|
HC IHC FIRST SINGLE MULTI PER SPEC MEDI
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
903800242
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.51 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$106.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$330.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.51
|
| Rate for Payer: Blue Shield of California Commercial |
$200.83
|
| Rate for Payer: Blue Shield of California EPN |
$161.50
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$347.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$330.55
|
| Rate for Payer: Heritage Provider Network Senior |
$330.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$254.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$400.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
|
OP
|
$1,902.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811387
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$89.30 |
| Max. Negotiated Rate |
$1,616.70 |
| Rate for Payer: Adventist Health Commercial |
$380.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,175.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,616.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,046.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,426.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,160.22
|
| Rate for Payer: Blue Shield of California EPN |
$928.18
|
| Rate for Payer: Cash Price |
$855.90
|
| Rate for Payer: Cash Price |
$855.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,236.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,616.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,616.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,616.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,122.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,177.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,177.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$907.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$344.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,331.40
|
| Rate for Payer: Multiplan Commercial |
$1,426.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$951.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,616.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,616.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,616.70
|
|
|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
|
IP
|
$1,902.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811387
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$344.26 |
| Max. Negotiated Rate |
$1,426.50 |
| Rate for Payer: Adventist Health Commercial |
$380.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,224.89
|
| Rate for Payer: Cash Price |
$855.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,287.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$344.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.50
|
| Rate for Payer: Multiplan Commercial |
$1,426.50
|
|
|
HC ILEOSCOPY STOMA W BX
|
Facility
|
OP
|
$5,368.00
|
|
|
Service Code
|
CPT 44382
|
| Hospital Charge Code |
906744382
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,073.60
|
| Rate for Payer: Adventist Health Commercial |
$545.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,685.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,317.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| 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 |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,772.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,489.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| 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 |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,688.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,300.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,560.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$971.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,342.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$4,026.00
|
| Rate for Payer: Multiplan Commercial |
$2,045.25
|
| 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 |
$3,544.00
|
| 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: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC ILEOSCOPY STOMA W BX
|
Facility
|
IP
|
$2,727.00
|
|
|
Service Code
|
CPT 44382
|
| Hospital Charge Code |
906744382
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$493.59 |
| Max. Negotiated Rate |
$2,045.25 |
| Rate for Payer: Adventist Health Commercial |
$545.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,756.19
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,846.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,846.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.75
|
| Rate for Payer: Multiplan Commercial |
$2,045.25
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
|
OP
|
$5,368.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,073.60
|
| Rate for Payer: Adventist Health Commercial |
$545.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,685.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,317.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| 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 |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,772.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,489.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| 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 |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,688.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,300.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,560.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$971.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,342.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$4,026.00
|
| Rate for Payer: Multiplan Commercial |
$2,045.25
|
| 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 |
$3,544.00
|
| 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: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
|
IP
|
$2,727.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$493.59 |
| Max. Negotiated Rate |
$2,045.25 |
| Rate for Payer: Adventist Health Commercial |
$545.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,756.19
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,846.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,846.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.75
|
| Rate for Payer: Multiplan Commercial |
$2,045.25
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
|
IP
|
$2,727.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$493.59 |
| Max. Negotiated Rate |
$2,045.25 |
| Rate for Payer: Adventist Health Commercial |
$545.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,756.19
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,846.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,846.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.75
|
| Rate for Payer: Multiplan Commercial |
$2,045.25
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
|
OP
|
$2,727.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$493.59 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$545.40
|
| Rate for Payer: Adventist Health Commercial |
$1,073.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,317.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,685.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| 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 |
$1,295.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2,549.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,030.81
|
| Rate for Payer: Blue Shield of California EPN |
$2,029.10
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,772.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,489.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| 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 |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,634.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,846.18
|
| Rate for Payer: Heritage Provider Network Senior |
$3,634.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,846.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,560.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,300.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$971.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,342.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$4,026.00
|
| Rate for Payer: Multiplan Commercial |
$2,045.25
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,636.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,220.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,220.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,636.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC ILEOSCOPY W/STNT PLCMNT
|
Facility
|
OP
|
$8,470.00
|
|
|
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 |
$1,694.00
|
| Rate for Payer: Adventist Health Commercial |
$1,537.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,749.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,234.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| 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 |
$3,811.50
|
| Rate for Payer: Cash Price |
$3,811.50
|
| Rate for Payer: Cash Price |
$3,458.25
|
| Rate for Payer: Cash Price |
$3,458.25
|
| Rate for Payer: Cash Price |
$3,811.50
|
| Rate for Payer: Cash Price |
$3,458.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,505.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| 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 |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,242.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,757.02
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,665.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,040.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,533.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,390.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,921.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,117.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$6,352.50
|
| Rate for Payer: Multiplan Commercial |
$5,763.75
|
| 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 |
$3,544.00
|
| 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: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ILEOSCOPY W/STNT PLCMNT
|
Facility
|
IP
|
$7,685.00
|
|
|
Service Code
|
CPT 44384
|
| Hospital Charge Code |
906744384
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,390.98 |
| Max. Negotiated Rate |
$5,763.75 |
| Rate for Payer: Adventist Health Commercial |
$1,537.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,949.14
|
| Rate for Payer: Cash Price |
$3,458.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,202.74
|
| Rate for Payer: Heritage Provider Network Senior |
$5,202.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,390.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,921.25
|
| Rate for Payer: Multiplan Commercial |
$5,763.75
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, PERC
|
Facility
|
OP
|
$5,944.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
900100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,075.86 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,188.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,673.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$2,674.80
|
| Rate for Payer: Cash Price |
$2,674.80
|
| Rate for Payer: Cash Price |
$2,674.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,863.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,679.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,036.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,075.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$4,458.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,336.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2,336.65
|
| 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 |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, PERC
|
Facility
|
IP
|
$5,944.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
900100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,075.86 |
| Max. Negotiated Rate |
$4,458.00 |
| Rate for Payer: Adventist Health Commercial |
$1,188.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,827.94
|
| Rate for Payer: Cash Price |
$2,674.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,024.09
|
| Rate for Payer: Heritage Provider Network Senior |
$4,024.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,075.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.00
|
| Rate for Payer: Multiplan Commercial |
$4,458.00
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, TRANSVAG/TRANSREC
|
Facility
|
OP
|
$4,331.00
|
|
|
Service Code
|
CPT 49407
|
| Hospital Charge Code |
900100012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$783.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$866.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,676.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$1,948.95
|
| Rate for Payer: Cash Price |
$1,948.95
|
| Rate for Payer: Cash Price |
$1,948.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,815.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,680.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,036.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$783.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$3,248.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,336.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2,336.65
|
| 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 |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, TRANSVAG/TRANSREC
|
Facility
|
IP
|
$4,331.00
|
|
|
Service Code
|
CPT 49407
|
| Hospital Charge Code |
900100012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$783.91 |
| Max. Negotiated Rate |
$3,248.25 |
| Rate for Payer: Adventist Health Commercial |
$866.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,789.16
|
| Rate for Payer: Cash Price |
$1,948.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,932.09
|
| Rate for Payer: Heritage Provider Network Senior |
$2,932.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$783.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.75
|
| Rate for Payer: Multiplan Commercial |
$3,248.25
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH VISCERAL, PERC
|
Facility
|
IP
|
$4,523.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
900100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$818.66 |
| Max. Negotiated Rate |
$3,392.25 |
| Rate for Payer: Adventist Health Commercial |
$904.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,912.81
|
| Rate for Payer: Cash Price |
$2,035.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,062.07
|
| Rate for Payer: Heritage Provider Network Senior |
$3,062.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$818.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,130.75
|
| Rate for Payer: Multiplan Commercial |
$3,392.25
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH VISCERAL, PERC
|
Facility
|
OP
|
$4,523.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
900100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$818.66 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$904.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,795.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| 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 |
$2,035.35
|
| Rate for Payer: Cash Price |
$2,035.35
|
| Rate for Payer: Cash Price |
$2,035.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,939.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,799.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,036.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$818.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,130.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$3,392.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,336.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2,336.65
|
| 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 |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC IMIPENEM E TEST
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912423
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$23.16 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.41
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$63.76
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$49.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC IMIPENEM E TEST
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912423
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.33
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.73
|
| Rate for Payer: Heritage Provider Network Senior |
$69.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
900912028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$255.18 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.18
|
| Rate for Payer: Blue Shield of California Commercial |
$215.48
|
| Rate for Payer: Blue Shield of California EPN |
$172.83
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.89
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.74
|
| Rate for Payer: TriValley Medical Group Senior |
$35.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Vantage Medical Group Senior |
$35.74
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
900912028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.03
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.96
|
| Rate for Payer: Heritage Provider Network Senior |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 20"
|
Facility
|
IP
|
$131.04
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698369
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$26.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$52.68
|
| Rate for Payer: Blue Shield of California EPN |
$52.68
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.67
|
| Rate for Payer: Heritage Provider Network Senior |
$60.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$65.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.76
|
| Rate for Payer: Multiplan Commercial |
$98.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.39
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 20"
|
Facility
|
OP
|
$131.04
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698369
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$53.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$80.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$52.68
|
| Rate for Payer: Blue Shield of California EPN |
$52.68
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.67
|
| Rate for Payer: Heritage Provider Network Senior |
$60.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$65.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$91.73
|
| Rate for Payer: Multiplan Commercial |
$98.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$111.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.38
|
| Rate for Payer: Vantage Medical Group Senior |
$111.38
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 24"
|
Facility
|
OP
|
$161.63
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698368
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.41 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$66.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$99.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$64.98
|
| Rate for Payer: Blue Shield of California EPN |
$64.98
|
| Rate for Payer: Cash Price |
$72.73
|
| Rate for Payer: Cash Price |
$72.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.83
|
| Rate for Payer: Heritage Provider Network Senior |
$74.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$80.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113.14
|
| Rate for Payer: Multiplan Commercial |
$121.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$58.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$53.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.39
|
| Rate for Payer: Vantage Medical Group Senior |
$137.39
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 24"
|
Facility
|
IP
|
$161.63
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698368
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$64.98
|
| Rate for Payer: Blue Shield of California EPN |
$64.98
|
| Rate for Payer: Cash Price |
$72.73
|
| Rate for Payer: Cash Price |
$72.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.83
|
| Rate for Payer: Heritage Provider Network Senior |
$74.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$80.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.41
|
| Rate for Payer: Multiplan Commercial |
$121.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$58.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$53.52
|
|
