|
HC CULTURE WOUND
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911520
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$251.16
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$264.03
|
| Rate for Payer: Heritage Provider Network Senior |
$264.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.50
|
| Rate for Payer: Multiplan Commercial |
$292.50
|
|
|
HC CULTURE YEAST ID
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
900911555
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$97.99 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.99
|
| Rate for Payer: Blue Shield of California Commercial |
$83.06
|
| Rate for Payer: Blue Shield of California Commercial |
$83.06
|
| Rate for Payer: Blue Shield of California EPN |
$66.62
|
| Rate for Payer: Blue Shield of California EPN |
$66.62
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.29
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.47
|
| Rate for Payer: Heritage Provider Network Senior |
$204.89
|
| Rate for Payer: Heritage Provider Network Senior |
$54.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$157.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.83
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.32
|
| Rate for Payer: TriValley Medical Group Senior |
$10.32
|
| Rate for Payer: TriValley Medical Group Senior |
$10.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10.32
|
| Rate for Payer: Vantage Medical Group Senior |
$10.32
|
|
|
HC CULTURE YEAST ID
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
900911555
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.16
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.09
|
| Rate for Payer: Heritage Provider Network Senior |
$224.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
|
|
HC CULTURE YEAST RAPID ID
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912425
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.80
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC CULTURE YEAST RAPID ID
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912425
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$76.64 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.64
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.57
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$44.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$34.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC CULTURE YERSINIA
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
900911529
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$75.92 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.37
|
| Rate for Payer: Blue Shield of California Commercial |
$75.92
|
| Rate for Payer: Blue Shield of California Commercial |
$75.92
|
| Rate for Payer: Blue Shield of California EPN |
$60.89
|
| Rate for Payer: Blue Shield of California EPN |
$60.89
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.44
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$173.32
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$133.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.65
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.44
|
| Rate for Payer: TriValley Medical Group Senior |
$9.44
|
| Rate for Payer: TriValley Medical Group Senior |
$9.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
|
|
HC CULTURE YERSINIA
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
900911529
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.32
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.56
|
| Rate for Payer: Heritage Provider Network Senior |
$189.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
|
|
HC CUTTING BALLOON
|
Facility
|
IP
|
$1,920.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$347.52 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Adventist Health Commercial |
$384.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,236.48
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,299.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,299.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
|
|
HC CUTTING BALLOON
|
Facility
|
OP
|
$1,920.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$347.52 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Adventist Health Commercial |
$384.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,186.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,632.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,056.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,440.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$960.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,171.20
|
| Rate for Payer: Blue Shield of California EPN |
$936.96
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,248.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,632.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,632.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,632.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,132.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$915.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,344.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$960.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$960.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,632.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,632.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,632.00
|
|
|
HC CVP-R & L TESSO CATH
|
Facility
|
IP
|
$1,019.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.44 |
| Max. Negotiated Rate |
$764.25 |
| Rate for Payer: Adventist Health Commercial |
$203.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$656.24
|
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$689.86
|
| Rate for Payer: Heritage Provider Network Senior |
$689.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$184.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$254.75
|
| Rate for Payer: Multiplan Commercial |
$764.25
|
|
|
HC CVP-R & L TESSO CATH
|
Facility
|
OP
|
$1,019.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.44 |
| Max. Negotiated Rate |
$866.15 |
| Rate for Payer: Adventist Health Commercial |
$203.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$629.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$866.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$560.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$764.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.70
|
| Rate for Payer: Blue Shield of California Commercial |
$621.59
|
| Rate for Payer: Blue Shield of California EPN |
$497.27
|
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$662.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$866.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$866.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$866.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$601.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$630.76
|
| Rate for Payer: Heritage Provider Network Senior |
$630.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$486.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$184.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$254.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$713.30
|
| Rate for Payer: Multiplan Commercial |
$764.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$509.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$509.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$866.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$866.15
|
| Rate for Payer: Vantage Medical Group Senior |
$866.15
|
|
|
HC CVS SAMPLING
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 59015
|
| Hospital Charge Code |
910409015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.33
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.67
|
| Rate for Payer: Heritage Provider Network Senior |
$109.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
|
|
HC CVS SAMPLING
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 59015
|
| Hospital Charge Code |
910409015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,184.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$98.82
|
| Rate for Payer: Blue Shield of California EPN |
$79.06
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,303.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,184.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,184.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.28
|
| Rate for Payer: Heritage Provider Network Senior |
$100.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,184.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$77.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,362.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,587.39
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,184.62
|
| Rate for Payer: TriValley Medical Group Senior |
$1,184.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$81.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$81.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,184.62
|
|
|
HC CYCLIC CITRUL PEPT AB
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
900913652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$120.24 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.24
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.66
|
| Rate for Payer: Heritage Provider Network Senior |
$34.66
|
| Rate for Payer: Heritage Provider Network Senior |
$47.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.35
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.95
|
| Rate for Payer: TriValley Medical Group Senior |
$12.95
|
| Rate for Payer: TriValley Medical Group Senior |
$12.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
|
|
HC CYCLIC CITRUL PEPT AB
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
900913652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.59
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.13
|
| Rate for Payer: Heritage Provider Network Senior |
$52.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
|
|
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: Aetna of CA Non-Gatekeeper |
$211.23
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$222.06
|
| Rate for Payer: Heritage Provider Network Senior |
$222.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
|
|
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: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$202.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.07
|
| 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 Medi-Cal |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.44
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$213.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.03
|
| Rate for Payer: Heritage Provider Network Senior |
$97.80
|
| Rate for Payer: Heritage Provider Network Senior |
$203.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$75.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$156.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.19
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.05
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$19.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$27.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.86
|
| Rate for Payer: Vantage Medical Group Senior |
$18.05
|
| Rate for Payer: Vantage Medical Group Senior |
$18.05
|
|
|
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 Non-Gatekeeper |
$329.39
|
| 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 |
$5,158.00
|
| 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 |
$239.85
|
| Rate for Payer: Cash Price |
$239.85
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$254.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$343.25
|
| Rate for Payer: Cash Price |
$239.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$360.84
|
| Rate for Payer: Heritage Provider Network Senior |
$360.84
|
| Rate for Payer: Kaiser Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$894.52
|
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$940.35
|
| Rate for Payer: Heritage Provider Network Senior |
$940.35
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$179.14 |
| Max. Negotiated Rate |
$1,041.75 |
| Rate for Payer: Adventist Health Commercial |
$277.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$858.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$285.16
|
| 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 |
$625.05
|
| Rate for Payer: Cash Price |
$625.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$902.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$819.51
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| 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) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$662.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$1,041.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$448.71
|
| Rate for Payer: TriValley Medical Group Senior |
$448.71
|
| 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 |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
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: Aetna of CA Non-Gatekeeper |
$512.62
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$538.89
|
| Rate for Payer: Heritage Provider Network Senior |
$538.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
|
|
HC CYSTOSTOMY TUBE CHG SIMPLE
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
900501165
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.08 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$491.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$378.10
|
| Rate for Payer: Blue Shield of California EPN |
$300.89
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$517.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$321.35
|
| 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) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$379.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$477.60
|
| Rate for Payer: TriValley Medical Group Senior |
$477.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
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: Aetna of CA Non-Gatekeeper |
$5,510.06
|
| Rate for Payer: Cash Price |
$3,850.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,792.41
|
| Rate for Payer: Heritage Provider Network Senior |
$5,792.41
|
| Rate for Payer: Kaiser Foundation Hospitals 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 DRAINAGE
|
Facility
|
OP
|
$8,556.00
|
|
|
Service Code
|
CPT 51040
|
| Hospital Charge Code |
900551040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,548.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,711.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,287.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,064.10
|
| Rate for Payer: Blue Shield of California EPN |
$3,234.17
|
| Rate for Payer: Cash Price |
$3,850.20
|
| Rate for Payer: Cash Price |
$3,850.20
|
| Rate for Payer: Cash Price |
$3,850.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,561.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,688.58
|
| 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) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,081.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,548.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,091.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,139.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$6,417.00
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,133.60
|
| Rate for Payer: TriValley Medical Group Senior |
$5,133.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
