|
HC LUMBAR SPINE AP AND LATERAL
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$819.75 |
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$750.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.49
|
| Rate for Payer: Blue Shield of California Commercial |
$137.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.91
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$710.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$710.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$676.57
|
| Rate for Payer: Heritage Provider Network Senior |
$676.57
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC LUMBAR SPINE AP AND LATERAL
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$197.83 |
| Max. Negotiated Rate |
$819.75 |
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$750.89
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$739.96
|
| Rate for Payer: Heritage Provider Network Senior |
$739.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.25
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
|
|
HC LUMBAR SPINE LIMITED
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.49
|
| Rate for Payer: Blue Shield of California Commercial |
$137.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.91
|
| 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 |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$403.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$383.78
|
| Rate for Payer: Heritage Provider Network Senior |
$383.78
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC LUMBAR SPINE LIMITED
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001136
|
|
Hospital Revenue Code
|
320
|
| 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 LUM/SAC ABL EA ADD LEVEL
|
Facility
|
OP
|
$3,304.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909000263
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$80.04 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$660.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,269.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,808.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,817.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,478.00
|
| 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 |
$1,486.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,147.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,808.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,808.40
|
| Rate for Payer: Dignity Health Senior |
$2,808.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,982.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,045.18
|
| Rate for Payer: Heritage Provider Network Senior |
$2,045.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,592.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$598.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$826.00
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
| 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 |
$2,808.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,808.40
|
|
|
HC LUM/SAC ABL EA ADD LEVEL
|
Facility
|
IP
|
$3,304.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909000263
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$598.02 |
| Max. Negotiated Rate |
$2,478.00 |
| Rate for Payer: Adventist Health Commercial |
$660.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,269.85
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,236.81
|
| Rate for Payer: Heritage Provider Network Senior |
$2,236.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$598.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$826.00
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
|
|
HC LUM SPINE BEND ONLY/4 VIEWS
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
909001318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$167.42 |
| Max. Negotiated Rate |
$693.75 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$635.48
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$626.22
|
| Rate for Payer: Heritage Provider Network Senior |
$626.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.25
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
|
|
HC LUM SPINE BEND ONLY/4 VIEWS
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
909001318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.99 |
| Max. Negotiated Rate |
$693.75 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$88.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$635.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.74
|
| Rate for Payer: Blue Shield of California Commercial |
$182.95
|
| Rate for Payer: Blue Shield of California EPN |
$104.04
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$601.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$601.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$572.58
|
| Rate for Payer: Heritage Provider Network Senior |
$572.58
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC LUM SPINE COMP W/BENDING VIEWS
|
Facility
|
OP
|
$1,341.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
909001316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.54 |
| Max. Negotiated Rate |
$1,005.75 |
| Rate for Payer: Adventist Health Commercial |
$268.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$921.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.39
|
| Rate for Payer: Blue Shield of California Commercial |
$241.76
|
| Rate for Payer: Blue Shield of California EPN |
$137.48
|
| Rate for Payer: Cash Price |
$603.45
|
| Rate for Payer: Cash Price |
$603.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$871.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$830.08
|
| Rate for Payer: Heritage Provider Network Senior |
$830.08
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,005.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC LUM SPINE COMP W/BENDING VIEWS
|
Facility
|
IP
|
$1,341.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
909001316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.72 |
| Max. Negotiated Rate |
$1,005.75 |
| Rate for Payer: Adventist Health Commercial |
$268.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$921.27
|
| Rate for Payer: Cash Price |
$603.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$907.86
|
| Rate for Payer: Heritage Provider Network Senior |
$907.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.25
|
| Rate for Payer: Multiplan Commercial |
$1,005.75
|
|
|
HC LUM SPINE W/OBLIQUES
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
909001317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.41 |
| Max. Negotiated Rate |
$664.50 |
| Rate for Payer: Adventist Health Commercial |
$177.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$88.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$608.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.21
|
| Rate for Payer: Blue Shield of California Commercial |
$186.87
|
| Rate for Payer: Blue Shield of California EPN |
$106.26
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$575.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$575.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$548.43
|
| Rate for Payer: Heritage Provider Network Senior |
$548.43
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$664.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC LUM SPINE W/OBLIQUES
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
909001317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.37 |
| Max. Negotiated Rate |
$664.50 |
| Rate for Payer: Adventist Health Commercial |
$177.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$608.68
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$599.82
|
| Rate for Payer: Heritage Provider Network Senior |
$599.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.50
|
| Rate for Payer: Multiplan Commercial |
$664.50
|
|
|
HC LUNG DIFFER PERF & VENTILATION
|
Facility
|
OP
|
$5,027.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
909301402
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$423.23 |
| Max. Negotiated Rate |
$3,770.25 |
| Rate for Payer: Adventist Health Commercial |
$1,005.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$589.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,453.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,822.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,514.17
|
| Rate for Payer: Blue Shield of California EPN |
$861.06
|
| Rate for Payer: Cash Price |
$2,262.15
|
| Rate for Payer: Cash Price |
$2,262.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,267.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: Dignity Health Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,267.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$675.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,111.71
|
| Rate for Payer: Heritage Provider Network Senior |
$3,111.71
|
| Rate for Payer: Humana Medicare |
$675.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$423.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,283.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$909.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$796.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,256.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$850.92
|
| Rate for Payer: Multiplan Commercial |
$3,770.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$742.86
|
| Rate for Payer: TriValley Medical Group Senior |
$675.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC LUNG DIFFER PERF & VENTILATION
|
Facility
|
IP
|
$5,027.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
909301402
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$909.89 |
| Max. Negotiated Rate |
$3,770.25 |
| Rate for Payer: Adventist Health Commercial |
$1,005.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,453.55
|
| Rate for Payer: Cash Price |
$2,262.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,403.28
|
| Rate for Payer: Heritage Provider Network Senior |
$3,403.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$909.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,256.75
|
| Rate for Payer: Multiplan Commercial |
$3,770.25
|
|
|
HC LUPUS SCREEN PTT
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900912006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.28
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.34
|
| Rate for Payer: Heritage Provider Network Senior |
$131.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
|
|
HC LUPUS SCREEN PTT
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900912006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$50.27 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.27
|
| Rate for Payer: Blue Shield of California Commercial |
$46.84
|
| Rate for Payer: Blue Shield of California EPN |
$36.62
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Senior |
$6.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$6.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.57
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Senior |
$6.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC LUTEINIZING HORMON
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
900910886
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$187.55
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$184.82
|
| Rate for Payer: Heritage Provider Network Senior |
$184.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.25
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
|
|
HC LUTEINIZING HORMON
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
900910886
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$155.02 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.02
|
| Rate for Payer: Blue Shield of California Commercial |
$144.67
|
| Rate for Payer: Blue Shield of California EPN |
$113.10
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.37
|
| Rate for Payer: Dignity Health Senior |
$18.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Humana Medicare |
$18.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.34
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.52
|
| Rate for Payer: TriValley Medical Group Senior |
$18.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Vantage Medical Group Senior |
$18.52
|
|
|
HC LYMPHANGIOGRAM, ABD/PLV UL
|
Facility
|
IP
|
$3,004.00
|
|
|
Service Code
|
CPT 75805
|
| Hospital Charge Code |
909001374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$543.72 |
| Max. Negotiated Rate |
$2,253.00 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,063.75
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,033.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,033.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$751.00
|
| Rate for Payer: Multiplan Commercial |
$2,253.00
|
|
|
HC LYMPHANGIOGRAM, ABD/PLV UL
|
Facility
|
OP
|
$3,004.00
|
|
|
Service Code
|
CPT 75805
|
| Hospital Charge Code |
909001374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.99 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$906.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,063.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,460.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,246.46
|
| Rate for Payer: Blue Shield of California EPN |
$708.82
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,952.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,952.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,859.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,859.48
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$203.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$751.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$2,253.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$680.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$680.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC LYMPHANGIOGRAM EXT BILAT
|
Facility
|
IP
|
$3,004.00
|
|
|
Service Code
|
CPT 75803
|
| Hospital Charge Code |
909001373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$543.72 |
| Max. Negotiated Rate |
$2,253.00 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,063.75
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,033.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,033.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$751.00
|
| Rate for Payer: Multiplan Commercial |
$2,253.00
|
|
|
HC LYMPHANGIOGRAM EXT BILAT
|
Facility
|
OP
|
$3,004.00
|
|
|
Service Code
|
CPT 75803
|
| Hospital Charge Code |
909001373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$202.49 |
| Max. Negotiated Rate |
$3,801.92 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$906.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,063.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,297.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,107.50
|
| Rate for Payer: Blue Shield of California EPN |
$629.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cash Price |
$1,351.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,952.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,952.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,859.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,859.48
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$202.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$751.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$2,253.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,001.01
|
| Rate for Payer: TriValley Medical Group Senior |
$2,001.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$680.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$680.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC LYMPHANGIOGRAM EXT UNILAT
|
Facility
|
OP
|
$2,605.00
|
|
|
Service Code
|
CPT 75801
|
| Hospital Charge Code |
909001375
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$202.49 |
| Max. Negotiated Rate |
$1,953.75 |
| Rate for Payer: Adventist Health Commercial |
$521.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$906.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,789.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,297.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,107.50
|
| Rate for Payer: Blue Shield of California EPN |
$629.80
|
| Rate for Payer: Cash Price |
$1,172.25
|
| Rate for Payer: Cash Price |
$1,172.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,693.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,693.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,612.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1,612.50
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$202.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$651.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$1,953.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$784.90
|
| Rate for Payer: TriValley Medical Group Senior |
$784.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$680.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$680.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC LYMPHANGIOGRAM EXT UNILAT
|
Facility
|
IP
|
$2,605.00
|
|
|
Service Code
|
CPT 75801
|
| Hospital Charge Code |
909001375
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$471.50 |
| Max. Negotiated Rate |
$1,953.75 |
| Rate for Payer: Adventist Health Commercial |
$521.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,789.64
|
| Rate for Payer: Cash Price |
$1,172.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,763.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,763.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$651.25
|
| Rate for Payer: Multiplan Commercial |
$1,953.75
|
|
|
HC LYMPHANGIOGRAM, PELV BILAT
|
Facility
|
OP
|
$3,582.00
|
|
|
Service Code
|
CPT 75807
|
| Hospital Charge Code |
909001365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$216.03 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$716.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$906.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,460.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,453.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,246.46
|
| Rate for Payer: Blue Shield of California EPN |
$708.82
|
| Rate for Payer: Cash Price |
$1,611.90
|
| Rate for Payer: Cash Price |
$1,611.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,328.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,328.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,217.26
|
| Rate for Payer: Heritage Provider Network Senior |
$2,217.26
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$216.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$648.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$895.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$2,686.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$680.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$680.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
