|
HC IVU EXCRETORY
|
Facility
|
OP
|
$1,693.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
909001910
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$1,269.75 |
| Rate for Payer: Adventist Health Commercial |
$338.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$904.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,163.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$439.40
|
| Rate for Payer: Blue Shield of California Commercial |
$357.26
|
| Rate for Payer: Blue Shield of California EPN |
$287.30
|
| Rate for Payer: Cash Price |
$931.15
|
| Rate for Payer: Cash Price |
$931.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,100.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,100.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,047.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,047.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$807.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$1,269.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$226.19
|
| Rate for Payer: TriValley Medical Group Senior |
$226.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC IVU HYPERTENSIVE
|
Facility
|
OP
|
$1,516.00
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
909001911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.90 |
| Max. Negotiated Rate |
$1,137.00 |
| Rate for Payer: Adventist Health Commercial |
$303.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$810.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,041.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$550.40
|
| Rate for Payer: Blue Shield of California Commercial |
$445.58
|
| Rate for Payer: Blue Shield of California EPN |
$358.32
|
| Rate for Payer: Cash Price |
$833.80
|
| Rate for Payer: Cash Price |
$833.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$985.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$985.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$938.40
|
| Rate for Payer: Heritage Provider Network Senior |
$938.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$160.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$723.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$379.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$1,137.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$226.19
|
| Rate for Payer: TriValley Medical Group Senior |
$226.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC IVU HYPERTENSIVE
|
Facility
|
IP
|
$1,516.00
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
909001911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$1,137.00 |
| Rate for Payer: Adventist Health Commercial |
$303.20
|
| Rate for Payer: Cash Price |
$833.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,026.33
|
| Rate for Payer: Heritage Provider Network Senior |
$1,026.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$379.00
|
| Rate for Payer: Multiplan Commercial |
$1,137.00
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
IP
|
$7,928.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906820035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,434.97 |
| Max. Negotiated Rate |
$5,946.00 |
| Rate for Payer: Adventist Health Commercial |
$1,585.60
|
| Rate for Payer: Cash Price |
$4,360.40
|
| Rate for Payer: Cash Price |
$4,360.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,434.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,982.00
|
| Rate for Payer: Multiplan Commercial |
$5,946.00
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
OP
|
$3,367.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906811210
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$223.22 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$673.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,313.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,861.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,851.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,525.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$1,851.85
|
| Rate for Payer: Cash Price |
$1,851.85
|
| Rate for Payer: Cash Price |
$1,851.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,861.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,861.95
|
| Rate for Payer: Dignity Health Senior |
$2,861.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,188.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,084.17
|
| Rate for Payer: Heritage Provider Network Senior |
$2,084.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$223.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,606.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,356.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,356.90
|
| Rate for Payer: Multiplan Commercial |
$2,525.25
|
| 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 |
$2,861.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,861.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,861.95
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
IP
|
$3,367.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906811210
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$609.43 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$673.40
|
| Rate for Payer: Cash Price |
$1,851.85
|
| Rate for Payer: Cash Price |
$1,851.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.75
|
| Rate for Payer: Multiplan Commercial |
$2,525.25
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
OP
|
$7,928.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906820035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$223.22 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,585.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,446.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,738.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,360.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,946.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$4,360.40
|
| Rate for Payer: Cash Price |
$4,360.40
|
| Rate for Payer: Cash Price |
$4,360.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,738.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,738.80
|
| Rate for Payer: Dignity Health Senior |
$6,738.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,153.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,907.43
|
| Rate for Payer: Heritage Provider Network Senior |
$4,907.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$223.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,781.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,434.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,982.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,549.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,549.60
|
| Rate for Payer: Multiplan Commercial |
$5,946.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$6,738.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,738.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6,738.80
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
IP
|
$5,951.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906811200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,077.13 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,190.20
|
| Rate for Payer: Cash Price |
$3,273.05
|
| Rate for Payer: Cash Price |
$3,273.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,487.75
|
| Rate for Payer: Multiplan Commercial |
$4,463.25
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
OP
|
$7,655.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906820034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$364.81 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,531.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,258.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,506.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,210.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,741.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$4,210.25
|
| Rate for Payer: Cash Price |
$4,210.25
|
| Rate for Payer: Cash Price |
$4,210.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,506.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,506.75
|
| Rate for Payer: Dignity Health Senior |
$6,506.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,975.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,738.44
|
| Rate for Payer: Heritage Provider Network Senior |
$4,738.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$364.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,651.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,385.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.50
|
| Rate for Payer: Multiplan Commercial |
$5,741.25
|
| 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 |
$6,506.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,506.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6,506.75
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
IP
|
$7,655.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906820034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,385.56 |
| Max. Negotiated Rate |
$5,741.25 |
| Rate for Payer: Adventist Health Commercial |
$1,531.00
|
| Rate for Payer: Cash Price |
$4,210.25
|
| Rate for Payer: Cash Price |
$4,210.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,385.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.75
|
| Rate for Payer: Multiplan Commercial |
$5,741.25
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
OP
|
$5,951.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906811200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$364.81 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,190.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,088.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,058.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,273.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,463.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$3,273.05
|
| Rate for Payer: Cash Price |
$3,273.05
|
| Rate for Payer: Cash Price |
$3,273.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,058.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,058.35
|
| Rate for Payer: Dignity Health Senior |
$5,058.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,868.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,683.67
|
| Rate for Payer: Heritage Provider Network Senior |
$3,683.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$364.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,838.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,487.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,165.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,165.70
|
| Rate for Payer: Multiplan Commercial |
$4,463.25
|
| 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 |
$5,058.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,058.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,058.35
|
|
|
HC JEJUNOSTOMY PERC
|
Facility
|
IP
|
$1,918.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$347.16 |
| Max. Negotiated Rate |
$1,438.50 |
| Rate for Payer: Adventist Health Commercial |
$383.60
|
| Rate for Payer: Cash Price |
$1,054.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,298.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,298.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.50
|
| Rate for Payer: Multiplan Commercial |
$1,438.50
|
|
|
HC JEJUNOSTOMY PERC
|
Facility
|
OP
|
$1,918.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.96 |
| Max. Negotiated Rate |
$1,630.30 |
| Rate for Payer: Adventist Health Commercial |
$383.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,025.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,317.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,630.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,054.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,438.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$684.57
|
| Rate for Payer: Blue Shield of California Commercial |
$549.46
|
| Rate for Payer: Blue Shield of California EPN |
$441.85
|
| Rate for Payer: Cash Price |
$1,054.90
|
| Rate for Payer: Cash Price |
$1,054.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,246.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,630.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,630.30
|
| Rate for Payer: Dignity Health Senior |
$1,630.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,246.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,187.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1,187.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$914.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,342.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,342.60
|
| Rate for Payer: Multiplan Commercial |
$1,438.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$959.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$959.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,630.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,630.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,630.30
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$176.47 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$195.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$521.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$669.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$828.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$536.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$731.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| 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 |
$536.25
|
| Rate for Payer: Cash Price |
$536.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$633.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$828.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$828.75
|
| Rate for Payer: Dignity Health Senior |
$828.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$603.52
|
| Rate for Payer: Heritage Provider Network Senior |
$603.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$465.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$682.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$682.50
|
| Rate for Payer: Multiplan Commercial |
$731.25
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$828.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$828.75
|
| Rate for Payer: Vantage Medical Group Senior |
$828.75
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$176.47 |
| Max. Negotiated Rate |
$731.25 |
| Rate for Payer: Adventist Health Commercial |
$195.00
|
| Rate for Payer: Cash Price |
$536.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$660.08
|
| Rate for Payer: Heritage Provider Network Senior |
$660.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.75
|
| Rate for Payer: Multiplan Commercial |
$731.25
|
|
|
HC JO-1 AUTO AB
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.77
|
| Rate for Payer: Heritage Provider Network Senior |
$115.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
|
|
HC JO-1 AUTO AB
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$144.35 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.03
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.85
|
| Rate for Payer: Heritage Provider Network Senior |
$105.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.59
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
OP
|
$1,191.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$238.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$818.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$655.05
|
| Rate for Payer: Cash Price |
$655.05
|
| Rate for Payer: Cash Price |
$655.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$774.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Senior |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$375.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.23
|
| Rate for Payer: Heritage Provider Network Senior |
$461.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$712.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$431.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$472.59
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$412.58
|
| Rate for Payer: TriValley Medical Group Senior |
$412.58
|
| 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 |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
IP
|
$1,191.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$215.57 |
| Max. Negotiated Rate |
$893.25 |
| Rate for Payer: Adventist Health Commercial |
$238.20
|
| Rate for Payer: Cash Price |
$655.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$806.31
|
| Rate for Payer: Heritage Provider Network Senior |
$806.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.75
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,051.50 |
| Rate for Payer: Adventist Health Commercial |
$280.40
|
| Rate for Payer: Cash Price |
$771.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$949.15
|
| Rate for Payer: Heritage Provider Network Senior |
$949.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.50
|
| Rate for Payer: Multiplan Commercial |
$1,051.50
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
|
OP
|
$1,402.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$124.76 |
| Max. Negotiated Rate |
$1,051.50 |
| Rate for Payer: Adventist Health Commercial |
$280.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$749.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$963.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$377.47
|
| Rate for Payer: Blue Shield of California EPN |
$303.55
|
| Rate for Payer: Cash Price |
$771.10
|
| Rate for Payer: Cash Price |
$771.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$911.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$867.84
|
| Rate for Payer: Heritage Provider Network Senior |
$867.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$124.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$668.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$1,051.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$701.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$701.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC KIDNEY SCAN
|
Facility
|
OP
|
$1,994.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$194.12 |
| Max. Negotiated Rate |
$1,495.50 |
| Rate for Payer: Adventist Health Commercial |
$398.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,065.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,369.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$747.12
|
| Rate for Payer: Blue Shield of California EPN |
$600.81
|
| Rate for Payer: Cash Price |
$1,096.70
|
| Rate for Payer: Cash Price |
$1,096.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,296.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,296.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,234.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,234.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$194.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$951.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$1,495.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$997.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$997.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC KIDNEY SCAN
|
Facility
|
IP
|
$1,994.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$360.91 |
| Max. Negotiated Rate |
$1,495.50 |
| Rate for Payer: Adventist Health Commercial |
$398.80
|
| Rate for Payer: Cash Price |
$1,096.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,349.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1,349.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.50
|
| Rate for Payer: Multiplan Commercial |
$1,495.50
|
|
|
HC KIT NDL BIOPSY TRAY 102MM
|
Facility
|
IP
|
$749.80
|
|
|
Service Code
|
CPT C1830
|
| Hospital Charge Code |
909081707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.71 |
| Max. Negotiated Rate |
$562.35 |
| Rate for Payer: Adventist Health Commercial |
$149.96
|
| Rate for Payer: Cash Price |
$412.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.61
|
| Rate for Payer: Heritage Provider Network Senior |
$507.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.45
|
| Rate for Payer: Multiplan Commercial |
$562.35
|
|
|
HC KIT NDL BIOPSY TRAY 102MM
|
Facility
|
OP
|
$749.80
|
|
|
Service Code
|
CPT C1830
|
| Hospital Charge Code |
909081707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.71 |
| Max. Negotiated Rate |
$637.33 |
| Rate for Payer: Adventist Health Commercial |
$149.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$400.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$515.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$562.35
|
| Rate for Payer: Blue Shield of California Commercial |
$457.38
|
| Rate for Payer: Blue Shield of California EPN |
$365.90
|
| Rate for Payer: Cash Price |
$412.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$487.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$637.33
|
| Rate for Payer: Dignity Health Senior |
$637.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$487.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$464.13
|
| Rate for Payer: Heritage Provider Network Senior |
$464.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$357.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$524.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$524.86
|
| Rate for Payer: Multiplan Commercial |
$562.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$374.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$374.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$637.33
|
| Rate for Payer: Vantage Medical Group Senior |
$637.33
|
|
