|
HC DFIB BS DYNAGEN CRT G151
|
Facility
|
OP
|
$30,210.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,042.00 |
| Max. Negotiated Rate |
$25,678.50 |
| Rate for Payer: Adventist Health Commercial |
$6,042.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,669.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,678.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,615.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,657.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,144.42
|
| Rate for Payer: Blue Shield of California EPN |
$12,144.42
|
| Rate for Payer: Cash Price |
$13,594.50
|
| Rate for Payer: Cash Price |
$13,594.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,896.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,678.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,678.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,678.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,334.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,987.23
|
| Rate for Payer: Heritage Provider Network Senior |
$13,987.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15,105.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,105.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,105.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,552.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21,147.00
|
| Rate for Payer: Multiplan Commercial |
$22,657.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,914.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,002.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,678.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,678.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25,678.50
|
|
|
HC DFIB BS DYNAGEN CRT G151
|
Facility
|
IP
|
$30,210.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,042.00 |
| Max. Negotiated Rate |
$22,657.50 |
| Rate for Payer: Adventist Health Commercial |
$6,042.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,455.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,144.42
|
| Rate for Payer: Blue Shield of California EPN |
$12,144.42
|
| Rate for Payer: Cash Price |
$13,594.50
|
| Rate for Payer: Cash Price |
$13,594.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,896.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,313.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,987.23
|
| Rate for Payer: Heritage Provider Network Senior |
$13,987.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15,105.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,105.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,105.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,552.50
|
| Rate for Payer: Multiplan Commercial |
$22,657.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,914.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,002.53
|
|
|
HC DFIB BS DYNAGEN DR D153
|
Facility
|
IP
|
$25,073.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,014.60 |
| Max. Negotiated Rate |
$18,804.75 |
| Rate for Payer: Adventist Health Commercial |
$5,014.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,147.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,079.35
|
| Rate for Payer: Blue Shield of California EPN |
$10,079.35
|
| Rate for Payer: Cash Price |
$11,282.85
|
| Rate for Payer: Cash Price |
$11,282.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,533.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,539.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,608.80
|
| Rate for Payer: Heritage Provider Network Senior |
$11,608.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,536.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,536.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,536.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,268.25
|
| Rate for Payer: Multiplan Commercial |
$18,804.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,058.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,301.67
|
|
|
HC DFIB BS DYNAGEN DR D153
|
Facility
|
OP
|
$25,073.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,014.60 |
| Max. Negotiated Rate |
$21,312.05 |
| Rate for Payer: Adventist Health Commercial |
$5,014.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,495.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,312.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,790.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,804.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,079.35
|
| Rate for Payer: Blue Shield of California EPN |
$10,079.35
|
| Rate for Payer: Cash Price |
$11,282.85
|
| Rate for Payer: Cash Price |
$11,282.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,533.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,312.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,312.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,312.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,046.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,608.80
|
| Rate for Payer: Heritage Provider Network Senior |
$11,608.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,536.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,536.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,536.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,268.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,551.10
|
| Rate for Payer: Multiplan Commercial |
$18,804.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,058.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,301.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,312.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,312.05
|
| Rate for Payer: Vantage Medical Group Senior |
$21,312.05
|
|
|
HC DFIB MED EVERA MRI DDMB1D4
|
Facility
|
IP
|
$25,270.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,054.00 |
| Max. Negotiated Rate |
$18,952.50 |
| Rate for Payer: Adventist Health Commercial |
$5,054.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,273.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,158.54
|
| Rate for Payer: Blue Shield of California EPN |
$10,158.54
|
| Rate for Payer: Cash Price |
$11,371.50
|
| Rate for Payer: Cash Price |
$11,371.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,624.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,645.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,700.01
|
| Rate for Payer: Heritage Provider Network Senior |
$11,700.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,635.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,635.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,635.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,317.50
|
| Rate for Payer: Multiplan Commercial |
$18,952.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,130.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,366.90
|
|
|
HC DFIB MED EVERA MRI DDMB1D4
|
Facility
|
OP
|
$25,270.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,054.00 |
| Max. Negotiated Rate |
$21,479.50 |
| Rate for Payer: Adventist Health Commercial |
$5,054.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,616.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,479.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,898.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,952.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,158.54
|
| Rate for Payer: Blue Shield of California EPN |
$10,158.54
|
| Rate for Payer: Cash Price |
$11,371.50
|
| Rate for Payer: Cash Price |
$11,371.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,624.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,479.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,479.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,479.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,172.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,700.01
|
| Rate for Payer: Heritage Provider Network Senior |
$11,700.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,635.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,635.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,635.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,317.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,689.00
|
| Rate for Payer: Multiplan Commercial |
$18,952.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,130.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,366.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,479.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,479.50
|
| Rate for Payer: Vantage Medical Group Senior |
$21,479.50
|
|
|
HC DFIB MED EVERA MRI DDMC3D4
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,450.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,050.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,050.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,000.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,575.00
|
| Rate for Payer: Heritage Provider Network Senior |
$11,575.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,032.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,277.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB MED EVERA MRI DDMC3D4
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$18,750.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,100.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,050.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,050.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,500.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,575.00
|
| Rate for Payer: Heritage Provider Network Senior |
$11,575.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,032.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,277.50
|
|
|
HC DFIB MED EVERA MRI DVMB1D4
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,450.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,050.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,050.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,000.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,575.00
|
| Rate for Payer: Heritage Provider Network Senior |
$11,575.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,032.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,277.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB MED EVERA MRI DVMB1D4
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$18,750.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,100.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,050.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,050.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,500.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,575.00
|
| Rate for Payer: Heritage Provider Network Senior |
$11,575.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,032.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,277.50
|
|
|
HC DFIB STJ QUIAD ASSUR CD3365-40Q
|
Facility
|
IP
|
$25,080.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,016.00 |
| Max. Negotiated Rate |
$18,810.00 |
| Rate for Payer: Adventist Health Commercial |
$5,016.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,151.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,082.16
|
| Rate for Payer: Blue Shield of California EPN |
$10,082.16
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,536.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,543.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,612.04
|
| Rate for Payer: Heritage Provider Network Senior |
$11,612.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,540.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,540.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,540.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,270.00
|
| Rate for Payer: Multiplan Commercial |
$18,810.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,061.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,303.99
|
|
|
HC DFIB STJ QUIAD ASSUR CD3365-40Q
|
Facility
|
OP
|
$25,080.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,016.00 |
| Max. Negotiated Rate |
$21,318.00 |
| Rate for Payer: Adventist Health Commercial |
$5,016.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,499.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,794.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,810.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,082.16
|
| Rate for Payer: Blue Shield of California EPN |
$10,082.16
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,536.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,318.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,318.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,051.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,612.04
|
| Rate for Payer: Heritage Provider Network Senior |
$11,612.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,540.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,540.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,540.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,270.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,556.00
|
| Rate for Payer: Multiplan Commercial |
$18,810.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,061.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,303.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,318.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,318.00
|
|
|
HC DFIB STJ UNIFY ASSURA CD3357-40C
|
Facility
|
IP
|
$23,655.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,731.00 |
| Max. Negotiated Rate |
$17,741.25 |
| Rate for Payer: Adventist Health Commercial |
$4,731.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,233.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,509.31
|
| Rate for Payer: Blue Shield of California EPN |
$9,509.31
|
| Rate for Payer: Cash Price |
$10,644.75
|
| Rate for Payer: Cash Price |
$10,644.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,881.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,773.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,952.26
|
| Rate for Payer: Heritage Provider Network Senior |
$10,952.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11,827.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,827.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,827.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,913.75
|
| Rate for Payer: Multiplan Commercial |
$17,741.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8,546.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7,832.17
|
|
|
HC DFIB STJ UNIFY ASSURA CD3357-40C
|
Facility
|
OP
|
$23,655.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,731.00 |
| Max. Negotiated Rate |
$20,106.75 |
| Rate for Payer: Adventist Health Commercial |
$4,731.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,618.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,106.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,010.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,741.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,509.31
|
| Rate for Payer: Blue Shield of California EPN |
$9,509.31
|
| Rate for Payer: Cash Price |
$10,644.75
|
| Rate for Payer: Cash Price |
$10,644.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,881.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,106.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,106.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,106.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,139.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,952.26
|
| Rate for Payer: Heritage Provider Network Senior |
$10,952.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11,827.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,827.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,827.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,913.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,558.50
|
| Rate for Payer: Multiplan Commercial |
$17,741.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8,546.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7,832.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,106.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,106.75
|
| Rate for Payer: Vantage Medical Group Senior |
$20,106.75
|
|
|
HC DGP IGA
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900913701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Blue Shield of California Commercial |
$66.41
|
| Rate for Payer: Blue Shield of California Commercial |
$66.41
|
| Rate for Payer: Blue Shield of California EPN |
$53.27
|
| Rate for Payer: Blue Shield of California EPN |
$53.27
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC DGP IGA
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900913701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.59
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
|
|
HC DGP IGG
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900913702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.59
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
|
|
HC DGP IGG
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
900913702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.75
|
| Rate for Payer: Blue Shield of California Commercial |
$66.41
|
| Rate for Payer: Blue Shield of California Commercial |
$66.41
|
| Rate for Payer: Blue Shield of California EPN |
$53.27
|
| Rate for Payer: Blue Shield of California EPN |
$53.27
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC DHEA-S
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.92
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.92
|
| Rate for Payer: Heritage Provider Network Senior |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
|
|
HC DHEA-S
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$211.07 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.07
|
| Rate for Payer: Blue Shield of California Commercial |
$178.96
|
| Rate for Payer: Blue Shield of California Commercial |
$178.96
|
| Rate for Payer: Blue Shield of California EPN |
$143.54
|
| Rate for Payer: Blue Shield of California EPN |
$143.54
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.23
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.66
|
| Rate for Payer: Heritage Provider Network Senior |
$74.90
|
| Rate for Payer: Heritage Provider Network Senior |
$47.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.79
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.23
|
| Rate for Payer: TriValley Medical Group Senior |
$22.23
|
| Rate for Payer: TriValley Medical Group Senior |
$22.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Vantage Medical Group Senior |
$22.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.23
|
|
|
HC DIAG GASTRO INTUB W ASP SPECS
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 43755
|
| Hospital Charge Code |
906743755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$110.77 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$122.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$378.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$397.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$378.83
|
| Rate for Payer: Heritage Provider Network Senior |
$203.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$291.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$459.00
|
| 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 |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC DIAG GASTRO INTUB W ASP SPECS
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 43755
|
| Hospital Charge Code |
906743755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$110.77 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Adventist Health Commercial |
$122.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$394.13
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.32
|
| Rate for Payer: Heritage Provider Network Senior |
$414.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.00
|
| Rate for Payer: Multiplan Commercial |
$459.00
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
OP
|
$2,877.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.74 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$575.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,777.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,366.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,087.51
|
| Rate for Payer: Cash Price |
$1,294.65
|
| Rate for Payer: Cash Price |
$1,294.65
|
| Rate for Payer: Cash Price |
$1,294.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,870.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,289.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,947.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,947.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,372.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$520.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$2,157.75
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,726.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1,726.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
IP
|
$2,877.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$520.74 |
| Max. Negotiated Rate |
$2,157.75 |
| Rate for Payer: Adventist Health Commercial |
$575.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,852.79
|
| Rate for Payer: Cash Price |
$1,294.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,947.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,947.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$520.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.25
|
| Rate for Payer: Multiplan Commercial |
$2,157.75
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
OP
|
$2,877.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$520.74 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$575.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,777.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,294.65
|
| Rate for Payer: Cash Price |
$1,294.65
|
| Rate for Payer: Cash Price |
$1,294.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,870.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,289.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,780.86
|
| Rate for Payer: Heritage Provider Network Senior |
$2,815.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,349.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$520.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$2,157.75
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,518.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2,518.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
