|
HC FINE NEEDLE ASP WO IMAGE
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
903800167
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$104.44 |
| Max. Negotiated Rate |
$432.75 |
| Rate for Payer: Adventist Health Commercial |
$115.40
|
| Rate for Payer: Cash Price |
$317.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$390.63
|
| Rate for Payer: Heritage Provider Network Senior |
$390.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.25
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
|
|
HC FINE NEEDLE ASP WO IMAGE
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
903800167
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$115.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$396.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$317.35
|
| Rate for Payer: Cash Price |
$317.35
|
| Rate for Payer: Cash Price |
$317.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$375.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Senior |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$390.63
|
| Rate for Payer: Heritage Provider Network Senior |
$390.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$275.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.63
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$207.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$191.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC FINGERS MIN 2 VIEWS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
909001521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.26 |
| Max. Negotiated Rate |
$396.75 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$282.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$363.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.20
|
| Rate for Payer: Blue Shield of California Commercial |
$85.73
|
| Rate for Payer: Blue Shield of California EPN |
$68.94
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$343.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$327.45
|
| Rate for Payer: Heritage Provider Network Senior |
$327.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$252.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC FINGERS MIN 2 VIEWS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
909001521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$396.75 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$358.13
|
| Rate for Payer: Heritage Provider Network Senior |
$358.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.25
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
|
|
HC FISH INTERPHASE 100-300 CELLS
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900918011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$2,389.68 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$316.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$406.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,389.68
|
| Rate for Payer: Blue Shield of California Commercial |
$323.19
|
| Rate for Payer: Blue Shield of California EPN |
$259.23
|
| Rate for Payer: Cash Price |
$325.60
|
| Rate for Payer: Cash Price |
$325.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$384.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Senior |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$366.45
|
| Rate for Payer: Heritage Provider Network Senior |
$366.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$282.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.19
|
| Rate for Payer: TriValley Medical Group Senior |
$51.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC FISH INTERPHASE 100-300 CELLS
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900918011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Cash Price |
$325.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$400.78
|
| Rate for Payer: Heritage Provider Network Senior |
$400.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.00
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
|
|
HC FISH INTERPHASE 25-99 CELLS
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900918010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$1,911.75 |
| Rate for Payer: Adventist Health Commercial |
$42.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$113.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$146.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,911.75
|
| Rate for Payer: Blue Shield of California Commercial |
$280.11
|
| Rate for Payer: Blue Shield of California EPN |
$224.67
|
| Rate for Payer: Cash Price |
$117.15
|
| Rate for Payer: Cash Price |
$117.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.62
|
| Rate for Payer: Dignity Health Senior |
$42.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.85
|
| Rate for Payer: Heritage Provider Network Senior |
$131.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$101.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.40
|
| Rate for Payer: Multiplan Commercial |
$159.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.38
|
| Rate for Payer: TriValley Medical Group Senior |
$42.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$45.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Vantage Medical Group Senior |
$42.38
|
|
|
HC FISH INTERPHASE 25-99 CELLS
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900918010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$159.75 |
| Rate for Payer: Adventist Health Commercial |
$42.60
|
| Rate for Payer: Cash Price |
$117.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.20
|
| Rate for Payer: Heritage Provider Network Senior |
$144.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.25
|
| Rate for Payer: Multiplan Commercial |
$159.75
|
|
|
HC FISH PROBE CYTOGEN 10-30 CELLS
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900918009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.81 |
| Max. Negotiated Rate |
$1,734.73 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$107.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,734.73
|
| Rate for Payer: Blue Shield of California Commercial |
$258.57
|
| Rate for Payer: Blue Shield of California EPN |
$207.39
|
| Rate for Payer: Cash Price |
$110.55
|
| Rate for Payer: Cash Price |
$110.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.29
|
| Rate for Payer: Dignity Health Senior |
$34.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$34.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.42
|
| Rate for Payer: Heritage Provider Network Senior |
$124.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.86
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.81
|
| Rate for Payer: TriValley Medical Group Senior |
$34.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.81
|
|
|
HC FISH PROBE CYTOGEN 10-30 CELLS
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900918009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$150.75 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$110.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$136.08
|
| Rate for Payer: Heritage Provider Network Senior |
$136.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.25
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
|
|
HC FISH PROBE CYTOGEN 3-5 CELLS
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 88272
|
| Hospital Charge Code |
900918008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$1,628.52 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$97.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$125.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,628.52
|
| Rate for Payer: Blue Shield of California Commercial |
$215.48
|
| Rate for Payer: Blue Shield of California EPN |
$172.83
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$118.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.77
|
| Rate for Payer: Dignity Health Senior |
$40.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$40.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.66
|
| Rate for Payer: Heritage Provider Network Senior |
$112.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$86.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.28
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$40.70
|
| Rate for Payer: TriValley Medical Group Senior |
$40.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.77
|
| Rate for Payer: Vantage Medical Group Senior |
$40.70
|
|
|
HC FISH PROBE CYTOGEN 3-5 CELLS
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 88272
|
| Hospital Charge Code |
900918008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.21
|
| Rate for Payer: Heritage Provider Network Senior |
$123.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.50
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
|
|
HC FISH PROBE CYTOGEN EA
|
Facility
|
OP
|
$385.51
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900918007
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$1,548.87 |
| Rate for Payer: Adventist Health Commercial |
$77.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$206.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$264.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,548.87
|
| Rate for Payer: Blue Shield of California Commercial |
$172.40
|
| Rate for Payer: Blue Shield of California EPN |
$138.28
|
| Rate for Payer: Cash Price |
$212.03
|
| Rate for Payer: Cash Price |
$212.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$250.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Senior |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$238.63
|
| Rate for Payer: Heritage Provider Network Senior |
$238.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$183.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.99
|
| Rate for Payer: Multiplan Commercial |
$289.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC FISH PROBE CYTOGEN EA
|
Facility
|
IP
|
$385.51
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900918007
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$69.78 |
| Max. Negotiated Rate |
$289.13 |
| Rate for Payer: Adventist Health Commercial |
$77.10
|
| Rate for Payer: Cash Price |
$212.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$260.99
|
| Rate for Payer: Heritage Provider Network Senior |
$260.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.38
|
| Rate for Payer: Multiplan Commercial |
$289.13
|
|
|
HC FISTULA/SINUS TRACT INJ
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
909000108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.34 |
| Max. Negotiated Rate |
$357.75 |
| Rate for Payer: Adventist Health Commercial |
$95.40
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$322.93
|
| Rate for Payer: Heritage Provider Network Senior |
$322.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.25
|
| Rate for Payer: Multiplan Commercial |
$357.75
|
|
|
HC FISTULA/SINUS TRACT INJ
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
909000108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$95.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$327.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$405.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$357.75
|
| 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 |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$310.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$405.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$405.45
|
| Rate for Payer: Dignity Health Senior |
$405.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$295.26
|
| Rate for Payer: Heritage Provider Network Senior |
$295.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$361.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$227.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.90
|
| Rate for Payer: Multiplan Commercial |
$357.75
|
| 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 |
$405.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$405.45
|
| Rate for Payer: Vantage Medical Group Senior |
$405.45
|
|
|
HC FIT & INSERT PESSARY SUPPORT D
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
900501760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$400.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$514.56
|
| 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 |
$3,531.00
|
| Rate for Payer: Cash Price |
$411.95
|
| Rate for Payer: Cash Price |
$411.95
|
| Rate for Payer: Cash Price |
$411.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$486.85
|
| 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 |
$507.07
|
| Rate for Payer: Heritage Provider Network Senior |
$507.07
|
| 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 |
$357.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| 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 |
$561.75
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$269.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$247.99
|
| 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 FIT & INSERT PESSARY SUPPORT D
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
900501760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.57 |
| Max. Negotiated Rate |
$561.75 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Cash Price |
$411.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.07
|
| Rate for Payer: Heritage Provider Network Senior |
$507.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
|
|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
|
OP
|
$6,090.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,218.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,183.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$3,349.50
|
| Rate for Payer: Cash Price |
$3,349.50
|
| Rate for Payer: Cash Price |
$3,349.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,958.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Senior |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,122.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,122.93
|
| Rate for Payer: Heritage Provider Network Senior |
$4,122.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,904.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,102.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,740.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,194.48
|
| Rate for Payer: Multiplan Commercial |
$4,567.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,191.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,016.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
|
IP
|
$6,090.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,102.29 |
| Max. Negotiated Rate |
$4,567.50 |
| Rate for Payer: Adventist Health Commercial |
$1,218.00
|
| Rate for Payer: Cash Price |
$3,349.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,122.93
|
| Rate for Payer: Heritage Provider Network Senior |
$4,122.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,102.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.50
|
| Rate for Payer: Multiplan Commercial |
$4,567.50
|
|
|
HC FK 506 (TACROLIMUS)
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
900911039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$158.25 |
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Cash Price |
$116.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.85
|
| Rate for Payer: Heritage Provider Network Senior |
$142.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.75
|
| Rate for Payer: Multiplan Commercial |
$158.25
|
|
|
HC FK 506 (TACROLIMUS)
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
900911039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$158.25 |
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$112.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.46
|
| Rate for Payer: Blue Shield of California Commercial |
$110.42
|
| Rate for Payer: Blue Shield of California EPN |
$88.57
|
| Rate for Payer: Cash Price |
$116.05
|
| Rate for Payer: Cash Price |
$116.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$137.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Senior |
$13.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$130.61
|
| Rate for Payer: Heritage Provider Network Senior |
$130.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$100.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.30
|
| Rate for Payer: Multiplan Commercial |
$158.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.73
|
| Rate for Payer: TriValley Medical Group Senior |
$13.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC FLEX VIDEOSCOPE AMBU
|
Facility
|
OP
|
$1,357.00
|
|
| Hospital Charge Code |
900800002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$1,153.45 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$725.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$932.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$746.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,017.75
|
| Rate for Payer: Blue Shield of California Commercial |
$827.77
|
| Rate for Payer: Blue Shield of California EPN |
$662.22
|
| Rate for Payer: Cash Price |
$746.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$882.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,153.45
|
| Rate for Payer: Dignity Health Senior |
$1,153.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$882.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$839.98
|
| Rate for Payer: Heritage Provider Network Senior |
$839.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$647.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$949.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$949.90
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$678.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$678.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,153.45
|
|
|
HC FLEX VIDEOSCOPE AMBU
|
Facility
|
IP
|
$1,357.00
|
|
| Hospital Charge Code |
900800002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$1,017.75 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Cash Price |
$746.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$918.69
|
| Rate for Payer: Heritage Provider Network Senior |
$918.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.25
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
|
|
HC FLEX VIDEOSCOPE AMBU LARGE
|
Facility
|
OP
|
$1,561.00
|
|
| Hospital Charge Code |
900800003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.54 |
| Max. Negotiated Rate |
$1,326.85 |
| Rate for Payer: Adventist Health Commercial |
$312.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$834.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,072.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,326.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$858.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,170.75
|
| Rate for Payer: Blue Shield of California Commercial |
$952.21
|
| Rate for Payer: Blue Shield of California EPN |
$761.77
|
| Rate for Payer: Cash Price |
$858.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,014.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,326.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,326.85
|
| Rate for Payer: Dignity Health Senior |
$1,326.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$966.26
|
| Rate for Payer: Heritage Provider Network Senior |
$966.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$744.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,092.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,092.70
|
| Rate for Payer: Multiplan Commercial |
$1,170.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$780.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$780.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,326.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,326.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,326.85
|
|
