |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.66
|
| Rate for Payer: Heritage Provider Network Senior |
$99.66
|
| Rate for Payer: Humana Medicare |
$14.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.79
|
| Rate for Payer: Multiplan Commercial |
$120.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.12
|
| Rate for Payer: TriValley Medical Group Senior |
$14.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC IMMUNE CELL MITOGEN STIM
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
900912313
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$410.29 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$142.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$410.29
|
| Rate for Payer: Blue Shield of California Commercial |
$382.86
|
| Rate for Payer: Blue Shield of California EPN |
$299.30
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.93
|
| Rate for Payer: Dignity Health Senior |
$49.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$49.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.32
|
| Rate for Payer: Heritage Provider Network Senior |
$121.32
|
| Rate for Payer: Humana Medicare |
$49.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.78
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$49.03
|
| Rate for Payer: TriValley Medical Group Senior |
$49.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$52.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.93
|
| Rate for Payer: Vantage Medical Group Senior |
$49.03
|
|
