|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
IP
|
$12,393.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906811409
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,243.13 |
| Max. Negotiated Rate |
$9,294.75 |
| Rate for Payer: Adventist Health Commercial |
$2,478.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,513.99
|
| Rate for Payer: Cash Price |
$5,576.85
|
| Rate for Payer: Cash Price |
$5,576.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,243.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,098.25
|
| Rate for Payer: Multiplan Commercial |
$9,294.75
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
OP
|
$12,490.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906820067
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$257.62 |
| Max. Negotiated Rate |
$13,496.00 |
| Rate for Payer: Adventist Health Commercial |
$2,498.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,580.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,616.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,869.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,367.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$5,620.50
|
| Rate for Payer: Cash Price |
$5,620.50
|
| Rate for Payer: Cash Price |
$5,620.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,616.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,616.50
|
| Rate for Payer: Dignity Health Senior |
$10,616.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,118.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,731.31
|
| Rate for Payer: Heritage Provider Network Senior |
$7,731.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$257.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,020.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,260.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,122.50
|
| Rate for Payer: Multiplan Commercial |
$9,367.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,616.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,616.50
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
OP
|
$12,393.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906811409
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$257.62 |
| Max. Negotiated Rate |
$13,496.00 |
| Rate for Payer: Adventist Health Commercial |
$2,478.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,513.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,534.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,816.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,294.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$5,576.85
|
| Rate for Payer: Cash Price |
$5,576.85
|
| Rate for Payer: Cash Price |
$5,576.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,534.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,534.05
|
| Rate for Payer: Dignity Health Senior |
$10,534.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,055.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,671.27
|
| Rate for Payer: Heritage Provider Network Senior |
$7,671.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$257.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,973.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,243.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,098.25
|
| Rate for Payer: Multiplan Commercial |
$9,294.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,534.05
|
| Rate for Payer: Vantage Medical Group Senior |
$10,534.05
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
OP
|
$12,393.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906811399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,190.06 |
| Max. Negotiated Rate |
$11,566.00 |
| Rate for Payer: Adventist Health Commercial |
$2,478.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,513.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$5,576.85
|
| Rate for Payer: Cash Price |
$5,576.85
|
| Rate for Payer: Cash Price |
$5,576.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: Dignity Health Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,055.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,071.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,671.27
|
| Rate for Payer: Heritage Provider Network Senior |
$5,007.77
|
| Rate for Payer: Humana Medicare |
$4,071.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,190.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,735.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,243.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,804.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,098.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,129.91
|
| Rate for Payer: Multiplan Commercial |
$9,294.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,566.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,766.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
IP
|
$12,393.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906811399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,243.13 |
| Max. Negotiated Rate |
$9,294.75 |
| Rate for Payer: Adventist Health Commercial |
$2,478.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,513.99
|
| Rate for Payer: Cash Price |
$5,576.85
|
| Rate for Payer: Cash Price |
$5,576.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,243.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,098.25
|
| Rate for Payer: Multiplan Commercial |
$9,294.75
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
OP
|
$11,351.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906820058
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,190.06 |
| Max. Negotiated Rate |
$11,566.00 |
| Rate for Payer: Adventist Health Commercial |
$2,270.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,798.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: Dignity Health Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,378.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,071.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,026.27
|
| Rate for Payer: Heritage Provider Network Senior |
$5,007.77
|
| Rate for Payer: Humana Medicare |
$4,071.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,190.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,735.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,054.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,804.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,837.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,129.91
|
| Rate for Payer: Multiplan Commercial |
$8,513.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,566.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,766.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
IP
|
$11,351.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906820058
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,054.53 |
| Max. Negotiated Rate |
$8,513.25 |
| Rate for Payer: Adventist Health Commercial |
$2,270.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,798.14
|
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,054.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,837.75
|
| Rate for Payer: Multiplan Commercial |
$8,513.25
|
|
|
HC LEG/ANKLE PROCEDURE UNLISTED
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
900501440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.94
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.74
|
| Rate for Payer: Heritage Provider Network Senior |
$419.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
|
|
HC LEG/ANKLE PROCEDURE UNLISTED
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
900501440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$403.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.74
|
| Rate for Payer: Heritage Provider Network Senior |
$419.74
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$298.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$225.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$207.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC LEUK ACID PHOSP (TRAP STAIN)
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$195.48 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Adventist Health Commercial |
$216.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$741.96
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$731.16
|
| Rate for Payer: Heritage Provider Network Senior |
$731.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$810.00
|
|
|
HC LEUK ACID PHOSP (TRAP STAIN)
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$60.01 |
| Max. Negotiated Rate |
$2,041.30 |
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$266.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.01
|
| Rate for Payer: Blue Shield of California Commercial |
$243.43
|
| Rate for Payer: Blue Shield of California EPN |
$230.10
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$254.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: Dignity Health Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,074.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$242.65
|
| Rate for Payer: Heritage Provider Network Senior |
$242.65
|
| Rate for Payer: Humana Medicare |
$1,074.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$107.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,074.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,041.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,267.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,353.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,353.71
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,074.37
|
| Rate for Payer: TriValley Medical Group Senior |
$1,074.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$722.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$722.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC LEUK ALK PHOS
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 85540
|
| Hospital Charge Code |
900910059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$71.96 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.96
|
| Rate for Payer: Blue Shield of California Commercial |
$67.19
|
| Rate for Payer: Blue Shield of California EPN |
$52.53
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.46
|
| Rate for Payer: Dignity Health Senior |
$8.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Humana Medicare |
$8.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.84
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.60
|
| Rate for Payer: TriValley Medical Group Senior |
$8.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.46
|
| Rate for Payer: Vantage Medical Group Senior |
$8.60
|
|
|
HC LEUK ALK PHOS
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 85540
|
| Hospital Charge Code |
900910059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$94.12 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$357.24
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$352.04
|
| Rate for Payer: Heritage Provider Network Senior |
$352.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
|
|
HC LEUKOCYTES FECAL
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900911641
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.97
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.18
|
| Rate for Payer: Heritage Provider Network Senior |
$121.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.75
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
|
|
HC LEUKOCYTES FECAL
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900911641
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$35.73 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.73
|
| Rate for Payer: Blue Shield of California Commercial |
$33.32
|
| Rate for Payer: Blue Shield of California EPN |
$26.05
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$4.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC LEVEEN SHUNT PATENCY TEST
|
Facility
|
OP
|
$1,492.00
|
|
|
Service Code
|
CPT 78291
|
| Hospital Charge Code |
909301414
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$220.13 |
| Max. Negotiated Rate |
$1,119.00 |
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$465.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,025.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$626.44
|
| Rate for Payer: Blue Shield of California EPN |
$356.24
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$969.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$969.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$923.55
|
| Rate for Payer: Heritage Provider Network Senior |
$923.55
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,119.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC LEVEEN SHUNT PATENCY TEST
|
Facility
|
IP
|
$1,492.00
|
|
|
Service Code
|
CPT 78291
|
| Hospital Charge Code |
909301414
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$270.05 |
| Max. Negotiated Rate |
$1,119.00 |
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,025.00
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,010.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,010.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.00
|
| Rate for Payer: Multiplan Commercial |
$1,119.00
|
|
|
HC LEVEL I-GROSS EXAM ONLY
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
903800021
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.98 |
| Max. Negotiated Rate |
$182.25 |
| Rate for Payer: Adventist Health Commercial |
$48.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.94
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$164.51
|
| Rate for Payer: Heritage Provider Network Senior |
$164.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.75
|
| Rate for Payer: Multiplan Commercial |
$182.25
|
|
|
HC LEVEL I-GROSS EXAM ONLY
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
903800021
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$70.68 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.72
|
| Rate for Payer: Blue Shield of California Commercial |
$39.12
|
| Rate for Payer: Blue Shield of California EPN |
$36.98
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.00
|
| Rate for Payer: Heritage Provider Network Senior |
$39.00
|
| Rate for Payer: Humana Medicare |
$37.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.87
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC LEVEL II-GROSS & MICRO EXAM
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
903800058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$104.13 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$104.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.49
|
| Rate for Payer: Blue Shield of California Commercial |
$39.74
|
| Rate for Payer: Blue Shield of California EPN |
$37.57
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Humana Medicare |
$37.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.87
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC LEVEL II-GROSS & MICRO EXAM
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
903800058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$91.77 |
| Max. Negotiated Rate |
$380.25 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$348.31
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$343.24
|
| Rate for Payer: Heritage Provider Network Senior |
$343.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.75
|
| Rate for Payer: Multiplan Commercial |
$380.25
|
|
|
HC LEVEL III- GROSS & MICRO EXAM
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
903800059
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$128.63 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$114.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.27
|
| Rate for Payer: Blue Shield of California Commercial |
$55.89
|
| Rate for Payer: Blue Shield of California EPN |
$52.83
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: Dignity Health Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.71
|
| Rate for Payer: Heritage Provider Network Senior |
$55.71
|
| Rate for Payer: Humana Medicare |
$67.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.30
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.70
|
| Rate for Payer: TriValley Medical Group Senior |
$67.70
|
| 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: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC LEVEL III- GROSS & MICRO EXAM
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
903800059
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$93.22 |
| Max. Negotiated Rate |
$386.25 |
| Rate for Payer: Adventist Health Commercial |
$103.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$353.80
|
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$348.66
|
| Rate for Payer: Heritage Provider Network Senior |
$348.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.75
|
| Rate for Payer: Multiplan Commercial |
$386.25
|
|
|
HC LEVEL IV-GROSS & MICRO EXAM
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
903800060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.54 |
| Max. Negotiated Rate |
$154.86 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.93
|
| Rate for Payer: Blue Shield of California Commercial |
$73.90
|
| Rate for Payer: Blue Shield of California EPN |
$69.85
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: Dignity Health Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.66
|
| Rate for Payer: Heritage Provider Network Senior |
$73.66
|
| Rate for Payer: Humana Medicare |
$67.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.30
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.70
|
| Rate for Payer: TriValley Medical Group Senior |
$67.70
|
| 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: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC LEVEL IV-GROSS & MICRO EXAM
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
903800060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$557.84
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$549.72
|
| Rate for Payer: Heritage Provider Network Senior |
$549.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
|
