|
HC ENDO SM INT W/ CONVERSION
|
Facility
|
IP
|
$4,026.00
|
|
|
Service Code
|
CPT 44373
|
| Hospital Charge Code |
906744373
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$728.71 |
| Max. Negotiated Rate |
$3,019.50 |
| Rate for Payer: Adventist Health Commercial |
$805.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,592.74
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,725.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,725.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$728.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,006.50
|
| Rate for Payer: Multiplan Commercial |
$3,019.50
|
|
|
HC ENDO SM INT W/ CONVERSION
|
Facility
|
OP
|
$5,360.00
|
|
|
Service Code
|
CPT 44373
|
| Hospital Charge Code |
906744373
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,072.00
|
| Rate for Payer: Adventist Health Commercial |
$805.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,488.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,312.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,412.00
|
| Rate for Payer: Cash Price |
$2,412.00
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Cash Price |
$2,412.00
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,616.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,484.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,317.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,492.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,920.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,556.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$970.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$728.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,006.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,340.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$4,020.00
|
| Rate for Payer: Multiplan Commercial |
$3,019.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ENDO SM INT W/FORCEPS
|
Facility
|
IP
|
$4,026.00
|
|
|
Service Code
|
CPT 44365
|
| Hospital Charge Code |
906744365
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$728.71 |
| Max. Negotiated Rate |
$3,019.50 |
| Rate for Payer: Adventist Health Commercial |
$805.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,592.74
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,725.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,725.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$728.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,006.50
|
| Rate for Payer: Multiplan Commercial |
$3,019.50
|
|
|
HC ENDO SM INT W/FORCEPS
|
Facility
|
OP
|
$4,026.00
|
|
|
Service Code
|
CPT 44365
|
| Hospital Charge Code |
906744365
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$805.20
|
| Rate for Payer: Adventist Health Commercial |
$617.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,908.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,488.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California 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 |
$1,811.70
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,007.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,616.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,492.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,911.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,472.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,920.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$728.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$558.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,006.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,019.50
|
| Rate for Payer: Multiplan Commercial |
$2,316.00
|
| 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 |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ENDO SM INT W/PLCMNT PERCUT
|
Facility
|
OP
|
$5,368.00
|
|
|
Service Code
|
CPT 44372
|
| Hospital Charge Code |
906744372
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,073.60
|
| Rate for Payer: Adventist Health Commercial |
$805.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,488.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,317.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,616.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,489.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,492.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,920.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,560.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$971.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$728.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,006.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,342.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$4,026.00
|
| Rate for Payer: Multiplan Commercial |
$3,019.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ENDO SM INT W/PLCMNT PERCUT
|
Facility
|
IP
|
$4,026.00
|
|
|
Service Code
|
CPT 44372
|
| Hospital Charge Code |
906744372
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$728.71 |
| Max. Negotiated Rate |
$3,019.50 |
| Rate for Payer: Adventist Health Commercial |
$805.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,592.74
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,725.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,725.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$728.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,006.50
|
| Rate for Payer: Multiplan Commercial |
$3,019.50
|
|
|
HC ENDO SM INT W/RMVL FB
|
Facility
|
IP
|
$2,727.00
|
|
|
Service Code
|
CPT 44363
|
| Hospital Charge Code |
906744363
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$493.59 |
| Max. Negotiated Rate |
$2,045.25 |
| Rate for Payer: Adventist Health Commercial |
$545.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,756.19
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,846.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,846.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.75
|
| Rate for Payer: Multiplan Commercial |
$2,045.25
|
|
|
HC ENDO SM INT W/RMVL FB
|
Facility
|
OP
|
$3,088.00
|
|
|
Service Code
|
CPT 44363
|
| Hospital Charge Code |
906744363
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$617.60
|
| Rate for Payer: Adventist Health Commercial |
$545.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,685.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,908.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California 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 |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,772.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,007.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,911.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,688.01
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,300.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,472.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$558.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,316.00
|
| Rate for Payer: Multiplan Commercial |
$2,045.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ENDO SM INT W/SNARE
|
Facility
|
IP
|
$4,026.00
|
|
|
Service Code
|
CPT 44364
|
| Hospital Charge Code |
906744364
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$728.71 |
| Max. Negotiated Rate |
$3,019.50 |
| Rate for Payer: Adventist Health Commercial |
$805.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,592.74
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,725.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,725.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$728.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,006.50
|
| Rate for Payer: Multiplan Commercial |
$3,019.50
|
|
|
HC ENDO SM INT W/SNARE
|
Facility
|
OP
|
$4,026.00
|
|
|
Service Code
|
CPT 44364
|
| Hospital Charge Code |
906744364
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$805.20
|
| Rate for Payer: Adventist Health Commercial |
$617.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,908.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,488.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California 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 |
$1,811.70
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,007.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,616.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,492.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,911.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,472.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,920.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$728.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$558.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,006.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$3,019.50
|
| Rate for Payer: Multiplan Commercial |
$2,316.00
|
| 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 |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ENDO SM INT W STENT PLCMNT
|
Facility
|
IP
|
$7,687.00
|
|
|
Service Code
|
CPT 44370
|
| Hospital Charge Code |
906744370
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,391.35 |
| Max. Negotiated Rate |
$5,765.25 |
| Rate for Payer: Adventist Health Commercial |
$1,537.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,950.43
|
| Rate for Payer: Cash Price |
$3,459.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,204.10
|
| Rate for Payer: Heritage Provider Network Senior |
$5,204.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,391.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,921.75
|
| Rate for Payer: Multiplan Commercial |
$5,765.25
|
|
|
HC ENDO SM INT W STENT PLCMNT
|
Facility
|
OP
|
$8,470.00
|
|
|
Service Code
|
CPT 44370
|
| Hospital Charge Code |
906744370
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$14,574.13 |
| Rate for Payer: Adventist Health Commercial |
$1,694.00
|
| Rate for Payer: Adventist Health Commercial |
$1,537.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,750.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,234.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$3,811.50
|
| Rate for Payer: Cash Price |
$3,811.50
|
| Rate for Payer: Cash Price |
$3,459.15
|
| Rate for Payer: Cash Price |
$3,459.15
|
| Rate for Payer: Cash Price |
$3,811.50
|
| Rate for Payer: Cash Price |
$3,459.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,996.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,505.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| 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 |
$7,808.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,808.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,242.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,758.25
|
| Rate for Payer: Heritage Provider Network Senior |
$9,604.07
|
| Rate for Payer: Heritage Provider Network Senior |
$9,604.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,666.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,040.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,533.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,391.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,979.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,979.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,921.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,117.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Multiplan Commercial |
$6,352.50
|
| Rate for Payer: Multiplan Commercial |
$5,765.25
|
| 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 |
$10,001.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
IP
|
$2,405.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$435.31 |
| Max. Negotiated Rate |
$1,803.75 |
| Rate for Payer: Adventist Health Commercial |
$481.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,548.82
|
| Rate for Payer: Cash Price |
$1,082.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,628.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,628.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$435.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.25
|
| Rate for Payer: Multiplan Commercial |
$1,803.75
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
OP
|
$2,405.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$481.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,486.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$1,082.25
|
| Rate for Payer: Cash Price |
$1,082.25
|
| Rate for Payer: Cash Price |
$1,082.25
|
| Rate for Payer: Cash Price |
$1,082.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,563.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,488.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,488.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,147.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$435.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$1,803.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
IP
|
$2,405.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$435.31 |
| Max. Negotiated Rate |
$1,803.75 |
| Rate for Payer: Adventist Health Commercial |
$481.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,548.82
|
| Rate for Payer: Cash Price |
$1,082.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,628.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,628.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$435.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.25
|
| Rate for Payer: Multiplan Commercial |
$1,803.75
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
OP
|
$2,405.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$481.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,486.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,142.38
|
| Rate for Payer: Blue Shield of California EPN |
$909.09
|
| Rate for Payer: Cash Price |
$1,082.25
|
| Rate for Payer: Cash Price |
$1,082.25
|
| Rate for Payer: Cash Price |
$1,082.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,563.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,628.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,628.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,147.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$435.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$1,803.75
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,443.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,443.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC ENDOVASC REPAIR DES THORACIC AO
|
Facility
|
OP
|
$3,420.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$619.02 |
| Max. Negotiated Rate |
$12,185.00 |
| Rate for Payer: Adventist Health Commercial |
$684.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,113.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,907.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,881.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,565.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,185.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,223.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,907.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,907.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,907.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,116.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,116.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,631.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$619.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,394.00
|
| Rate for Payer: Multiplan Commercial |
$2,565.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$2,907.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,907.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,907.00
|
|
|
HC ENDOVASC REPAIR DES THORACIC AO
|
Facility
|
IP
|
$3,420.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$619.02 |
| Max. Negotiated Rate |
$2,565.00 |
| Rate for Payer: Adventist Health Commercial |
$684.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,202.48
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,315.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2,315.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$619.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.00
|
| Rate for Payer: Multiplan Commercial |
$2,565.00
|
|
|
HC ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
OP
|
$44,264.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$8,011.78 |
| Max. Negotiated Rate |
$33,198.00 |
| Rate for Payer: Adventist Health Commercial |
$8,852.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27,355.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27,001.04
|
| Rate for Payer: Blue Shield of California EPN |
$21,600.83
|
| Rate for Payer: Cash Price |
$19,918.80
|
| Rate for Payer: Cash Price |
$19,918.80
|
| Rate for Payer: Cash Price |
$19,918.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28,771.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,115.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$27,399.42
|
| Rate for Payer: Heritage Provider Network Senior |
$27,399.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21,113.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,011.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,066.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$33,198.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,847.76
|
| Rate for Payer: TriValley Medical Group Senior |
$14,847.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22,132.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22,132.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
IP
|
$44,264.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$8,011.78 |
| Max. Negotiated Rate |
$33,198.00 |
| Rate for Payer: Adventist Health Commercial |
$8,852.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,506.02
|
| Rate for Payer: Cash Price |
$19,918.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$29,966.73
|
| Rate for Payer: Heritage Provider Network Senior |
$29,966.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,011.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,066.00
|
| Rate for Payer: Multiplan Commercial |
$33,198.00
|
|
|
HC ENOVENOUS ABLATION THERAPY
|
Facility
|
IP
|
$19,038.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,445.88 |
| Max. Negotiated Rate |
$14,278.50 |
| Rate for Payer: Adventist Health Commercial |
$3,807.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,260.47
|
| Rate for Payer: Cash Price |
$8,567.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,888.73
|
| Rate for Payer: Heritage Provider Network Senior |
$12,888.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,445.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,759.50
|
| Rate for Payer: Multiplan Commercial |
$14,278.50
|
|
|
HC ENOVENOUS ABLATION THERAPY
|
Facility
|
OP
|
$19,038.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,445.88 |
| Max. Negotiated Rate |
$14,278.50 |
| Rate for Payer: Adventist Health Commercial |
$3,807.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,765.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$8,567.10
|
| Rate for Payer: Cash Price |
$8,567.10
|
| Rate for Payer: Cash Price |
$8,567.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,374.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,784.52
|
| Rate for Payer: Heritage Provider Network Senior |
$4,995.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,715.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,445.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,759.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$14,278.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,467.15
|
| Rate for Payer: TriValley Medical Group Senior |
$4,467.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
|
OP
|
$1,145.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.25 |
| Max. Negotiated Rate |
$858.75 |
| Rate for Payer: Adventist Health Commercial |
$229.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$707.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.37
|
| Rate for Payer: Blue Shield of California Commercial |
$274.70
|
| Rate for Payer: Blue Shield of California EPN |
$220.91
|
| Rate for Payer: Cash Price |
$515.25
|
| Rate for Payer: Cash Price |
$515.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$744.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$675.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$708.75
|
| Rate for Payer: Heritage Provider Network Senior |
$708.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$546.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$858.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.59
|
| Rate for Payer: TriValley Medical Group Senior |
$225.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$227.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$227.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
|
IP
|
$1,145.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.25 |
| Max. Negotiated Rate |
$858.75 |
| Rate for Payer: Adventist Health Commercial |
$229.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.38
|
| Rate for Payer: Cash Price |
$515.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$775.16
|
| Rate for Payer: Heritage Provider Network Senior |
$775.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.25
|
| Rate for Payer: Multiplan Commercial |
$858.75
|
|
|
HC ENTEROSCOPY SUBMCSL INJ
|
Facility
|
OP
|
$3,548.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906765000
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$709.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,192.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,774.71
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,596.60
|
| Rate for Payer: Cash Price |
$1,596.60
|
| Rate for Payer: Cash Price |
$1,596.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,306.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,196.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,692.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$642.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,661.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
