|
HC EMBOLIZATION LCBEADS
|
Facility
|
OP
|
$4,397.50
|
|
| Hospital Charge Code |
909020052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$795.95 |
| Max. Negotiated Rate |
$3,737.88 |
| Rate for Payer: Adventist Health Commercial |
$879.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,717.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,737.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,418.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,298.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,199.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,682.47
|
| Rate for Payer: Blue Shield of California EPN |
$2,145.98
|
| Rate for Payer: Cash Price |
$1,978.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,858.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,737.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,737.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,737.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,594.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,722.05
|
| Rate for Payer: Heritage Provider Network Senior |
$2,722.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,097.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$795.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,099.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,078.25
|
| Rate for Payer: Multiplan Commercial |
$3,298.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,198.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,198.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,737.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,737.88
|
| Rate for Payer: Vantage Medical Group Senior |
$3,737.88
|
|
|
HC EMBOLIZATION LCBEADS
|
Facility
|
IP
|
$4,397.50
|
|
| Hospital Charge Code |
909020052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$795.95 |
| Max. Negotiated Rate |
$3,298.12 |
| Rate for Payer: Adventist Health Commercial |
$879.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,831.99
|
| Rate for Payer: Cash Price |
$1,978.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,977.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,977.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$795.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,099.38
|
| Rate for Payer: Multiplan Commercial |
$3,298.12
|
|
|
HC EMBOLIZATION PARTICLE
|
Facility
|
IP
|
$1,122.40
|
|
| Hospital Charge Code |
909081256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.48 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$224.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$722.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$451.20
|
| Rate for Payer: Blue Shield of California EPN |
$451.20
|
| Rate for Payer: Cash Price |
$505.08
|
| Rate for Payer: Cash Price |
$505.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$519.67
|
| Rate for Payer: Heritage Provider Network Senior |
$519.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$561.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$561.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$561.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.60
|
| Rate for Payer: Multiplan Commercial |
$841.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$405.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$371.63
|
|
|
HC EMBOLIZATION PARTICLE
|
Facility
|
OP
|
$1,122.40
|
|
| Hospital Charge Code |
909081256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.48 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$224.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$693.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$954.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$617.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$841.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$451.20
|
| Rate for Payer: Blue Shield of California EPN |
$451.20
|
| Rate for Payer: Cash Price |
$505.08
|
| Rate for Payer: Cash Price |
$505.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$954.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$954.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$954.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$718.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$519.67
|
| Rate for Payer: Heritage Provider Network Senior |
$519.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$561.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$561.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$561.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$785.68
|
| Rate for Payer: Multiplan Commercial |
$841.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$405.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$371.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$954.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$954.04
|
| Rate for Payer: Vantage Medical Group Senior |
$954.04
|
|
|
HC EMBOLIZ, INTRACRAN/SP.CRD.
|
Facility
|
IP
|
$13,709.00
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
909081337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,481.33 |
| Max. Negotiated Rate |
$10,281.75 |
| Rate for Payer: Adventist Health Commercial |
$2,741.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,828.60
|
| Rate for Payer: Cash Price |
$6,169.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,280.99
|
| Rate for Payer: Heritage Provider Network Senior |
$9,280.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,481.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,427.25
|
| Rate for Payer: Multiplan Commercial |
$10,281.75
|
|
|
HC EMBOLIZ, INTRACRAN/SP.CRD.
|
Facility
|
OP
|
$13,709.00
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
909081337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,481.33 |
| Max. Negotiated Rate |
$44,797.35 |
| Rate for Payer: Adventist Health Commercial |
$2,741.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,472.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$6,169.05
|
| Rate for Payer: Cash Price |
$6,169.05
|
| Rate for Payer: Cash Price |
$6,169.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,910.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,225.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,577.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,485.87
|
| Rate for Payer: Heritage Provider Network Senior |
$29,000.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44,797.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,481.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,114.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,427.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$10,281.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,935.31
|
| Rate for Payer: TriValley Medical Group Senior |
$25,935.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC EM EMBED ONLY
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 88399
|
| Hospital Charge Code |
903800053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$54.82 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Adventist Health Commercial |
$119.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$368.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$202.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$298.62
|
| Rate for Payer: Blue Shield of California Commercial |
$200.08
|
| Rate for Payer: Blue Shield of California Commercial |
$364.17
|
| Rate for Payer: Blue Shield of California EPN |
$160.06
|
| Rate for Payer: Blue Shield of California EPN |
$291.34
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$268.65
|
| Rate for Payer: Cash Price |
$268.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$213.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$388.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$369.54
|
| Rate for Payer: Heritage Provider Network Senior |
$203.03
|
| Rate for Payer: Heritage Provider Network Senior |
$369.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$156.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$284.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: Multiplan Commercial |
$447.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.02
|
| Rate for Payer: TriValley Medical Group Senior |
$67.02
|
| Rate for Payer: TriValley Medical Group Senior |
$67.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC EM EMBED ONLY
|
Facility
|
IP
|
$597.00
|
|
|
Service Code
|
CPT 88399
|
| Hospital Charge Code |
903800053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$108.06 |
| Max. Negotiated Rate |
$447.75 |
| Rate for Payer: Adventist Health Commercial |
$119.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.47
|
| Rate for Payer: Cash Price |
$268.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.17
|
| Rate for Payer: Heritage Provider Network Senior |
$404.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.25
|
| Rate for Payer: Multiplan Commercial |
$447.75
|
|
|
HC ENDLMNL BX RNL PLVS AND OR URE
|
Facility
|
IP
|
$6,462.00
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
909050606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,169.62 |
| Max. Negotiated Rate |
$4,846.50 |
| Rate for Payer: Adventist Health Commercial |
$1,292.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,161.53
|
| Rate for Payer: Cash Price |
$2,907.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,374.77
|
| Rate for Payer: Heritage Provider Network Senior |
$4,374.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,169.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,615.50
|
| Rate for Payer: Multiplan Commercial |
$4,846.50
|
|
|
HC ENDLMNL BX RNL PLVS AND OR URE
|
Facility
|
OP
|
$6,462.00
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
909050606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,292.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,993.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,492.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,554.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,846.50
|
| 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 |
$2,907.90
|
| Rate for Payer: Cash Price |
$2,907.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,200.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,492.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,492.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,492.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,999.98
|
| Rate for Payer: Heritage Provider Network Senior |
$3,999.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,082.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,169.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,615.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,523.40
|
| Rate for Payer: Multiplan Commercial |
$4,846.50
|
| 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 |
$5,492.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,492.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5,492.70
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
900501170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.79 |
| Max. Negotiated Rate |
$1,192.50 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,023.96
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,076.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,076.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.50
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
900501170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.79 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$982.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,184.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$755.25
|
| Rate for Payer: Blue Shield of California EPN |
$601.02
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,033.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,303.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,184.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,184.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,076.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,076.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,184.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$758.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,362.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,587.39
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
| Rate for Payer: Multiplan WC |
$1,762.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$954.00
|
| Rate for Payer: TriValley Medical Group Senior |
$954.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,184.62
|
|
|
HC ENDO EVAL SM INTESTINE W BX
|
Facility
|
OP
|
$2,859.00
|
|
|
Service Code
|
CPT 44386
|
| Hospital Charge Code |
906744386
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$571.80
|
| Rate for Payer: Adventist Health Commercial |
$502.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,552.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,766.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| 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 |
$1,286.55
|
| Rate for Payer: Cash Price |
$1,286.55
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cash Price |
$1,286.55
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,632.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,858.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| 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 |
$1,196.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,196.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,769.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,554.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,471.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,471.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,198.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,363.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$517.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$454.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,375.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,375.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$2,144.25
|
| Rate for Payer: Multiplan Commercial |
$1,884.00
|
| 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 |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
HC ENDO EVAL SM INTESTINE W BX
|
Facility
|
IP
|
$2,512.00
|
|
|
Service Code
|
CPT 44386
|
| Hospital Charge Code |
906744386
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$454.67 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Adventist Health Commercial |
$502.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,617.73
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,700.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,700.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$454.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.00
|
| Rate for Payer: Multiplan Commercial |
$1,884.00
|
|
|
HC ENDO EVAL SM INTESTINE W WO COLLECT
|
Facility
|
IP
|
$2,512.00
|
|
|
Service Code
|
CPT 44385
|
| Hospital Charge Code |
906744385
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$454.67 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Adventist Health Commercial |
$502.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,617.73
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,700.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,700.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$454.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.00
|
| Rate for Payer: Multiplan Commercial |
$1,884.00
|
|
|
HC ENDO EVAL SM INTESTINE W WO COLLECT
|
Facility
|
OP
|
$2,859.00
|
|
|
Service Code
|
CPT 44385
|
| Hospital Charge Code |
906744385
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$571.80
|
| Rate for Payer: Adventist Health Commercial |
$502.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,552.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,766.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| 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 |
$1,286.55
|
| Rate for Payer: Cash Price |
$1,286.55
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cash Price |
$1,286.55
|
| Rate for Payer: Cash Price |
$1,130.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,632.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,858.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| 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 |
$1,196.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,196.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,769.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,554.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,471.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,471.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,198.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,363.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$517.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$454.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,375.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,375.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$2,144.25
|
| Rate for Payer: Multiplan Commercial |
$1,884.00
|
| 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 |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
HC ENDOLUMINAL BRUSHING
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.94 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$476.56
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.98
|
| Rate for Payer: Heritage Provider Network Senior |
$500.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Multiplan Commercial |
$555.00
|
|
|
HC ENDOLUMINAL BRUSHING
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.94 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$476.56
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.98
|
| Rate for Payer: Heritage Provider Network Senior |
$500.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Multiplan Commercial |
$555.00
|
|
|
HC ENDOLUMINAL BRUSHING
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.94 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$457.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.00
|
| 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 EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$629.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$629.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$629.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$458.06
|
| Rate for Payer: Heritage Provider Network Senior |
$458.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$352.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$518.00
|
| Rate for Payer: Multiplan Commercial |
$555.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$629.00
|
| Rate for Payer: Vantage Medical Group Senior |
$629.00
|
|
|
HC ENDOLUMINAL BRUSHING
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.94 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$457.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$351.50
|
| Rate for Payer: Blue Shield of California EPN |
$279.72
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$629.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$629.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$629.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.98
|
| Rate for Payer: Heritage Provider Network Senior |
$500.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$352.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$518.00
|
| Rate for Payer: Multiplan Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$444.00
|
| Rate for Payer: TriValley Medical Group Senior |
$444.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$629.00
|
| Rate for Payer: Vantage Medical Group Senior |
$629.00
|
|
|
HC ENDOLUMINAL BX BILIARY TREE
|
Facility
|
OP
|
$1,487.00
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
909047543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$269.15 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$297.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$918.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,263.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$817.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,115.25
|
| 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 |
$669.15
|
| Rate for Payer: Cash Price |
$669.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$966.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,263.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,263.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,263.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$920.45
|
| Rate for Payer: Heritage Provider Network Senior |
$920.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$709.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$269.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,040.90
|
| Rate for Payer: Multiplan Commercial |
$1,115.25
|
| 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 |
$1,263.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,263.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,263.95
|
|
|
HC ENDOLUMINAL BX BILIARY TREE
|
Facility
|
IP
|
$1,487.00
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
909047543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$269.15 |
| Max. Negotiated Rate |
$1,115.25 |
| Rate for Payer: Adventist Health Commercial |
$297.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$957.63
|
| Rate for Payer: Cash Price |
$669.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,006.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,006.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$269.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.75
|
| Rate for Payer: Multiplan Commercial |
$1,115.25
|
|
|
HC ENDOMETRIAL BIOPSY
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
900501615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$80.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$248.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$190.95
|
| Rate for Payer: Blue Shield of California EPN |
$151.96
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$261.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$260.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$272.15
|
| Rate for Payer: Heritage Provider Network Senior |
$272.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$191.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$348.44
|
| Rate for Payer: Multiplan Commercial |
$301.50
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$241.20
|
| Rate for Payer: TriValley Medical Group Senior |
$241.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Vantage Medical Group Senior |
$260.03
|
|
|
HC ENDOMETRIAL BIOPSY
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
900501615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Adventist Health Commercial |
$80.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$258.89
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$272.15
|
| Rate for Payer: Heritage Provider Network Senior |
$272.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.50
|
| Rate for Payer: Multiplan Commercial |
$301.50
|
|
|
HC ENDOMYCARDIAL BIOPSY
|
Facility
|
IP
|
$4,737.00
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
906811308
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$857.40 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$947.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,050.63
|
| Rate for Payer: Cash Price |
$2,131.65
|
| Rate for Payer: Cash Price |
$2,131.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$857.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,184.25
|
| Rate for Payer: Multiplan Commercial |
$3,552.75
|
|
