|
HC INTERNAL CAROTID UNI
|
Facility
|
IP
|
$29,291.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
909020147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,301.67 |
| Max. Negotiated Rate |
$21,968.25 |
| Rate for Payer: Adventist Health Commercial |
$5,858.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,122.92
|
| Rate for Payer: Cash Price |
$13,180.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,830.01
|
| Rate for Payer: Heritage Provider Network Senior |
$19,830.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,301.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,322.75
|
| Rate for Payer: Multiplan Commercial |
$21,968.25
|
|
|
HC INTERNAL CAROTID UNI
|
Facility
|
OP
|
$25,095.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
906820222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$437.91 |
| Max. Negotiated Rate |
$18,821.25 |
| Rate for Payer: Adventist Health Commercial |
$5,019.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,240.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| 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 |
$11,292.75
|
| Rate for Payer: Cash Price |
$11,292.75
|
| Rate for Payer: Cash Price |
$11,292.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,311.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,533.80
|
| Rate for Payer: Heritage Provider Network Senior |
$8,445.27
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$437.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,542.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,273.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$18,821.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,552.68
|
| Rate for Payer: TriValley Medical Group Senior |
$7,552.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$58.00
|
|
| Hospital Charge Code |
909000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.27
|
| Rate for Payer: Heritage Provider Network Senior |
$39.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$54.00
|
|
| Hospital Charge Code |
906600075
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.10
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.56
|
| Rate for Payer: Heritage Provider Network Senior |
$36.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$58.00
|
|
| Hospital Charge Code |
909300075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$49.30 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.50
|
| Rate for Payer: Blue Shield of California Commercial |
$36.02
|
| Rate for Payer: Blue Shield of California EPN |
$34.05
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.30
|
| Rate for Payer: Dignity Health Senior |
$49.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.90
|
| Rate for Payer: Heritage Provider Network Senior |
$35.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.30
|
| Rate for Payer: Vantage Medical Group Senior |
$49.30
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$58.00
|
|
| Hospital Charge Code |
909300075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.27
|
| Rate for Payer: Heritage Provider Network Senior |
$39.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
909200075
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.98
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.50
|
| Rate for Payer: Heritage Provider Network Senior |
$32.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
909200075
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.81
|
| Rate for Payer: Blue Shield of California EPN |
$28.18
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Senior |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$58.00
|
|
| Hospital Charge Code |
909000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$49.30 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.50
|
| Rate for Payer: Blue Shield of California Commercial |
$36.02
|
| Rate for Payer: Blue Shield of California EPN |
$34.05
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.30
|
| Rate for Payer: Dignity Health Senior |
$49.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.90
|
| Rate for Payer: Heritage Provider Network Senior |
$35.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.30
|
| Rate for Payer: Vantage Medical Group Senior |
$49.30
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
906600075
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.50
|
| Rate for Payer: Blue Shield of California Commercial |
$33.53
|
| Rate for Payer: Blue Shield of California EPN |
$31.70
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.90
|
| Rate for Payer: Dignity Health Senior |
$45.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.43
|
| Rate for Payer: Heritage Provider Network Senior |
$33.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.90
|
| Rate for Payer: Vantage Medical Group Senior |
$45.90
|
|
|
HC INTERPRET OUTSIDE FILMS MRI
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
908800075
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$1,075.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.29
|
| Rate for Payer: Blue Shield of California EPN |
$30.52
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.20
|
| Rate for Payer: Dignity Health Senior |
$44.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.20
|
| Rate for Payer: Vantage Medical Group Senior |
$44.20
|
|
|
HC INTERPRET OUTSIDE FILMS MRI
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
908800075
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$929.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.72
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.20
|
| Rate for Payer: Heritage Provider Network Senior |
$35.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
|
|
HC INTERROGATE SUBQ DEFIB
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
900293261
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$27.33 |
| Max. Negotiated Rate |
$113.25 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.74
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.23
|
| Rate for Payer: Heritage Provider Network Senior |
$102.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.75
|
| Rate for Payer: Multiplan Commercial |
$113.25
|
|
|
HC INTERROGATE SUBQ DEFIB
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
900293261
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$27.33 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.12
|
| Rate for Payer: Blue Shield of California Commercial |
$93.77
|
| Rate for Payer: Blue Shield of California EPN |
$88.64
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$98.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.83
|
| Rate for Payer: Dignity Health Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$47.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.47
|
| Rate for Payer: Heritage Provider Network Senior |
$93.47
|
| Rate for Payer: Humana Medicare |
$47.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$89.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.37
|
| Rate for Payer: Multiplan Commercial |
$113.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.83
|
| Rate for Payer: TriValley Medical Group Senior |
$47.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Vantage Medical Group Senior |
$47.12
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
IP
|
$8,225.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,488.72 |
| Max. Negotiated Rate |
$6,168.75 |
| Rate for Payer: Adventist Health Commercial |
$1,645.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,650.58
|
| Rate for Payer: Cash Price |
$3,701.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,568.32
|
| Rate for Payer: Heritage Provider Network Senior |
$5,568.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,488.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,056.25
|
| Rate for Payer: Multiplan Commercial |
$6,168.75
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
IP
|
$8,225.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,488.72 |
| Max. Negotiated Rate |
$6,168.75 |
| Rate for Payer: Adventist Health Commercial |
$1,645.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,650.58
|
| Rate for Payer: Cash Price |
$3,701.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,568.32
|
| Rate for Payer: Heritage Provider Network Senior |
$5,568.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,488.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,056.25
|
| Rate for Payer: Multiplan Commercial |
$6,168.75
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
OP
|
$8,225.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,645.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,650.58
|
| 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 |
$1,756.00
|
| Rate for Payer: Cash Price |
$3,701.25
|
| Rate for Payer: Cash Price |
$3,701.25
|
| Rate for Payer: Cash Price |
$3,701.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,346.25
|
| 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 |
$5,568.32
|
| Rate for Payer: Heritage Provider Network Senior |
$5,568.32
|
| 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 |
$3,964.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,488.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,056.25
|
| 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 |
$6,168.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,986.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,747.97
|
| 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 INTESTINE CELLVIZIO
|
Facility
|
OP
|
$8,225.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,645.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,650.58
|
| 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: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$3,701.25
|
| Rate for Payer: Cash Price |
$3,701.25
|
| Rate for Payer: Cash Price |
$3,701.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,346.25
|
| 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 |
$5,091.28
|
| 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) 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 |
$1,488.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,056.25
|
| 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 |
$6,168.75
|
| 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 INTRA AORTIC BALLOON INSERTION
|
Facility
|
OP
|
$3,162.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906820104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$338.02 |
| Max. Negotiated Rate |
$18,042.00 |
| Rate for Payer: Adventist Health Commercial |
$632.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,172.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,687.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,739.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,371.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,055.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,687.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,687.70
|
| Rate for Payer: Dignity Health Senior |
$2,687.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,957.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,957.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$338.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,524.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$572.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$790.50
|
| Rate for Payer: Multiplan Commercial |
$2,371.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,042.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,173.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,687.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,687.70
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
IP
|
$5,362.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906811310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$970.52 |
| Max. Negotiated Rate |
$4,021.50 |
| Rate for Payer: Adventist Health Commercial |
$1,072.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,683.69
|
| Rate for Payer: Cash Price |
$2,412.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,630.07
|
| Rate for Payer: Heritage Provider Network Senior |
$3,630.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$970.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,340.50
|
| Rate for Payer: Multiplan Commercial |
$4,021.50
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
OP
|
$5,362.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906811310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$338.02 |
| Max. Negotiated Rate |
$18,042.00 |
| Rate for Payer: Adventist Health Commercial |
$1,072.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,683.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,557.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,949.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,021.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,412.90
|
| Rate for Payer: Cash Price |
$2,412.90
|
| Rate for Payer: Cash Price |
$2,412.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,485.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,557.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,557.70
|
| Rate for Payer: Dignity Health Senior |
$4,557.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,319.08
|
| Rate for Payer: Heritage Provider Network Senior |
$3,319.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$338.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,584.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$970.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,340.50
|
| Rate for Payer: Multiplan Commercial |
$4,021.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,042.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,173.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,557.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,557.70
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
IP
|
$3,162.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906820104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$572.32 |
| Max. Negotiated Rate |
$2,371.50 |
| Rate for Payer: Adventist Health Commercial |
$632.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,172.29
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,140.67
|
| Rate for Payer: Heritage Provider Network Senior |
$2,140.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$572.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$790.50
|
| Rate for Payer: Multiplan Commercial |
$2,371.50
|
|
|
HC INTRA-ART INJ OR INFUS
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT 96379
|
| Hospital Charge Code |
911896379
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$59.35 |
| Max. Negotiated Rate |
$671.25 |
| Rate for Payer: Adventist Health Commercial |
$179.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$135.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$614.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$581.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: Dignity Health Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$581.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$59.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$554.00
|
| Rate for Payer: Heritage Provider Network Senior |
$554.00
|
| Rate for Payer: Humana Medicare |
$59.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$112.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.78
|
| Rate for Payer: Multiplan Commercial |
$671.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$65.28
|
| Rate for Payer: TriValley Medical Group Senior |
$59.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC INTRA-ART INJ OR INFUS
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT 96379
|
| Hospital Charge Code |
911896379
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$671.25 |
| Rate for Payer: Adventist Health Commercial |
$179.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$614.86
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$605.92
|
| Rate for Payer: Heritage Provider Network Senior |
$605.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.75
|
| Rate for Payer: Multiplan Commercial |
$671.25
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
|
IP
|
$36,376.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906811745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,584.06 |
| Max. Negotiated Rate |
$27,282.00 |
| Rate for Payer: Adventist Health Commercial |
$7,275.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,990.31
|
| Rate for Payer: Cash Price |
$16,369.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,626.55
|
| Rate for Payer: Heritage Provider Network Senior |
$24,626.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,584.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,094.00
|
| Rate for Payer: Multiplan Commercial |
$27,282.00
|
|
