|
HC FISH PROBE CYTOGEN EA
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900918007
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$1,610.83 |
| Rate for Payer: Blue Shield of California EPN |
$138.28
|
| Rate for Payer: Adventist Health Commercial |
$77.00
|
| Rate for Payer: Adventist Health Commercial |
$72.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$223.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$237.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,610.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,610.83
|
| Rate for Payer: Blue Shield of California Commercial |
$172.40
|
| Rate for Payer: Blue Shield of California Commercial |
$172.40
|
| Rate for Payer: Blue Shield of California EPN |
$138.28
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$235.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$250.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$235.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$238.31
|
| Rate for Payer: Heritage Provider Network Senior |
$224.08
|
| Rate for Payer: Heritage Provider Network Senior |
$238.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$172.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$183.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$271.50
|
| Rate for Payer: Multiplan Commercial |
$288.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC FISTULA/SINUS TRACT INJ
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
909000108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$95.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$294.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$405.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$357.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$310.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$405.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$405.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$405.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$295.26
|
| Rate for Payer: Heritage Provider Network Senior |
$295.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$227.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$333.90
|
| Rate for Payer: Multiplan Commercial |
$357.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$405.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$405.45
|
| Rate for Payer: Vantage Medical Group Senior |
$405.45
|
|
|
HC FISTULA/SINUS TRACT INJ
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
909000108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.34 |
| Max. Negotiated Rate |
$357.75 |
| Rate for Payer: Adventist Health Commercial |
$95.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$307.19
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$322.93
|
| Rate for Payer: Heritage Provider Network Senior |
$322.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.25
|
| Rate for Payer: Multiplan Commercial |
$357.75
|
|
|
HC FIT & INSERT PESSARY SUPPORT D
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
900501760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Multiplan Commercial |
$561.75
|
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$462.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$355.77
|
| Rate for Payer: Blue Shield of California EPN |
$283.12
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$486.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$260.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.07
|
| Rate for Payer: Heritage Provider Network Senior |
$507.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$357.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$348.44
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$449.40
|
| Rate for Payer: TriValley Medical Group Senior |
$449.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Vantage Medical Group Senior |
$260.03
|
|
|
HC FIT & INSERT PESSARY SUPPORT D
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
900501760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.57 |
| Max. Negotiated Rate |
$561.75 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$482.36
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.07
|
| Rate for Payer: Heritage Provider Network Senior |
$507.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
|
|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
|
IP
|
$6,090.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,102.29 |
| Max. Negotiated Rate |
$4,567.50 |
| Rate for Payer: Adventist Health Commercial |
$1,218.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,921.96
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,122.93
|
| Rate for Payer: Heritage Provider Network Senior |
$4,122.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,102.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.50
|
| Rate for Payer: Multiplan Commercial |
$4,567.50
|
|
|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
|
OP
|
$6,090.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,102.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,218.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,763.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,892.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,302.02
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,958.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,122.93
|
| Rate for Payer: Heritage Provider Network Senior |
$4,122.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,904.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,102.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$4,567.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,654.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,654.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC FK 506 (TACROLIMUS)
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
900911039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$158.25 |
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$93.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$130.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.88
|
| Rate for Payer: Blue Shield of California Commercial |
$110.42
|
| Rate for Payer: Blue Shield of California Commercial |
$110.42
|
| Rate for Payer: Blue Shield of California EPN |
$88.57
|
| Rate for Payer: Blue Shield of California EPN |
$88.57
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$98.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$137.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$130.61
|
| Rate for Payer: Heritage Provider Network Senior |
$94.09
|
| Rate for Payer: Heritage Provider Network Senior |
$130.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$72.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$100.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$158.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.73
|
| Rate for Payer: TriValley Medical Group Senior |
$13.73
|
| Rate for Payer: TriValley Medical Group Senior |
$13.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC FK 506 (TACROLIMUS)
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
900911039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$158.25 |
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$135.88
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.85
|
| Rate for Payer: Heritage Provider Network Senior |
$142.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.75
|
| Rate for Payer: Multiplan Commercial |
$158.25
|
|
|
HC FLEX VIDEOSCOPE AMBU
|
Facility
|
OP
|
$1,357.00
|
|
| Hospital Charge Code |
900800002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$1,153.45 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$838.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$746.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,017.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$678.77
|
| Rate for Payer: Blue Shield of California Commercial |
$827.77
|
| Rate for Payer: Blue Shield of California EPN |
$662.22
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$882.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,153.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,153.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$800.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$839.98
|
| Rate for Payer: Heritage Provider Network Senior |
$839.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$647.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$949.90
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$678.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$678.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,153.45
|
|
|
HC FLEX VIDEOSCOPE AMBU
|
Facility
|
IP
|
$1,357.00
|
|
| Hospital Charge Code |
900800002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$1,017.75 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$873.91
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$918.69
|
| Rate for Payer: Heritage Provider Network Senior |
$918.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.25
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
|
|
HC FLEX VIDEOSCOPE AMBU LARGE
|
Facility
|
IP
|
$1,561.00
|
|
| Hospital Charge Code |
900800003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.54 |
| Max. Negotiated Rate |
$1,170.75 |
| Rate for Payer: Adventist Health Commercial |
$312.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,005.28
|
| Rate for Payer: Cash Price |
$702.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,056.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1,056.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$282.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.25
|
| Rate for Payer: Multiplan Commercial |
$1,170.75
|
|
|
HC FLEX VIDEOSCOPE AMBU LARGE
|
Facility
|
OP
|
$1,561.00
|
|
| Hospital Charge Code |
900800003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.54 |
| Max. Negotiated Rate |
$1,326.85 |
| Rate for Payer: Adventist Health Commercial |
$312.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$964.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,326.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$858.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,170.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$780.81
|
| Rate for Payer: Blue Shield of California Commercial |
$952.21
|
| Rate for Payer: Blue Shield of California EPN |
$761.77
|
| Rate for Payer: Cash Price |
$702.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,014.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,326.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,326.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,326.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$966.26
|
| Rate for Payer: Heritage Provider Network Senior |
$966.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$744.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$282.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,092.70
|
| Rate for Payer: Multiplan Commercial |
$1,170.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$780.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$780.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,326.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,326.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,326.85
|
|
|
HC FLEX VIDEOSCOPE AMBU SLIM
|
Facility
|
OP
|
$1,357.00
|
|
| Hospital Charge Code |
900800001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$1,153.45 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,153.45
|
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$838.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$746.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,017.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$678.77
|
| Rate for Payer: Blue Shield of California Commercial |
$827.77
|
| Rate for Payer: Blue Shield of California EPN |
$662.22
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$882.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,153.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,153.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$800.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$839.98
|
| Rate for Payer: Heritage Provider Network Senior |
$839.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$647.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$949.90
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$678.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$678.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,153.45
|
|
|
HC FLEX VIDEOSCOPE AMBU SLIM
|
Facility
|
IP
|
$1,357.00
|
|
| Hospital Charge Code |
900800001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$1,017.75 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$873.91
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$918.69
|
| Rate for Payer: Heritage Provider Network Senior |
$918.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.25
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
|
|
HC FLOW VOLUME STUDY
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
900801022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$76.20 |
| Max. Negotiated Rate |
$416.56 |
| Rate for Payer: Adventist Health Commercial |
$84.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$260.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$210.58
|
| Rate for Payer: Blue Shield of California Commercial |
$105.89
|
| Rate for Payer: Blue Shield of California EPN |
$85.15
|
| Rate for Payer: Cash Price |
$189.45
|
| Rate for Payer: Cash Price |
$189.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$273.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$277.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$260.60
|
| Rate for Payer: Heritage Provider Network Senior |
$260.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$200.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$315.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$305.48
|
| Rate for Payer: TriValley Medical Group Senior |
$277.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$210.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$210.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC FLOW VOLUME STUDY
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
900801022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$76.20 |
| Max. Negotiated Rate |
$315.75 |
| Rate for Payer: Adventist Health Commercial |
$84.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$271.12
|
| Rate for Payer: Cash Price |
$189.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$285.02
|
| Rate for Payer: Heritage Provider Network Senior |
$285.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.25
|
| Rate for Payer: Multiplan Commercial |
$315.75
|
|
|
HC FLUORESCENT STAIN FUNGI
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900912418
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.24 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.46
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.61
|
| Rate for Payer: Heritage Provider Network Senior |
$105.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
|
|
HC FLUORESCENT STAIN FUNGI
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900912418
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$51.01 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| 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 |
$35.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.01
|
| Rate for Payer: Blue Shield of California Commercial |
$43.20
|
| Rate for Payer: Blue Shield of California Commercial |
$43.20
|
| Rate for Payer: Blue Shield of California EPN |
$34.65
|
| Rate for Payer: Blue Shield of California EPN |
$34.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| 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 |
$37.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.28
|
| Rate for Payer: Heritage Provider Network Senior |
$96.56
|
| Rate for Payer: Heritage Provider Network Senior |
$35.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$74.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$27.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Senior |
$5.39
|
| Rate for Payer: TriValley Medical Group Senior |
$5.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC FLUORO GUIDANCE CNTRL VNS ACCESS DVC
|
Facility
|
OP
|
$928.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
909081673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$167.97 |
| Max. Negotiated Rate |
$788.80 |
| Rate for Payer: Adventist Health Commercial |
$185.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$573.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$788.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$510.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.65
|
| Rate for Payer: Blue Shield of California Commercial |
$513.36
|
| Rate for Payer: Blue Shield of California EPN |
$412.83
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$603.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$788.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$788.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$788.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$547.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$574.43
|
| Rate for Payer: Heritage Provider Network Senior |
$574.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$442.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$649.60
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$464.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$464.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$788.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$788.80
|
| Rate for Payer: Vantage Medical Group Senior |
$788.80
|
|
|
HC FLUORO GUIDANCE CNTRL VNS ACCESS DVC
|
Facility
|
IP
|
$928.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
909081673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$167.97 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Adventist Health Commercial |
$185.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$597.63
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$628.26
|
| Rate for Payer: Heritage Provider Network Senior |
$628.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
|
|
HC FLUORO GUIDE NDL PLCMNT THRPY INJ
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
909001368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$367.08
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$385.89
|
| Rate for Payer: Heritage Provider Network Senior |
$385.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.50
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
|
|
HC FLUORO GUIDE NDL PLCMNT THRPY INJ
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
909001368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$352.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$427.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.04
|
| Rate for Payer: Blue Shield of California Commercial |
$214.13
|
| Rate for Payer: Blue Shield of California EPN |
$172.19
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$370.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$484.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$484.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$484.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$352.83
|
| Rate for Payer: Heritage Provider Network Senior |
$352.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$271.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$399.00
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$285.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$484.50
|
| Rate for Payer: Vantage Medical Group Senior |
$484.50
|
|
|
HC FLUORO GUIDE SPINE OR PARASPINOUS
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
909001358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.77 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$313.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$278.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$380.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$349.14
|
| Rate for Payer: Blue Shield of California Commercial |
$131.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.61
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$329.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$430.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$430.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$430.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$313.83
|
| Rate for Payer: Heritage Provider Network Senior |
$313.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$241.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$354.90
|
| Rate for Payer: Multiplan Commercial |
$380.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$253.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$253.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$430.95
|
| Rate for Payer: Vantage Medical Group Senior |
$430.95
|
|
|
HC FLUORO GUIDE SPINE OR PARASPINOUS
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
909001358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.77 |
| Max. Negotiated Rate |
$380.25 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$326.51
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$343.24
|
| Rate for Payer: Heritage Provider Network Senior |
$343.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.75
|
| Rate for Payer: Multiplan Commercial |
$380.25
|
|
