|
HC DIGITAL-SCREENING MAMMO, BILAT
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
909002010
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$618.29 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$429.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$382.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$521.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.64
|
| Rate for Payer: Blue Shield of California Commercial |
$618.29
|
| Rate for Payer: Blue Shield of California EPN |
$497.21
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$451.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$590.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$590.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$430.20
|
| Rate for Payer: Heritage Provider Network Senior |
$430.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$331.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$486.50
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$168.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$168.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.75
|
| Rate for Payer: Vantage Medical Group Senior |
$590.75
|
|
|
HC DIGITAL-SCREENING MAMMO, BILAT
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
909002010
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$521.25 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$447.58
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$470.51
|
| Rate for Payer: Heritage Provider Network Senior |
$470.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.75
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
|
|
HC DIGOXIN
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
900910816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$126.05 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.05
|
| Rate for Payer: Blue Shield of California Commercial |
$106.85
|
| Rate for Payer: Blue Shield of California Commercial |
$106.85
|
| Rate for Payer: Blue Shield of California EPN |
$85.70
|
| Rate for Payer: Blue Shield of California EPN |
$85.70
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.57
|
| Rate for Payer: Heritage Provider Network Senior |
$118.23
|
| Rate for Payer: Heritage Provider Network Senior |
$31.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$91.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.28
|
| Rate for Payer: TriValley Medical Group Senior |
$13.28
|
| Rate for Payer: TriValley Medical Group Senior |
$13.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: Vantage Medical Group Senior |
$13.28
|
| Rate for Payer: Vantage Medical Group Senior |
$13.28
|
|
|
HC DIGOXIN
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
900910816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$143.25 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.00
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.31
|
| Rate for Payer: Heritage Provider Network Senior |
$129.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
|
|
HC DILAT ANAL SPHINC UNDER ANES
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
CPT 45905
|
| Hospital Charge Code |
906745905
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$986.09 |
| Max. Negotiated Rate |
$4,086.00 |
| Rate for Payer: Adventist Health Commercial |
$1,089.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,508.51
|
| Rate for Payer: Cash Price |
$2,451.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,688.30
|
| Rate for Payer: Heritage Provider Network Senior |
$3,688.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$986.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,362.00
|
| Rate for Payer: Multiplan Commercial |
$4,086.00
|
|
|
HC DILAT ANAL SPHINC UNDER ANES
|
Facility
|
OP
|
$9,701.00
|
|
|
Service Code
|
CPT 45905
|
| Hospital Charge Code |
906745905
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,940.20
|
| Rate for Payer: Adventist Health Commercial |
$1,089.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,366.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,995.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,365.45
|
| Rate for Payer: Cash Price |
$4,365.45
|
| Rate for Payer: Cash Price |
$2,451.60
|
| Rate for Payer: Cash Price |
$2,451.60
|
| Rate for Payer: Cash Price |
$4,365.45
|
| Rate for Payer: Cash Price |
$2,451.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,541.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,305.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,539.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,539.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,004.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,372.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,893.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1,893.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,598.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,627.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,755.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$986.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,769.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,769.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,362.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,425.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$7,275.75
|
| Rate for Payer: Multiplan Commercial |
$4,086.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
HC DILATE BILIARY OR AMPULLA PERC
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
909047542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$356.39 |
| Max. Negotiated Rate |
$1,476.75 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,268.04
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,333.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,333.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$356.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.25
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
|
|
HC DILATE BILIARY OR AMPULLA PERC
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
909047542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$356.39 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,216.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,082.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,476.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,279.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,673.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,673.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,218.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,218.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$939.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$356.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,378.30
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,673.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,673.65
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
OP
|
$4,603.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$920.60
|
| Rate for Payer: Adventist Health Commercial |
$308.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$952.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,844.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,002.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,991.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,849.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$954.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$735.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,195.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$833.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,150.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,452.25
|
| Rate for Payer: Multiplan Commercial |
$1,156.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$279.10 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$308.40
|
| Rate for Payer: Adventist Health Commercial |
$920.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,844.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$952.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$732.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2,186.43
|
| Rate for Payer: Blue Shield of California EPN |
$582.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,739.93
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Cash Price |
$2,071.35
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,002.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,991.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,116.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,043.93
|
| Rate for Payer: Heritage Provider Network Senior |
$3,116.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,043.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,195.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$735.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$833.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,150.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,452.25
|
| Rate for Payer: Multiplan Commercial |
$1,156.50
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$925.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,761.80
|
| Rate for Payer: TriValley Medical Group Senior |
$2,761.80
|
| Rate for Payer: TriValley Medical Group Senior |
$925.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$279.10 |
| Max. Negotiated Rate |
$1,156.50 |
| Rate for Payer: Adventist Health Commercial |
$308.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$993.05
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,043.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,043.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$1,156.50
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$279.10 |
| Max. Negotiated Rate |
$1,156.50 |
| Rate for Payer: Adventist Health Commercial |
$308.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$993.05
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,043.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,043.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$1,156.50
|
|
|
HC DILAT ESOPH OVER GUIDE WIRE
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
906743453
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$279.10 |
| Max. Negotiated Rate |
$1,156.50 |
| Rate for Payer: Adventist Health Commercial |
$308.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$993.05
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,043.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,043.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$1,156.50
|
|
|
HC DILAT ESOPH OVER GUIDE WIRE
|
Facility
|
OP
|
$4,595.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
906743453
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$919.00
|
| Rate for Payer: Adventist Health Commercial |
$308.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$952.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,839.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,067.75
|
| Rate for Payer: Cash Price |
$2,067.75
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Cash Price |
$2,067.75
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,002.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,986.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,844.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$954.50
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$735.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,191.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$831.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,148.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,446.25
|
| Rate for Payer: Multiplan Commercial |
$1,156.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC DILATE TEAR DUCT OPENING
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
900501698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.61 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$162.29
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$170.60
|
| Rate for Payer: Heritage Provider Network Senior |
$170.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
|
|
HC DILATE TEAR DUCT OPENING
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
900501698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.61 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$119.70
|
| Rate for Payer: Blue Shield of California EPN |
$95.26
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$163.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$574.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$170.60
|
| Rate for Payer: Heritage Provider Network Senior |
$170.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$120.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$151.20
|
| Rate for Payer: TriValley Medical Group Senior |
$151.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
|
OP
|
$4,386.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$793.87 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$877.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,710.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,083.35
|
| Rate for Payer: Blue Shield of California EPN |
$1,657.91
|
| Rate for Payer: Cash Price |
$1,973.70
|
| Rate for Payer: Cash Price |
$1,973.70
|
| Rate for Payer: Cash Price |
$1,973.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,850.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,163.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,969.32
|
| Rate for Payer: Heritage Provider Network Senior |
$2,969.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,092.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$793.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,788.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,096.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$3,289.50
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,631.60
|
| Rate for Payer: TriValley Medical Group Senior |
$2,631.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
|
IP
|
$4,386.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$793.87 |
| Max. Negotiated Rate |
$3,289.50 |
| Rate for Payer: Adventist Health Commercial |
$877.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,824.58
|
| Rate for Payer: Cash Price |
$1,973.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,969.32
|
| Rate for Payer: Heritage Provider Network Senior |
$2,969.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$793.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,096.50
|
| Rate for Payer: Multiplan Commercial |
$3,289.50
|
|
|
HC DILATION OF NEPHROSTOMY
|
Facility
|
OP
|
$11,641.00
|
|
|
Service Code
|
CPT 50436
|
| Hospital Charge Code |
909000168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,107.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Cigna of CA HMO/PPO |
$7,566.65
|
| Rate for Payer: Adventist Health Commercial |
$2,328.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,194.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| 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 |
$5,238.45
|
| Rate for Payer: Cash Price |
$5,238.45
|
| Rate for Payer: Cash Price |
$5,238.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,533.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,205.78
|
| Rate for Payer: Heritage Provider Network Senior |
$5,576.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,614.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,107.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,213.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,910.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,075.17
|
| Rate for Payer: Multiplan Commercial |
$8,730.75
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,987.08
|
| Rate for Payer: TriValley Medical Group Senior |
$4,987.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
HC DILATION OF NEPHROSTOMY
|
Facility
|
IP
|
$11,641.00
|
|
|
Service Code
|
CPT 50436
|
| Hospital Charge Code |
909000168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,107.02 |
| Max. Negotiated Rate |
$8,730.75 |
| Rate for Payer: Adventist Health Commercial |
$2,328.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,496.80
|
| Rate for Payer: Cash Price |
$5,238.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,880.96
|
| Rate for Payer: Heritage Provider Network Senior |
$7,880.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,107.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,910.25
|
| Rate for Payer: Multiplan Commercial |
$8,730.75
|
|
|
HC DILATOR VESSEL 5-13 FR 20 CM
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
909001071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$26.35 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.51
|
| Rate for Payer: Blue Shield of California Commercial |
$18.91
|
| Rate for Payer: Blue Shield of California EPN |
$15.13
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.70
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.35
|
| Rate for Payer: Vantage Medical Group Senior |
$26.35
|
|
|
HC DILATOR VESSEL 5-13 FR 20 CM
|
Facility
|
IP
|
$31.00
|
|
| Hospital Charge Code |
909001071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.96
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.99
|
| Rate for Payer: Heritage Provider Network Senior |
$20.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
OP
|
$9,953.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,990.60
|
| Rate for Payer: Adventist Health Commercial |
$1,089.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,366.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,150.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,478.85
|
| Rate for Payer: Cash Price |
$4,478.85
|
| Rate for Payer: Cash Price |
$2,451.60
|
| Rate for Payer: Cash Price |
$2,451.60
|
| Rate for Payer: Cash Price |
$4,478.85
|
| Rate for Payer: Cash Price |
$2,451.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,541.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,469.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,539.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,539.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,160.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,372.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,893.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1,893.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,598.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,747.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,801.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$986.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,769.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,769.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,362.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,488.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$7,464.75
|
| Rate for Payer: Multiplan Commercial |
$4,086.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$986.09 |
| Max. Negotiated Rate |
$4,086.00 |
| Rate for Payer: Adventist Health Commercial |
$1,089.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,508.51
|
| Rate for Payer: Cash Price |
$2,451.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,688.30
|
| Rate for Payer: Heritage Provider Network Senior |
$3,688.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$986.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,362.00
|
| Rate for Payer: Multiplan Commercial |
$4,086.00
|
|
|
HC DILAT XST TRC NEW ACCESS RCS
|
Facility
|
IP
|
$12,158.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
909050437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,200.60 |
| Max. Negotiated Rate |
$9,118.50 |
| Rate for Payer: Adventist Health Commercial |
$2,431.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,829.75
|
| Rate for Payer: Cash Price |
$5,471.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,230.97
|
| Rate for Payer: Heritage Provider Network Senior |
$8,230.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,200.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,039.50
|
| Rate for Payer: Multiplan Commercial |
$9,118.50
|
|
