|
HC PROCTOSIGMOIDOSCOPY W FB RMVL
|
Facility
|
OP
|
$4,390.00
|
|
|
Service Code
|
CPT 45307
|
| Hospital Charge Code |
906745307
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$120.81 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$878.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,015.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,508.15
|
| 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 |
$1,975.50
|
| Rate for Payer: Cash Price |
$1,975.50
|
| Rate for Payer: Cash Price |
$1,975.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,853.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,858.96
|
| Rate for Payer: Dignity Health Senior |
$3,508.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,508.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,717.41
|
| Rate for Payer: Heritage Provider Network Senior |
$4,315.02
|
| Rate for Payer: Humana Medicare |
$3,508.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$120.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,508.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,665.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$794.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,139.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,420.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,420.27
|
| Rate for Payer: Multiplan Commercial |
$3,292.50
|
| 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 |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,508.15
|
|
|
HC PROCTOSIGMOIDOSCOPY W WO COLL
|
Facility
|
OP
|
$3,372.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
900501380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$610.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$674.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,316.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,191.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,282.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,282.84
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,625.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$610.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$2,529.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,224.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,126.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC PROCTOSIGMOIDOSCOPY W WO COLL
|
Facility
|
OP
|
$3,205.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
906745300
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$56.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$641.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,201.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| 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 |
$1,442.25
|
| Rate for Payer: Cash Price |
$1,442.25
|
| Rate for Payer: Cash Price |
$1,442.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,083.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,983.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,404.57
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$580.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$2,403.75
|
| 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 |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC PROCTOSIGMOIDOSCOPY W WO COLL
|
Facility
|
IP
|
$3,372.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
906745300
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$610.33 |
| Max. Negotiated Rate |
$2,529.00 |
| Rate for Payer: Adventist Health Commercial |
$674.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,316.56
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,282.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,282.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$610.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.00
|
| Rate for Payer: Multiplan Commercial |
$2,529.00
|
|
|
HC PROCTOSIGMOIDOSCOPY W WO COLL
|
Facility
|
IP
|
$3,372.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
900501380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$610.33 |
| Max. Negotiated Rate |
$2,529.00 |
| Rate for Payer: Adventist Health Commercial |
$674.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,316.56
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,282.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,282.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$610.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.00
|
| Rate for Payer: Multiplan Commercial |
$2,529.00
|
|
|
HC PROCTOSIGMOIDOSCPY RIG W/BX
|
Facility
|
OP
|
$1,716.00
|
|
|
Service Code
|
CPT 45305
|
| Hospital Charge Code |
906745305
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$78.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$343.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,178.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| 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 |
$772.20
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,115.40
|
| 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 |
$1,062.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,813.54
|
| Rate for Payer: Humana Medicare |
$1,474.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,801.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$310.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.00
|
| 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 |
$1,287.00
|
| 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 |
$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 PROCTOSIGMOIDOSCPY RIG W/BX
|
Facility
|
IP
|
$1,830.00
|
|
|
Service Code
|
CPT 45305
|
| Hospital Charge Code |
906745305
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$331.23 |
| Max. Negotiated Rate |
$1,372.50 |
| Rate for Payer: Adventist Health Commercial |
$366.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,257.21
|
| Rate for Payer: Cash Price |
$823.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,238.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,238.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.50
|
| Rate for Payer: Multiplan Commercial |
$1,372.50
|
|
|
HC PROCTOSIGMOIDOSCPY W DECOM
|
Facility
|
IP
|
$4,238.00
|
|
|
Service Code
|
CPT 45321
|
| Hospital Charge Code |
900501352
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$767.08 |
| Max. Negotiated Rate |
$3,178.50 |
| Rate for Payer: Adventist Health Commercial |
$847.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,911.51
|
| Rate for Payer: Cash Price |
$1,907.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,869.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2,869.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$767.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,059.50
|
| Rate for Payer: Multiplan Commercial |
$3,178.50
|
|
|
HC PROCTOSIGMOIDOSCPY W DECOM
|
Facility
|
OP
|
$4,238.00
|
|
|
Service Code
|
CPT 45321
|
| Hospital Charge Code |
900501352
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$767.08 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$847.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,911.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,508.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,907.10
|
| Rate for Payer: Cash Price |
$1,907.10
|
| Rate for Payer: Cash Price |
$1,907.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,754.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,858.96
|
| Rate for Payer: Dignity Health Senior |
$3,508.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,508.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,869.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2,869.13
|
| Rate for Payer: Humana Medicare |
$3,508.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,508.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,042.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$767.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,139.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,059.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,420.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,420.27
|
| Rate for Payer: Multiplan Commercial |
$3,178.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,538.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,415.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,508.15
|
|
|
HC PROGESTERONE
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$174.63 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.63
|
| Rate for Payer: Blue Shield of California Commercial |
$162.95
|
| Rate for Payer: Blue Shield of California EPN |
$127.39
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Senior |
$20.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.62
|
| Rate for Payer: Heritage Provider Network Senior |
$26.62
|
| Rate for Payer: Humana Medicare |
$20.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.28
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.86
|
| Rate for Payer: TriValley Medical Group Senior |
$20.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$20.86
|
|
|
HC PROGESTERONE
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.12
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.44
|
| Rate for Payer: Heritage Provider Network Senior |
$181.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
|
|
HC PROLACTIN
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
900910808
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$298.50 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$273.43
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.45
|
| Rate for Payer: Heritage Provider Network Senior |
$269.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.50
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
|
|
HC PROLACTIN
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
900910808
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$162.18 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.18
|
| Rate for Payer: Blue Shield of California Commercial |
$151.38
|
| Rate for Payer: Blue Shield of California EPN |
$118.34
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.32
|
| Rate for Payer: Dignity Health Senior |
$19.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.81
|
| Rate for Payer: Heritage Provider Network Senior |
$19.81
|
| Rate for Payer: Humana Medicare |
$19.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.42
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.38
|
| Rate for Payer: TriValley Medical Group Senior |
$19.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.32
|
| Rate for Payer: Vantage Medical Group Senior |
$19.38
|
|
|
HC PROPHYLAXIS OF RETINAL DETCHMNT
|
Facility
|
IP
|
$1,009.00
|
|
|
Service Code
|
CPT 67141
|
| Hospital Charge Code |
900567141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.63 |
| Max. Negotiated Rate |
$756.75 |
| Rate for Payer: Adventist Health Commercial |
$201.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$693.18
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$683.09
|
| Rate for Payer: Heritage Provider Network Senior |
$683.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.25
|
| Rate for Payer: Multiplan Commercial |
$756.75
|
|
|
HC PROPHYLAXIS OF RETINAL DETCHMNT
|
Facility
|
OP
|
$1,009.00
|
|
|
Service Code
|
CPT 67141
|
| Hospital Charge Code |
900567141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.63 |
| Max. Negotiated Rate |
$4,547.00 |
| Rate for Payer: Adventist Health Commercial |
$201.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$693.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$655.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: Dignity Health Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$655.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$363.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$683.09
|
| Rate for Payer: Heritage Provider Network Senior |
$683.09
|
| Rate for Payer: Humana Medicare |
$363.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$363.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$486.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$458.61
|
| Rate for Payer: Multiplan Commercial |
$756.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$366.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$337.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC PROSTATE BIOPSIES 10-20 SPEC
|
Facility
|
OP
|
$12,253.00
|
|
|
Service Code
|
CPT G0416
|
| Hospital Charge Code |
903800232
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$321.25 |
| Max. Negotiated Rate |
$9,189.75 |
| Rate for Payer: Adventist Health Commercial |
$2,450.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$887.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,417.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,931.26
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.11
|
| Rate for Payer: Blue Shield of California EPN |
$7,192.51
|
| Rate for Payer: Cash Price |
$5,513.85
|
| Rate for Payer: Cash Price |
$5,513.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,964.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.02
|
| Rate for Payer: Dignity Health Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,964.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$449.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,584.61
|
| Rate for Payer: Heritage Provider Network Senior |
$7,584.61
|
| Rate for Payer: Humana Medicare |
$449.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$533.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$449.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$853.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,217.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$529.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,063.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$565.88
|
| Rate for Payer: Multiplan Commercial |
$9,189.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$449.11
|
| Rate for Payer: TriValley Medical Group Senior |
$449.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC PROSTATE BIOPSIES 10-20 SPEC
|
Facility
|
IP
|
$12,253.00
|
|
|
Service Code
|
CPT G0416
|
| Hospital Charge Code |
903800232
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2,217.79 |
| Max. Negotiated Rate |
$9,189.75 |
| Rate for Payer: Adventist Health Commercial |
$2,450.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,417.81
|
| Rate for Payer: Cash Price |
$5,513.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,295.28
|
| Rate for Payer: Heritage Provider Network Senior |
$8,295.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,217.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,063.25
|
| Rate for Payer: Multiplan Commercial |
$9,189.75
|
|
|
HC PROSTATE BIOPSY
|
Facility
|
IP
|
$2,826.00
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
909000175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$511.51 |
| Max. Negotiated Rate |
$2,119.50 |
| Rate for Payer: Adventist Health Commercial |
$565.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,941.46
|
| Rate for Payer: Cash Price |
$1,271.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,913.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,913.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$511.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.50
|
| Rate for Payer: Multiplan Commercial |
$2,119.50
|
|
|
HC PROSTATE BIOPSY
|
Facility
|
OP
|
$2,826.00
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
909000175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.48 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$565.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,941.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,271.70
|
| Rate for Payer: Cash Price |
$1,271.70
|
| Rate for Payer: Cash Price |
$1,271.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,836.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: Dignity Health Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,749.29
|
| Rate for Payer: Heritage Provider Network Senior |
$3,130.19
|
| Rate for Payer: Humana Medicare |
$2,544.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,835.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$511.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,206.54
|
| Rate for Payer: Multiplan Commercial |
$2,119.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,799.36
|
| Rate for Payer: TriValley Medical Group Senior |
$2,799.36
|
| 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 |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC PROSTATE CANCER SCREEN (PSA)
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900912101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$153.95 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.95
|
| Rate for Payer: Blue Shield of California Commercial |
$143.66
|
| Rate for Payer: Blue Shield of California EPN |
$112.31
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Senior |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Humana Medicare |
$18.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.17
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.39
|
| Rate for Payer: TriValley Medical Group Senior |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC PROSTATE CANCER SCREEN (PSA)
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900912101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.64
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.52
|
| Rate for Payer: Heritage Provider Network Senior |
$143.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
|
|
HC PROSTATE SPECIFIC AG. FREE
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
900912133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$153.27 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.27
|
| Rate for Payer: Blue Shield of California Commercial |
$143.66
|
| Rate for Payer: Blue Shield of California EPN |
$112.31
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Senior |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.28
|
| Rate for Payer: Heritage Provider Network Senior |
$35.28
|
| Rate for Payer: Humana Medicare |
$18.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.17
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.39
|
| Rate for Payer: TriValley Medical Group Senior |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC PROSTATE SPECIFIC AG. FREE
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
900912133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.63
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.19
|
| Rate for Payer: Heritage Provider Network Senior |
$165.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
|
|
HC PROSTATE SPECIFIC ANTIGEN
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900910879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.63
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.19
|
| Rate for Payer: Heritage Provider Network Senior |
$165.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
|
|
HC PROSTATE SPECIFIC ANTIGEN
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900910879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$153.95 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.95
|
| Rate for Payer: Blue Shield of California Commercial |
$143.66
|
| Rate for Payer: Blue Shield of California EPN |
$112.31
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Senior |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Humana Medicare |
$18.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.17
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.39
|
| Rate for Payer: TriValley Medical Group Senior |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
