|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
OP
|
$1,615.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$323.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,109.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$888.25
|
| Rate for Payer: Cash Price |
$888.25
|
| Rate for Payer: Cash Price |
$888.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,049.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Senior |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$255.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,093.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,093.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$770.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$322.07
|
| Rate for Payer: Multiplan Commercial |
$1,211.25
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$581.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$534.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
IP
|
$1,615.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$292.31 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Adventist Health Commercial |
$323.00
|
| Rate for Payer: Cash Price |
$888.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,093.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,093.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.75
|
| Rate for Payer: Multiplan Commercial |
$1,211.25
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
OP
|
$1,615.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$323.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,109.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| 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 |
$888.25
|
| Rate for Payer: Cash Price |
$888.25
|
| Rate for Payer: Cash Price |
$888.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,049.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Senior |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$255.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$999.68
|
| Rate for Payer: Heritage Provider Network Senior |
$314.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$485.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$322.07
|
| Rate for Payer: Multiplan Commercial |
$1,211.25
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$281.17
|
| Rate for Payer: TriValley Medical Group Senior |
$281.17
|
| 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 |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
IP
|
$1,615.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.31 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Adventist Health Commercial |
$323.00
|
| Rate for Payer: Cash Price |
$888.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,093.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,093.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.75
|
| Rate for Payer: Multiplan Commercial |
$1,211.25
|
|
|
HC FEMORAL NERVE BLOCK SINGLE
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
900501590
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.61 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$640.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$512.60
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$605.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Senior |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$559.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$576.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,082.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,671.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,108.70
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$967.91
|
| Rate for Payer: TriValley Medical Group Senior |
$967.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC FEMORAL NERVE BLOCK SINGLE
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
900501590
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$168.69 |
| Max. Negotiated Rate |
$699.00 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$630.96
|
| Rate for Payer: Heritage Provider Network Senior |
$630.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
|
|
HC FERN TEST
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 82120
|
| Hospital Charge Code |
910400132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.48
|
| Rate for Payer: Blue Shield of California Commercial |
$30.24
|
| Rate for Payer: Blue Shield of California EPN |
$24.25
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Senior |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.90
|
| Rate for Payer: Heritage Provider Network Senior |
$74.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.55
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.99
|
| Rate for Payer: TriValley Medical Group Senior |
$5.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC FERN TEST
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 82120
|
| Hospital Charge Code |
910400132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.92
|
| Rate for Payer: Heritage Provider Network Senior |
$81.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
|
|
HC FERRITIN
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
900910819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.40
|
| Rate for Payer: Blue Shield of California Commercial |
$109.61
|
| Rate for Payer: Blue Shield of California EPN |
$87.92
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.99
|
| Rate for Payer: Dignity Health Senior |
$13.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.17
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.63
|
| Rate for Payer: TriValley Medical Group Senior |
$13.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.99
|
| Rate for Payer: Vantage Medical Group Senior |
$13.63
|
|
|
HC FERRITIN
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
900910819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC FETAL BLEED SCREEN
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
900904562
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$158.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$203.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.64
|
| Rate for Payer: Blue Shield of California Commercial |
$53.34
|
| Rate for Payer: Blue Shield of California EPN |
$42.78
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$192.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.30
|
| Rate for Payer: Dignity Health Senior |
$9.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.22
|
| Rate for Payer: Heritage Provider Network Senior |
$183.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$141.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.79
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.36
|
| Rate for Payer: TriValley Medical Group Senior |
$9.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9.36
|
|
|
HC FETAL BLEED SCREEN
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
900904562
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$53.58 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$200.39
|
| Rate for Payer: Heritage Provider Network Senior |
$200.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
|
|
HC FETAL CORD OCCLUS ADDL FETUS
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 59072
|
| Hospital Charge Code |
910400091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$549.72
|
| Rate for Payer: Heritage Provider Network Senior |
$549.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
|
|
HC FETAL CORD OCCLUS ADDL FETUS
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 59072
|
| Hospital Charge Code |
910400091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$557.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$495.32
|
| Rate for Payer: Blue Shield of California EPN |
$396.26
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Senior |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$386.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.63
|
| Rate for Payer: Heritage Provider Network Senior |
$502.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$715.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$387.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.99
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$406.00
|
| Rate for Payer: TriValley Medical Group Senior |
$406.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$406.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$406.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC FETAL CORD OCCLUSION
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 59072
|
| Hospital Charge Code |
910400090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$557.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$495.32
|
| Rate for Payer: Blue Shield of California EPN |
$396.26
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Senior |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$386.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.63
|
| Rate for Payer: Heritage Provider Network Senior |
$502.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$715.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$387.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.99
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$406.00
|
| Rate for Payer: TriValley Medical Group Senior |
$406.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$406.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$406.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC FETAL CORD OCCLUSION
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 59072
|
| Hospital Charge Code |
910400090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$549.72
|
| Rate for Payer: Heritage Provider Network Senior |
$549.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
|
|
HC FETAL DOPPLER MID CEREBRAL ART
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
906601316
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$173.76 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$649.92
|
| Rate for Payer: Heritage Provider Network Senior |
$649.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
|
|
HC FETAL DOPPLER MID CEREBRAL ART
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
906601316
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$513.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$659.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$342.58
|
| Rate for Payer: Blue Shield of California EPN |
$275.49
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$624.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$594.24
|
| Rate for Payer: Heritage Provider Network Senior |
$594.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$457.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC FETAL DOPPLER UMBILICAL ARTERY
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
906601315
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$62.74 |
| Max. Negotiated Rate |
$342.58 |
| Rate for Payer: Adventist Health Commercial |
$87.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$234.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$301.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$342.58
|
| Rate for Payer: Blue Shield of California EPN |
$275.49
|
| Rate for Payer: Cash Price |
$241.45
|
| Rate for Payer: Cash Price |
$241.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$285.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$271.74
|
| Rate for Payer: Heritage Provider Network Senior |
$271.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$209.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$329.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC FETAL DOPPLER UMBILICAL ARTERY
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
906601315
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$79.46 |
| Max. Negotiated Rate |
$329.25 |
| Rate for Payer: Adventist Health Commercial |
$87.80
|
| Rate for Payer: Cash Price |
$241.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$297.20
|
| Rate for Payer: Heritage Provider Network Senior |
$297.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.75
|
| Rate for Payer: Multiplan Commercial |
$329.25
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
OP
|
$1,778.00
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
900912319
|
|
Hospital Revenue Code
|
304
|
| Min. Negotiated Rate |
$64.41 |
| Max. Negotiated Rate |
$1,333.50 |
| Rate for Payer: Adventist Health Commercial |
$355.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$950.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,221.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,229.26
|
| Rate for Payer: Blue Shield of California Commercial |
$518.34
|
| Rate for Payer: Blue Shield of California EPN |
$415.75
|
| Rate for Payer: Cash Price |
$977.90
|
| Rate for Payer: Cash Price |
$977.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,155.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.85
|
| Rate for Payer: Dignity Health Senior |
$64.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,155.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$64.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,100.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,100.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$848.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.16
|
| Rate for Payer: Multiplan Commercial |
$1,333.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$64.41
|
| Rate for Payer: TriValley Medical Group Senior |
$64.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Vantage Medical Group Senior |
$64.41
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
IP
|
$1,778.00
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
900912319
|
|
Hospital Revenue Code
|
304
|
| Min. Negotiated Rate |
$321.82 |
| Max. Negotiated Rate |
$1,333.50 |
| Rate for Payer: Adventist Health Commercial |
$355.60
|
| Rate for Payer: Cash Price |
$977.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,203.71
|
| Rate for Payer: Heritage Provider Network Senior |
$1,203.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.50
|
| Rate for Payer: Multiplan Commercial |
$1,333.50
|
|
|
HC FETAL FLUID DRAIN INCLUD US GU
|
Facility
|
OP
|
$1,111.00
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
910400098
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$222.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$763.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$677.71
|
| Rate for Payer: Blue Shield of California EPN |
$542.17
|
| Rate for Payer: Cash Price |
$611.05
|
| Rate for Payer: Cash Price |
$611.05
|
| Rate for Payer: Cash Price |
$611.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Senior |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$386.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$687.71
|
| Rate for Payer: Heritage Provider Network Senior |
$687.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$508.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$529.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.99
|
| Rate for Payer: Multiplan Commercial |
$833.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$555.50
|
| Rate for Payer: TriValley Medical Group Senior |
$555.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$555.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$555.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC FETAL FLUID DRAIN INCLUD US GU
|
Facility
|
IP
|
$1,111.00
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
910400098
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$201.09 |
| Max. Negotiated Rate |
$833.25 |
| Rate for Payer: Adventist Health Commercial |
$222.20
|
| Rate for Payer: Cash Price |
$611.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$752.15
|
| Rate for Payer: Heritage Provider Network Senior |
$752.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.75
|
| Rate for Payer: Multiplan Commercial |
$833.25
|
|
|
HC FETAL LUNG MATURITY (FLM)
|
Facility
|
IP
|
$538.00
|
|
|
Service Code
|
CPT 83663
|
| Hospital Charge Code |
900910962
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.38 |
| Max. Negotiated Rate |
$403.50 |
| Rate for Payer: Adventist Health Commercial |
$107.60
|
| Rate for Payer: Cash Price |
$295.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$364.23
|
| Rate for Payer: Heritage Provider Network Senior |
$364.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.50
|
| Rate for Payer: Multiplan Commercial |
$403.50
|
|
