|
HC EYE PARACENTESIS W/RELEASE AQU
|
Facility
|
OP
|
$4,187.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$757.85 |
| Max. Negotiated Rate |
$4,617.28 |
| Rate for Payer: Adventist Health Commercial |
$837.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,587.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,988.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,582.69
|
| Rate for Payer: Cash Price |
$1,884.15
|
| Rate for Payer: Cash Price |
$1,884.15
|
| Rate for Payer: Cash Price |
$1,884.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,721.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,721.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,968.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,834.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,834.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,997.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$757.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,413.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,046.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$3,140.25
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,512.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,512.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC EYE PARACENTESIS W/RELEASE AQU
|
Facility
|
IP
|
$4,187.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$757.85 |
| Max. Negotiated Rate |
$3,140.25 |
| Rate for Payer: Adventist Health Commercial |
$837.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,696.43
|
| Rate for Payer: Cash Price |
$1,884.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,834.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,834.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$757.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,046.75
|
| Rate for Payer: Multiplan Commercial |
$3,140.25
|
|
|
HC EYE PARACENTESIS W/RML VITREOU
|
Facility
|
OP
|
$6,288.00
|
|
|
Service Code
|
CPT 65810
|
| Hospital Charge Code |
900501528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,138.13 |
| Max. Negotiated Rate |
$6,245.00 |
| Rate for Payer: Adventist Health Commercial |
$1,257.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,885.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,986.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,376.86
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,087.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,087.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,968.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,256.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4,256.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,999.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,138.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,413.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,572.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$4,716.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,772.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,772.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC EYE PARACENTESIS W/RML VITREOU
|
Facility
|
IP
|
$6,288.00
|
|
|
Service Code
|
CPT 65810
|
| Hospital Charge Code |
900501528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,138.13 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,257.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,049.47
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,256.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4,256.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,138.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,572.00
|
| Rate for Payer: Multiplan Commercial |
$4,716.00
|
|
|
HC EYE SERVICE ORPROCEDURE
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$194.25 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.80
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$175.34
|
| Rate for Payer: Heritage Provider Network Senior |
$175.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.75
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
|
|
HC EYE SERVICE ORPROCEDURE
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.06
|
| 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 |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$123.03
|
| Rate for Payer: Blue Shield of California EPN |
$97.90
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$168.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$175.34
|
| Rate for Payer: Heritage Provider Network Senior |
$175.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$123.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: Multiplan WC |
$49.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$155.40
|
| Rate for Payer: TriValley Medical Group Senior |
$155.40
|
| 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 FACIAL BONES COMPLETE
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
909001101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.57 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$699.38
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$735.22
|
| Rate for Payer: Heritage Provider Network Senior |
$735.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.50
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
|
|
HC FACIAL BONES COMPLETE
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
909001101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$671.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.82
|
| Rate for Payer: Blue Shield of California Commercial |
$166.80
|
| Rate for Payer: Blue Shield of California EPN |
$134.13
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$705.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$672.23
|
| Rate for Payer: Heritage Provider Network Senior |
$672.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$518.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| 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 |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC FACIAL BONES LIMITED
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
909001102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.18
|
| Rate for Payer: Blue Shield of California Commercial |
$131.04
|
| Rate for Payer: Blue Shield of California EPN |
$105.38
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$392.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$373.88
|
| Rate for Payer: Heritage Provider Network Senior |
$373.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$288.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| 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 |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC FACIAL BONES LIMITED
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
909001102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.98
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.91
|
| Rate for Payer: Heritage Provider Network Senior |
$408.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
|
|
HC FACTOR II (2) ASSAY
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
900910075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$95.39 |
| Max. Negotiated Rate |
$395.25 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$339.39
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$356.78
|
| Rate for Payer: Heritage Provider Network Senior |
$356.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.75
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
|
|
HC FACTOR II (2) ASSAY
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
900910075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$123.31 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$325.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.31
|
| Rate for Payer: Blue Shield of California Commercial |
$104.49
|
| Rate for Payer: Blue Shield of California Commercial |
$104.49
|
| Rate for Payer: Blue Shield of California EPN |
$83.81
|
| Rate for Payer: Blue Shield of California EPN |
$83.81
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$342.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.52
|
| Rate for Payer: Heritage Provider Network Senior |
$326.21
|
| Rate for Payer: Heritage Provider Network Senior |
$36.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$251.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.39
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.98
|
| Rate for Payer: TriValley Medical Group Senior |
$12.98
|
| Rate for Payer: TriValley Medical Group Senior |
$12.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$12.98
|
| Rate for Payer: Vantage Medical Group Senior |
$12.98
|
|
|
HC FACTOR IX PTC
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900910029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$296.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.77
|
| Rate for Payer: Blue Shield of California Commercial |
$153.22
|
| Rate for Payer: Blue Shield of California Commercial |
$153.22
|
| Rate for Payer: Blue Shield of California EPN |
$122.89
|
| Rate for Payer: Blue Shield of California EPN |
$122.89
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$312.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$297.12
|
| Rate for Payer: Heritage Provider Network Senior |
$103.99
|
| Rate for Payer: Heritage Provider Network Senior |
$297.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$80.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$228.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.51
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.04
|
| Rate for Payer: TriValley Medical Group Senior |
$19.04
|
| Rate for Payer: TriValley Medical Group Senior |
$19.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Vantage Medical Group Senior |
$19.04
|
| Rate for Payer: Vantage Medical Group Senior |
$19.04
|
|
|
HC FACTOR IX PTC
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900910029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$309.12
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.96
|
| Rate for Payer: Heritage Provider Network Senior |
$324.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
|
|
HC FACTOR V, ACG
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
900910060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$241.50 |
| Rate for Payer: Adventist Health Commercial |
$64.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$207.37
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$217.99
|
| Rate for Payer: Heritage Provider Network Senior |
$217.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.50
|
| Rate for Payer: Multiplan Commercial |
$241.50
|
|
|
HC FACTOR V, ACG
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
900910060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$241.50 |
| Rate for Payer: Adventist Health Commercial |
$64.40
|
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$199.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.60
|
| Rate for Payer: Blue Shield of California Commercial |
$142.04
|
| Rate for Payer: Blue Shield of California Commercial |
$142.04
|
| Rate for Payer: Blue Shield of California EPN |
$113.93
|
| Rate for Payer: Blue Shield of California EPN |
$113.93
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$209.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$199.32
|
| Rate for Payer: Heritage Provider Network Senior |
$95.33
|
| Rate for Payer: Heritage Provider Network Senior |
$199.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$73.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$153.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.65
|
| Rate for Payer: Multiplan Commercial |
$115.50
|
| Rate for Payer: Multiplan Commercial |
$241.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.65
|
| Rate for Payer: TriValley Medical Group Senior |
$17.65
|
| Rate for Payer: TriValley Medical Group Senior |
$17.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.41
|
| Rate for Payer: Vantage Medical Group Senior |
$17.65
|
| Rate for Payer: Vantage Medical Group Senior |
$17.65
|
|
|
HC FACTOR VIII AHG
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900910028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$65.88 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Adventist Health Commercial |
$72.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$234.42
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$246.43
|
| Rate for Payer: Heritage Provider Network Senior |
$246.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$273.00
|
|
|
HC FACTOR VIII AHG
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900910028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Adventist Health Commercial |
$72.80
|
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$224.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.03
|
| Rate for Payer: Blue Shield of California Commercial |
$144.12
|
| Rate for Payer: Blue Shield of California Commercial |
$144.12
|
| Rate for Payer: Blue Shield of California EPN |
$115.59
|
| Rate for Payer: Blue Shield of California EPN |
$115.59
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$101.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$236.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.32
|
| Rate for Payer: Heritage Provider Network Senior |
$96.56
|
| Rate for Payer: Heritage Provider Network Senior |
$225.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$74.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$173.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$273.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.90
|
| Rate for Payer: TriValley Medical Group Senior |
$17.90
|
| Rate for Payer: TriValley Medical Group Senior |
$17.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC FACTOR VII, (PROCONVERTIN)
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
900910027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$80.55 |
| Max. Negotiated Rate |
$333.75 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$286.58
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$301.26
|
| Rate for Payer: Heritage Provider Network Senior |
$301.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.25
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
|
|
HC FACTOR VII, (PROCONVERTIN)
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
900910027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$333.75 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$275.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.03
|
| Rate for Payer: Blue Shield of California Commercial |
$144.12
|
| Rate for Payer: Blue Shield of California Commercial |
$144.12
|
| Rate for Payer: Blue Shield of California EPN |
$115.59
|
| Rate for Payer: Blue Shield of California EPN |
$115.59
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$101.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$289.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$275.45
|
| Rate for Payer: Heritage Provider Network Senior |
$96.56
|
| Rate for Payer: Heritage Provider Network Senior |
$275.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$74.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$212.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.90
|
| Rate for Payer: TriValley Medical Group Senior |
$17.90
|
| Rate for Payer: TriValley Medical Group Senior |
$17.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC FACTOR V LEIDEN MUTATION
|
Facility
|
IP
|
$727.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900912323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$545.25 |
| Rate for Payer: Adventist Health Commercial |
$145.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$468.19
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$492.18
|
| Rate for Payer: Heritage Provider Network Senior |
$492.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.75
|
| Rate for Payer: Multiplan Commercial |
$545.25
|
|
|
HC FACTOR V LEIDEN MUTATION
|
Facility
|
OP
|
$727.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900912323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$73.37 |
| Max. Negotiated Rate |
$545.25 |
| Rate for Payer: Adventist Health Commercial |
$145.40
|
| Rate for Payer: Adventist Health Commercial |
$77.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$238.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$449.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.57
|
| Rate for Payer: Blue Shield of California Commercial |
$235.46
|
| Rate for Payer: Blue Shield of California Commercial |
$443.47
|
| Rate for Payer: Blue Shield of California EPN |
$354.78
|
| Rate for Payer: Blue Shield of California EPN |
$188.37
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$250.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$472.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$472.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$73.37
|
| Rate for Payer: EPIC Health Plan Medicare |
$73.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$238.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.01
|
| Rate for Payer: Heritage Provider Network Senior |
$238.93
|
| Rate for Payer: Heritage Provider Network Senior |
$450.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$184.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$346.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.32
|
| Rate for Payer: Multiplan Commercial |
$289.50
|
| Rate for Payer: Multiplan Commercial |
$545.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$73.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$73.37
|
| Rate for Payer: TriValley Medical Group Senior |
$73.37
|
| Rate for Payer: TriValley Medical Group Senior |
$73.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$79.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$79.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$79.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$79.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Vantage Medical Group Senior |
$73.37
|
| Rate for Payer: Vantage Medical Group Senior |
$73.37
|
|
|
HC FACTOR V LEIDEN MUTATN B INDI
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900913619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.01 |
| Max. Negotiated Rate |
$323.25 |
| Rate for Payer: Adventist Health Commercial |
$86.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$277.56
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$291.79
|
| Rate for Payer: Heritage Provider Network Senior |
$291.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.75
|
| Rate for Payer: Multiplan Commercial |
$323.25
|
|
|
HC FACTOR V LEIDEN MUTATN B INDI
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900913619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.37 |
| Max. Negotiated Rate |
$382.57 |
| Rate for Payer: Adventist Health Commercial |
$86.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$266.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.57
|
| Rate for Payer: Blue Shield of California Commercial |
$262.91
|
| Rate for Payer: Blue Shield of California EPN |
$210.33
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$280.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.29
|
| Rate for Payer: EPIC Health Plan Medicare |
$73.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$266.79
|
| Rate for Payer: Heritage Provider Network Senior |
$266.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$205.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.32
|
| Rate for Payer: Multiplan Commercial |
$323.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$73.37
|
| Rate for Payer: TriValley Medical Group Senior |
$73.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$79.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$79.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Vantage Medical Group Senior |
$73.37
|
|
|
HC FACTOR XII HAGEMANN
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
900910062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$183.71 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Commercial |
$102.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$316.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.71
|
| Rate for Payer: Blue Shield of California Commercial |
$155.75
|
| Rate for Payer: Blue Shield of California Commercial |
$155.75
|
| Rate for Payer: Blue Shield of California EPN |
$124.92
|
| Rate for Payer: Blue Shield of California EPN |
$124.92
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$332.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$316.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$316.93
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$244.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$33.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.35
|
| Rate for Payer: TriValley Medical Group Senior |
$19.35
|
| Rate for Payer: TriValley Medical Group Senior |
$19.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
