|
HC IDR CORDIS VISTA BRITE TIPN
|
Facility
OP
|
$5,293.00
|
|
|
Service Code
|
CPT 0220T
|
| Hospital Charge Code |
909010220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$1,058.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,636.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,499.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,911.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,969.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$2,381.85
|
| Rate for Payer: Cash Price |
$2,381.85
|
| Rate for Payer: Cash Price |
$2,381.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,440.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,499.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,499.05
|
| Rate for Payer: Dignity Health Senior |
$4,499.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,175.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,276.37
|
| Rate for Payer: Heritage Provider Network Senior |
$3,276.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,551.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$958.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,323.25
|
| Rate for Payer: Multiplan Commercial |
$3,969.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,499.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,499.05
|
|
|
HC IDR CORDIS VISTA BRITE TIPN
|
Facility
IP
|
$5,293.00
|
|
|
Service Code
|
CPT 0220T
|
| Hospital Charge Code |
909010220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$958.03 |
| Max. Negotiated Rate |
$3,969.75 |
| Rate for Payer: Adventist Health Commercial |
$1,058.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,636.29
|
| Rate for Payer: Cash Price |
$2,381.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,583.36
|
| Rate for Payer: Heritage Provider Network Senior |
$3,583.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$958.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,323.25
|
| Rate for Payer: Multiplan Commercial |
$3,969.75
|
|
|
HC I&D RECTAL ABSCESS
|
Facility
OP
|
$5,146.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
900501335
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$931.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,029.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,535.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,315.70
|
| Rate for Payer: Cash Price |
$2,315.70
|
| Rate for Payer: Cash Price |
$2,315.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,344.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: Dignity Health Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,474.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,483.84
|
| Rate for Payer: Heritage Provider Network Senior |
$3,483.84
|
| Rate for Payer: Humana Medicare |
$1,474.42
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,480.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$931.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,286.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,857.77
|
| Rate for Payer: Multiplan Commercial |
$3,859.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,868.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,719.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC I&D RECTAL ABSCESS
|
Facility
IP
|
$5,146.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
900501335
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$931.43 |
| Max. Negotiated Rate |
$3,859.50 |
| Rate for Payer: Adventist Health Commercial |
$1,029.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,535.30
|
| Rate for Payer: Cash Price |
$2,315.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,483.84
|
| Rate for Payer: Heritage Provider Network Senior |
$3,483.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$931.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,286.50
|
| Rate for Payer: Multiplan Commercial |
$3,859.50
|
|
|
HC I & D THYROGLOSSAL DUCT CYST
|
Facility
OP
|
$2,068.00
|
|
|
Service Code
|
CPT 60000
|
| Hospital Charge Code |
900501674
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$374.31 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$413.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,420.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,344.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: Dignity Health Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,344.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,400.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.04
|
| Rate for Payer: Humana Medicare |
$1,905.44
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$996.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,400.85
|
| Rate for Payer: Multiplan Commercial |
$1,551.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$750.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$690.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC I & D THYROGLOSSAL DUCT CYST
|
Facility
IP
|
$2,068.00
|
|
|
Service Code
|
CPT 60000
|
| Hospital Charge Code |
900501674
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$374.31 |
| Max. Negotiated Rate |
$1,551.00 |
| Rate for Payer: Adventist Health Commercial |
$413.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,420.72
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,400.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.00
|
| Rate for Payer: Multiplan Commercial |
$1,551.00
|
|
|
HC I & D VAGINAL HEMATOMA
|
Facility
IP
|
$2,641.00
|
|
|
Service Code
|
CPT 57022
|
| Hospital Charge Code |
902400747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$478.02 |
| Max. Negotiated Rate |
$1,980.75 |
| Rate for Payer: Adventist Health Commercial |
$528.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,814.37
|
| Rate for Payer: Cash Price |
$1,188.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,787.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,787.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.25
|
| Rate for Payer: Multiplan Commercial |
$1,980.75
|
|
|
HC I & D VAGINAL HEMATOMA
|
Facility
OP
|
$2,641.00
|
|
|
Service Code
|
CPT 57022
|
| Hospital Charge Code |
902400747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$478.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$528.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,814.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,188.45
|
| Rate for Payer: Cash Price |
$1,188.45
|
| Rate for Payer: Cash Price |
$1,188.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,716.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: Dignity Health Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,550.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,787.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,787.96
|
| Rate for Payer: Humana Medicare |
$3,550.26
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,272.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,189.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,473.33
|
| Rate for Payer: Multiplan Commercial |
$1,980.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$958.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$882.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
OP
|
$2,356.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811387
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$2,002.60 |
| Rate for Payer: Adventist Health Commercial |
$471.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,618.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,002.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,295.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,767.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,463.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,382.97
|
| Rate for Payer: Cash Price |
$1,060.20
|
| Rate for Payer: Cash Price |
$1,060.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,531.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,002.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,002.60
|
| Rate for Payer: Dignity Health Senior |
$2,002.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,531.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,458.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,458.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,135.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.00
|
| Rate for Payer: Multiplan Commercial |
$1,767.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,002.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,002.60
|
|
|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
IP
|
$2,356.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811387
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$426.44 |
| Max. Negotiated Rate |
$1,767.00 |
| Rate for Payer: Adventist Health Commercial |
$471.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,618.57
|
| Rate for Payer: Cash Price |
$1,060.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,595.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,595.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.00
|
| Rate for Payer: Multiplan Commercial |
$1,767.00
|
|
|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
IP
|
$2,852.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906820131
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$516.21 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Adventist Health Commercial |
$570.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,959.32
|
| Rate for Payer: Cash Price |
$1,283.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,930.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1,930.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$516.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.00
|
| Rate for Payer: Multiplan Commercial |
$2,139.00
|
|
|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
OP
|
$2,852.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906820131
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$2,424.20 |
| Rate for Payer: Adventist Health Commercial |
$570.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,959.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,424.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,568.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,139.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,771.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,674.12
|
| Rate for Payer: Cash Price |
$1,283.40
|
| Rate for Payer: Cash Price |
$1,283.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,853.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,424.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,424.20
|
| Rate for Payer: Dignity Health Senior |
$2,424.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,853.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,765.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,765.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,374.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$516.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.00
|
| Rate for Payer: Multiplan Commercial |
$2,139.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,424.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,424.20
|
|
|
HC ILEOSCOPY STOMA W BX
|
Facility
IP
|
$2,496.00
|
|
|
Service Code
|
CPT 44382
|
| Hospital Charge Code |
906744382
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$451.78 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Adventist Health Commercial |
$499.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,714.75
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,689.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,689.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
|
|
HC ILEOSCOPY STOMA W BX
|
Facility
OP
|
$4,558.00
|
|
|
Service Code
|
CPT 44382
|
| Hospital Charge Code |
906744382
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$170.16 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$911.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,131.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,962.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,821.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$170.16
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,139.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$3,418.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
OP
|
$4,558.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$131.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$911.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,131.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,962.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,821.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$131.26
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,139.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$3,418.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
IP
|
$2,496.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$451.78 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Adventist Health Commercial |
$499.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,714.75
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,689.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,689.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
OP
|
$4,558.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$911.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,131.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cash Price |
$2,051.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,962.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,085.77
|
| Rate for Payer: Heritage Provider Network Senior |
$3,085.77
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,196.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,139.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$3,418.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,655.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,522.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
IP
|
$2,496.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$451.78 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Adventist Health Commercial |
$499.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,714.75
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,689.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,689.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
|
|
HC ILEOSCOPY W/STNT PLCMNT
|
Facility
OP
|
$7,192.00
|
|
|
Service Code
|
CPT 44384
|
| Hospital Charge Code |
906744384
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,940.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,674.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,451.85
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ILEOSCOPY W/STNT PLCMNT
|
Facility
IP
|
$7,035.00
|
|
|
Service Code
|
CPT 44384
|
| Hospital Charge Code |
906744384
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,273.34 |
| Max. Negotiated Rate |
$5,276.25 |
| Rate for Payer: Adventist Health Commercial |
$1,407.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,833.04
|
| Rate for Payer: Cash Price |
$3,165.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,762.70
|
| Rate for Payer: Heritage Provider Network Senior |
$4,762.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,273.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,758.75
|
| Rate for Payer: Multiplan Commercial |
$5,276.25
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, PERC
|
Facility
IP
|
$4,495.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
900100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$813.60 |
| Max. Negotiated Rate |
$3,371.25 |
| Rate for Payer: Adventist Health Commercial |
$899.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,088.06
|
| Rate for Payer: Cash Price |
$2,022.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,043.12
|
| Rate for Payer: Heritage Provider Network Senior |
$3,043.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$813.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,123.75
|
| Rate for Payer: Multiplan Commercial |
$3,371.25
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, PERC
|
Facility
OP
|
$4,495.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
900100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$287.49 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$899.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,088.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$2,022.75
|
| Rate for Payer: Cash Price |
$2,022.75
|
| Rate for Payer: Cash Price |
$2,022.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,921.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,782.40
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$287.49
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$813.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,123.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$3,371.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, TRANSVAG/TRANSREC
|
Facility
OP
|
$4,511.00
|
|
|
Service Code
|
CPT 49407
|
| Hospital Charge Code |
900100012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$816.49 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$902.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,099.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$2,029.95
|
| Rate for Payer: Cash Price |
$2,029.95
|
| Rate for Payer: Cash Price |
$2,029.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,932.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,792.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$928.11
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,127.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$3,383.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, TRANSVAG/TRANSREC
|
Facility
IP
|
$4,511.00
|
|
|
Service Code
|
CPT 49407
|
| Hospital Charge Code |
900100012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$816.49 |
| Max. Negotiated Rate |
$3,383.25 |
| Rate for Payer: Adventist Health Commercial |
$902.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,099.06
|
| Rate for Payer: Cash Price |
$2,029.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,053.95
|
| Rate for Payer: Heritage Provider Network Senior |
$3,053.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,127.75
|
| Rate for Payer: Multiplan Commercial |
$3,383.25
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH VISCERAL, PERC
|
Facility
IP
|
$3,420.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
900100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$619.02 |
| Max. Negotiated Rate |
$2,565.00 |
| Rate for Payer: Adventist Health Commercial |
$684.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,349.54
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,315.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2,315.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$619.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.00
|
| Rate for Payer: Multiplan Commercial |
$2,565.00
|
|
