|
HC LIPASE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900910334
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$57.59 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.59
|
| Rate for Payer: Blue Shield of California Commercial |
$53.78
|
| Rate for Payer: Blue Shield of California EPN |
$42.04
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Senior |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Senior |
$16.09
|
| Rate for Payer: Humana Medicare |
$6.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.89
|
| Rate for Payer: TriValley Medical Group Senior |
$6.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC LIPASE BODY FLUID
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900912244
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.98
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
|
|
HC LIPASE BODY FLUID
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900912244
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$57.59 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.59
|
| Rate for Payer: Blue Shield of California Commercial |
$53.78
|
| Rate for Payer: Blue Shield of California EPN |
$42.04
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Senior |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$6.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.89
|
| Rate for Payer: TriValley Medical Group Senior |
$6.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC LIPID PANEL MC
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
900912170
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$112.08 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.08
|
| Rate for Payer: Blue Shield of California Commercial |
$104.64
|
| Rate for Payer: Blue Shield of California EPN |
$81.81
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.73
|
| Rate for Payer: Dignity Health Senior |
$13.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Humana Medicare |
$13.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.87
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.39
|
| Rate for Payer: TriValley Medical Group Senior |
$13.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.73
|
| Rate for Payer: Vantage Medical Group Senior |
$13.39
|
|
|
HC LIPID PANEL MC
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
900912170
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.33
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC LIQUID COILS
|
Facility
|
IP
|
$1,030.40
|
|
| Hospital Charge Code |
909081813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.08 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$206.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$494.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$707.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$463.68
|
| Rate for Payer: Cash Price |
$463.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$473.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$556.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$697.58
|
| Rate for Payer: Heritage Provider Network Senior |
$697.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$515.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$375.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$344.26
|
|
|
HC LIQUID COILS
|
Facility
|
OP
|
$1,030.40
|
|
| Hospital Charge Code |
909081813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.08 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$206.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$494.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$707.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$875.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$772.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$639.88
|
| Rate for Payer: Blue Shield of California EPN |
$604.84
|
| Rate for Payer: Cash Price |
$463.68
|
| Rate for Payer: Cash Price |
$463.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$473.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$875.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$875.84
|
| Rate for Payer: Dignity Health Senior |
$875.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$477.08
|
| Rate for Payer: Heritage Provider Network Senior |
$477.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$515.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$375.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$344.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$875.84
|
| Rate for Payer: Vantage Medical Group Senior |
$875.84
|
|
|
HC LITHIUM
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
900910332
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$55.28 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.28
|
| Rate for Payer: Blue Shield of California Commercial |
$51.65
|
| Rate for Payer: Blue Shield of California EPN |
$40.38
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.27
|
| Rate for Payer: Dignity Health Senior |
$6.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Senior |
$16.09
|
| Rate for Payer: Humana Medicare |
$6.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.33
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.61
|
| Rate for Payer: TriValley Medical Group Senior |
$6.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.27
|
| Rate for Payer: Vantage Medical Group Senior |
$6.61
|
|
|
HC LITHIUM
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
900910332
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$80.38
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.21
|
| Rate for Payer: Heritage Provider Network Senior |
$79.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.25
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
|
|
HC LITHOTRIPSY STENT ATHERECTOMY
|
Facility
|
OP
|
$49,162.00
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
906819767
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,088.00 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$9,832.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,774.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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 |
$22,122.90
|
| Rate for Payer: Cash Price |
$22,122.90
|
| Rate for Payer: Cash Price |
$22,122.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31,955.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,497.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,431.28
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,898.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,290.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$36,871.50
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$24,099.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC LITHOTRIPSY STENT ATHERECTOMY
|
Facility
|
IP
|
$49,162.00
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
906820315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,898.32 |
| Max. Negotiated Rate |
$36,871.50 |
| Rate for Payer: Adventist Health Commercial |
$9,832.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,774.29
|
| Rate for Payer: Cash Price |
$22,122.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$33,282.67
|
| Rate for Payer: Heritage Provider Network Senior |
$33,282.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,898.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,290.50
|
| Rate for Payer: Multiplan Commercial |
$36,871.50
|
|
|
HC LITHOTRIPSY STENT ATHERECTOMY
|
Facility
|
OP
|
$49,162.00
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
906820315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,088.00 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$9,832.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,774.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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 |
$22,122.90
|
| Rate for Payer: Cash Price |
$22,122.90
|
| Rate for Payer: Cash Price |
$22,122.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31,955.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,497.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,431.28
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,898.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,290.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$36,871.50
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$24,099.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC LITHOTRIPSY STENT ATHERECTOMY
|
Facility
|
IP
|
$49,162.00
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
906819767
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,898.32 |
| Max. Negotiated Rate |
$36,871.50 |
| Rate for Payer: Adventist Health Commercial |
$9,832.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,774.29
|
| Rate for Payer: Cash Price |
$22,122.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$33,282.67
|
| Rate for Payer: Heritage Provider Network Senior |
$33,282.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,898.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,290.50
|
| Rate for Payer: Multiplan Commercial |
$36,871.50
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$2,181.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$394.76 |
| Max. Negotiated Rate |
$1,635.75 |
| Rate for Payer: Adventist Health Commercial |
$436.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,498.35
|
| Rate for Payer: Cash Price |
$981.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,476.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,476.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$545.25
|
| Rate for Payer: Multiplan Commercial |
$1,635.75
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$2,181.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$262.52 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$436.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,498.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,354.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,280.25
|
| Rate for Payer: Cash Price |
$981.45
|
| Rate for Payer: Cash Price |
$981.45
|
| Rate for Payer: Cash Price |
$981.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,417.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,350.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,350.04
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$262.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$545.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$1,635.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,025.69
|
| Rate for Payer: TriValley Medical Group Senior |
$2,025.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC LIVER BIOPSY W OTHER PROC
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT 47001
|
| Hospital Charge Code |
909000141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.08 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$537.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$664.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$430.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$586.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$351.90
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$508.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$664.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$664.70
|
| Rate for Payer: Dignity Health Senior |
$664.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.06
|
| Rate for Payer: Heritage Provider Network Senior |
$484.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$376.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.50
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| 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 |
$664.70
|
| Rate for Payer: Vantage Medical Group Senior |
$664.70
|
|
|
HC LIVER BIOPSY W OTHER PROC
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT 47001
|
| Hospital Charge Code |
909000141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$141.54 |
| Max. Negotiated Rate |
$586.50 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$537.23
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$529.41
|
| Rate for Payer: Heritage Provider Network Senior |
$529.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.50
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
|
|
HC LIVER/SPLEEN SCAN
|
Facility
|
IP
|
$1,917.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
909301351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$346.98 |
| Max. Negotiated Rate |
$1,437.75 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,316.98
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,297.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,297.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| Rate for Payer: Multiplan Commercial |
$1,437.75
|
|
|
HC LIVER/SPLEEN SCAN
|
Facility
|
OP
|
$1,917.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
909301351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$134.97 |
| Max. Negotiated Rate |
$1,437.75 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$372.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,316.98
|
| 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 |
$598.16
|
| Rate for Payer: Blue Shield of California EPN |
$340.15
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,246.05
|
| 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 |
$1,246.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,186.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,186.62
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$134.97
|
| 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 |
$346.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| 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 |
$1,437.75
|
| 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 LIVER/SPLEEN VAS FLO
|
Facility
|
IP
|
$2,248.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
909301352
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$406.89 |
| Max. Negotiated Rate |
$1,686.00 |
| Rate for Payer: Adventist Health Commercial |
$449.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,544.38
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,521.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,521.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$562.00
|
| Rate for Payer: Multiplan Commercial |
$1,686.00
|
|
|
HC LIVER/SPLEEN VAS FLO
|
Facility
|
OP
|
$2,248.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
909301352
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$177.53 |
| Max. Negotiated Rate |
$1,686.00 |
| Rate for Payer: Adventist Health Commercial |
$449.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$228.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,544.38
|
| 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 |
$709.67
|
| Rate for Payer: Blue Shield of California EPN |
$403.57
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,461.20
|
| 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 |
$1,461.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,391.51
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.51
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.53
|
| 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 |
$406.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$562.00
|
| 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 |
$1,686.00
|
| 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 LMA AIRWARY
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800911
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$74.03 |
| Max. Negotiated Rate |
$370.82 |
| Rate for Payer: Adventist Health Commercial |
$81.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$218.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$280.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Blue Shield of California Commercial |
$253.99
|
| Rate for Payer: Blue Shield of California EPN |
$240.08
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$265.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.17
|
| Rate for Payer: Heritage Provider Network Senior |
$253.17
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC LMA AIRWARY
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800911
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$74.03 |
| Max. Negotiated Rate |
$306.75 |
| Rate for Payer: Adventist Health Commercial |
$81.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$280.98
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$276.89
|
| Rate for Payer: Heritage Provider Network Senior |
$276.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.25
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
|
|
HC LOCALIZATION OF TUMOR PLANAR
|
Facility
|
OP
|
$2,728.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
909301253
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$206.54 |
| Max. Negotiated Rate |
$2,046.00 |
| Rate for Payer: Adventist Health Commercial |
$545.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$475.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,874.14
|
| 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 |
$862.33
|
| Rate for Payer: Blue Shield of California EPN |
$490.38
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,773.20
|
| 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 |
$1,773.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,688.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,688.63
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$206.54
|
| 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 |
$493.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.00
|
| 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 |
$2,046.00
|
| 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 LOCALIZATION OF TUMOR PLANAR
|
Facility
|
IP
|
$2,728.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
909301253
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$493.77 |
| Max. Negotiated Rate |
$2,046.00 |
| Rate for Payer: Adventist Health Commercial |
$545.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,874.14
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,846.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1,846.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.00
|
| Rate for Payer: Multiplan Commercial |
$2,046.00
|
|
