|
HC FLUORO IN RAD > 1 HR
|
Facility
|
OP
|
$867.00
|
|
|
Service Code
|
CPT 76001
|
| Hospital Charge Code |
909001670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.93 |
| Max. Negotiated Rate |
$736.95 |
| Rate for Payer: Adventist Health Commercial |
$173.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$535.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$736.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$476.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$650.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$712.67
|
| Rate for Payer: Blue Shield of California Commercial |
$528.87
|
| Rate for Payer: Blue Shield of California EPN |
$423.10
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$563.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$736.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$736.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$511.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$536.67
|
| Rate for Payer: Heritage Provider Network Senior |
$536.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$413.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$606.90
|
| Rate for Payer: Multiplan Commercial |
$650.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$433.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$433.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$736.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.95
|
| Rate for Payer: Vantage Medical Group Senior |
$736.95
|
|
|
HC FLUORO IN RAD > 1 HR
|
Facility
|
IP
|
$867.00
|
|
|
Service Code
|
CPT 76001
|
| Hospital Charge Code |
909001670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.93 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Adventist Health Commercial |
$173.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$558.35
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$586.96
|
| Rate for Payer: Heritage Provider Network Senior |
$586.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.75
|
| Rate for Payer: Multiplan Commercial |
$650.25
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906811312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$460.32 |
| Rate for Payer: Adventist Health Commercial |
$111.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$344.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.06
|
| Rate for Payer: Blue Shield of California Commercial |
$274.70
|
| Rate for Payer: Blue Shield of California EPN |
$220.91
|
| Rate for Payer: Cash Price |
$251.10
|
| Rate for Payer: Cash Price |
$251.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$362.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$329.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.40
|
| Rate for Payer: Heritage Provider Network Senior |
$345.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$266.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.88
|
| Rate for Payer: TriValley Medical Group Senior |
$306.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$141.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$141.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906811312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$418.50 |
| Rate for Payer: Adventist Health Commercial |
$111.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$359.35
|
| Rate for Payer: Cash Price |
$251.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$377.77
|
| Rate for Payer: Heritage Provider Network Senior |
$377.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.50
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
|
|
HC FLUORO XM G/COLON TUBE
|
Facility
|
OP
|
$2,286.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$457.20
|
| Rate for Payer: Adventist Health Commercial |
$261.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$807.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,412.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,028.70
|
| Rate for Payer: Cash Price |
$1,028.70
|
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: Cash Price |
$1,028.70
|
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$848.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,485.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,415.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$808.41
|
| Rate for Payer: Heritage Provider Network Senior |
$377.46
|
| Rate for Payer: Heritage Provider Network Senior |
$377.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$622.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,090.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$413.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$236.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,714.50
|
| Rate for Payer: Multiplan Commercial |
$979.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| 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: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC FLUORO XM G/COLON TUBE
|
Facility
|
IP
|
$1,306.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$236.39 |
| Max. Negotiated Rate |
$979.50 |
| Rate for Payer: Adventist Health Commercial |
$261.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$841.06
|
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$884.16
|
| Rate for Payer: Heritage Provider Network Senior |
$884.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$236.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.50
|
| Rate for Payer: Multiplan Commercial |
$979.50
|
|
|
HC FMRI BRAIN BY PHYS/PSYCH
|
Facility
|
IP
|
$6,425.00
|
|
|
Service Code
|
CPT 70555
|
| Hospital Charge Code |
908801023
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,818.75 |
| Rate for Payer: Adventist Health Commercial |
$1,285.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,137.70
|
| Rate for Payer: Cash Price |
$2,891.25
|
| Rate for Payer: Cash Price |
$2,891.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,349.73
|
| Rate for Payer: Heritage Provider Network Senior |
$4,349.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,162.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,606.25
|
| Rate for Payer: Multiplan Commercial |
$4,818.75
|
|
|
HC FMRI BRAIN BY PHYS/PSYCH
|
Facility
|
OP
|
$1,636.00
|
|
|
Service Code
|
CPT 70555
|
| Hospital Charge Code |
908801023
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$296.12 |
| Max. Negotiated Rate |
$1,227.00 |
| Rate for Payer: Adventist Health Commercial |
$327.20
|
| Rate for Payer: Adventist Health Commercial |
$1,285.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,970.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,011.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,213.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$818.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3,919.25
|
| Rate for Payer: Blue Shield of California Commercial |
$997.96
|
| Rate for Payer: Blue Shield of California EPN |
$798.37
|
| Rate for Payer: Blue Shield of California EPN |
$3,135.40
|
| Rate for Payer: Cash Price |
$2,891.25
|
| Rate for Payer: Cash Price |
$736.20
|
| Rate for Payer: Cash Price |
$736.20
|
| Rate for Payer: Cash Price |
$2,891.25
|
| Rate for Payer: Cash Price |
$2,891.25
|
| Rate for Payer: Cash Price |
$736.20
|
| Rate for Payer: Cash Price |
$2,891.25
|
| Rate for Payer: Cash Price |
$736.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$780.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,064.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$296.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,162.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,606.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,227.00
|
| Rate for Payer: Multiplan Commercial |
$4,818.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC FMRI BRAIN BY TECH
|
Facility
|
IP
|
$5,962.00
|
|
|
Service Code
|
CPT 70554
|
| Hospital Charge Code |
908801022
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,471.50 |
| Rate for Payer: Adventist Health Commercial |
$1,192.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,839.53
|
| Rate for Payer: Cash Price |
$2,682.90
|
| Rate for Payer: Cash Price |
$2,682.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,036.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4,036.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,079.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,490.50
|
| Rate for Payer: Multiplan Commercial |
$4,471.50
|
|
|
HC FMRI BRAIN BY TECH
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
CPT 70554
|
| Hospital Charge Code |
908801022
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$2,722.22 |
| Rate for Payer: Adventist Health Commercial |
$342.00
|
| Rate for Payer: Adventist Health Commercial |
$1,192.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,684.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,056.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,982.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$855.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2,722.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,722.22
|
| Rate for Payer: Blue Shield of California EPN |
$2,189.12
|
| Rate for Payer: Blue Shield of California EPN |
$2,189.12
|
| Rate for Payer: Cash Price |
$2,682.90
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cash Price |
$2,682.90
|
| Rate for Payer: Cash Price |
$2,682.90
|
| Rate for Payer: Cash Price |
$2,682.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,843.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$815.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,079.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$309.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,490.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,282.50
|
| Rate for Payer: Multiplan Commercial |
$4,471.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC FNA BX W/CT GDN 1ST LESION
|
Facility
|
IP
|
$1,749.00
|
|
|
Service Code
|
CPT 10009
|
| Hospital Charge Code |
909010009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.57 |
| Max. Negotiated Rate |
$1,311.75 |
| Rate for Payer: Adventist Health Commercial |
$349.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,126.36
|
| Rate for Payer: Cash Price |
$787.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,184.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1,184.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$316.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.25
|
| Rate for Payer: Multiplan Commercial |
$1,311.75
|
|
|
HC FNA BX W/CT GDN 1ST LESION
|
Facility
|
OP
|
$1,749.00
|
|
|
Service Code
|
CPT 10009
|
| Hospital Charge Code |
909010009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$349.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,080.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| 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 |
$787.05
|
| Rate for Payer: Cash Price |
$787.05
|
| Rate for Payer: Cash Price |
$787.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,136.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,082.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,730.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$316.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,311.75
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,001.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,001.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC FNA BX W/CT GDN EA ADDL LSN
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
909010010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$540.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$481.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$656.25
|
| 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 |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$568.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$743.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$541.62
|
| Rate for Payer: Heritage Provider Network Senior |
$541.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$417.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$612.50
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| 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 |
$743.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.75
|
| Rate for Payer: Vantage Medical Group Senior |
$743.75
|
|
|
HC FNA BX W/CT GDN EA ADDL LSN
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
909010010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.38 |
| Max. Negotiated Rate |
$656.25 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$563.50
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$592.38
|
| Rate for Payer: Heritage Provider Network Senior |
$592.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.75
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
|
|
HC FNA BX W/FLUOR GDN 1ST LESION
|
Facility
|
OP
|
$1,749.00
|
|
|
Service Code
|
CPT 10007
|
| Hospital Charge Code |
909010007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$349.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,080.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| 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 |
$787.05
|
| Rate for Payer: Cash Price |
$787.05
|
| Rate for Payer: Cash Price |
$787.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,136.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,082.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,730.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$316.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,311.75
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,001.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,001.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC FNA BX W/FLUOR GDN 1ST LESION
|
Facility
|
IP
|
$1,749.00
|
|
|
Service Code
|
CPT 10007
|
| Hospital Charge Code |
909010007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.57 |
| Max. Negotiated Rate |
$1,311.75 |
| Rate for Payer: Adventist Health Commercial |
$349.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,126.36
|
| Rate for Payer: Cash Price |
$787.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,184.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1,184.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$316.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.25
|
| Rate for Payer: Multiplan Commercial |
$1,311.75
|
|
|
HC FNA BX W/FLUOR GDN EA ADDL LSN
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
909010008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$540.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$481.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$656.25
|
| 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 |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$568.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$743.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$541.62
|
| Rate for Payer: Heritage Provider Network Senior |
$541.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$417.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$612.50
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| 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 |
$743.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.75
|
| Rate for Payer: Vantage Medical Group Senior |
$743.75
|
|
|
HC FNA BX W/FLUOR GDN EA ADDL LSN
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
909010008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.38 |
| Max. Negotiated Rate |
$656.25 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$563.50
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$592.38
|
| Rate for Payer: Heritage Provider Network Senior |
$592.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.75
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
|
|
HC FNA BX W/MR GDN 1ST LESION
|
Facility
|
IP
|
$1,749.00
|
|
|
Service Code
|
CPT 10011
|
| Hospital Charge Code |
909010011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.57 |
| Max. Negotiated Rate |
$1,311.75 |
| Rate for Payer: Adventist Health Commercial |
$349.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,126.36
|
| Rate for Payer: Cash Price |
$787.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,184.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1,184.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$316.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.25
|
| Rate for Payer: Multiplan Commercial |
$1,311.75
|
|
|
HC FNA BX W/MR GDN 1ST LESION
|
Facility
|
OP
|
$1,749.00
|
|
|
Service Code
|
CPT 10011
|
| Hospital Charge Code |
909010011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$349.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,080.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| 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 |
$787.05
|
| Rate for Payer: Cash Price |
$787.05
|
| Rate for Payer: Cash Price |
$787.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,136.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,082.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,730.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$316.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,311.75
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,001.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,001.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC FNA BX W/US GDN 1ST LESION
|
Facility
|
OP
|
$1,749.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
909010005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$349.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,080.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| 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 |
$787.05
|
| Rate for Payer: Cash Price |
$787.05
|
| Rate for Payer: Cash Price |
$787.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,136.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,082.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,730.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$316.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,311.75
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,001.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,001.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC FNA BX W/US GDN 1ST LESION
|
Facility
|
IP
|
$1,749.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
909010005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.57 |
| Max. Negotiated Rate |
$1,311.75 |
| Rate for Payer: Adventist Health Commercial |
$349.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,126.36
|
| Rate for Payer: Cash Price |
$787.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,184.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1,184.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$316.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.25
|
| Rate for Payer: Multiplan Commercial |
$1,311.75
|
|
|
HC FNA BX W/US GDN EA ADDL LSN
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
909010006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.38 |
| Max. Negotiated Rate |
$656.25 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$563.50
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$592.38
|
| Rate for Payer: Heritage Provider Network Senior |
$592.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.75
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
|
|
HC FNA BX W/US GDN EA ADDL LSN
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
909010006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$540.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$481.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$656.25
|
| 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 |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$568.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$743.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$541.62
|
| Rate for Payer: Heritage Provider Network Senior |
$541.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$417.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$612.50
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| 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 |
$743.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.75
|
| Rate for Payer: Vantage Medical Group Senior |
$743.75
|
|
|
HC FNA INTERP & RPT PG
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800218
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$93.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.81
|
| Rate for Payer: Blue Shield of California Commercial |
$235.20
|
| Rate for Payer: Blue Shield of California EPN |
$189.14
|
| 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: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.09
|
| Rate for Payer: Heritage Provider Network Senior |
$94.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$72.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.02
|
| Rate for Payer: TriValley Medical Group Senior |
$67.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
