|
HC LEFT ATRIAL APPENDAGE CLOSURE
|
Facility
|
OP
|
$78,157.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
906820337
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,099.49 |
| Max. Negotiated Rate |
$66,433.45 |
| Rate for Payer: Adventist Health Commercial |
$15,631.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53,693.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66,433.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42,986.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58,617.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,551.84
|
| Rate for Payer: Blue Shield of California EPN |
$8,451.82
|
| Rate for Payer: Cash Price |
$42,986.35
|
| Rate for Payer: Cash Price |
$42,986.35
|
| Rate for Payer: Cash Price |
$42,986.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50,802.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66,433.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$66,433.45
|
| Rate for Payer: Dignity Health Senior |
$66,433.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$48,379.18
|
| Rate for Payer: Heritage Provider Network Senior |
$48,379.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,099.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37,280.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,146.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,539.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54,709.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54,709.90
|
| Rate for Payer: Multiplan Commercial |
$58,617.75
|
| 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 |
$66,433.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66,433.45
|
| Rate for Payer: Vantage Medical Group Senior |
$66,433.45
|
|
|
HC LEFT ATRIAL APPENDAGE CLOSURE
|
Facility
|
OP
|
$59,559.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
906811496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,099.49 |
| Max. Negotiated Rate |
$50,625.15 |
| Rate for Payer: Adventist Health Commercial |
$11,911.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40,917.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50,625.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32,757.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44,669.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,551.84
|
| Rate for Payer: Blue Shield of California EPN |
$8,451.82
|
| Rate for Payer: Cash Price |
$32,757.45
|
| Rate for Payer: Cash Price |
$32,757.45
|
| Rate for Payer: Cash Price |
$32,757.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38,713.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50,625.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$50,625.15
|
| Rate for Payer: Dignity Health Senior |
$50,625.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,867.02
|
| Rate for Payer: Heritage Provider Network Senior |
$36,867.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,099.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28,409.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,780.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,889.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,691.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,691.30
|
| Rate for Payer: Multiplan Commercial |
$44,669.25
|
| 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 |
$50,625.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50,625.15
|
| Rate for Payer: Vantage Medical Group Senior |
$50,625.15
|
|
|
HC LEFT ATRIAL APPENDAGE CLOSURE
|
Facility
|
IP
|
$78,157.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
906820337
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,146.42 |
| Max. Negotiated Rate |
$58,617.75 |
| Rate for Payer: Adventist Health Commercial |
$15,631.40
|
| Rate for Payer: Cash Price |
$42,986.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$52,912.29
|
| Rate for Payer: Heritage Provider Network Senior |
$52,912.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,146.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,539.25
|
| Rate for Payer: Multiplan Commercial |
$58,617.75
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
OP
|
$10,577.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906811409
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$2,115.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,266.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,990.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,817.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,932.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| 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 |
$5,817.35
|
| Rate for Payer: Cash Price |
$5,817.35
|
| Rate for Payer: Cash Price |
$5,817.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,990.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,990.45
|
| Rate for Payer: Dignity Health Senior |
$8,990.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,875.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,547.16
|
| Rate for Payer: Heritage Provider Network Senior |
$6,547.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$267.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,045.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,914.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,644.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,403.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,403.90
|
| Rate for Payer: Multiplan Commercial |
$7,932.75
|
| 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 |
$8,990.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,990.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8,990.45
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
IP
|
$10,577.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906811409
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,914.44 |
| Max. Negotiated Rate |
$7,932.75 |
| Rate for Payer: Adventist Health Commercial |
$2,115.40
|
| Rate for Payer: Cash Price |
$5,817.35
|
| Rate for Payer: Cash Price |
$5,817.35
|
| 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 |
$1,914.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,644.25
|
| Rate for Payer: Multiplan Commercial |
$7,932.75
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
OP
|
$11,866.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906820067
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$2,373.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,151.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,086.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,526.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,899.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| 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 |
$6,526.30
|
| Rate for Payer: Cash Price |
$6,526.30
|
| Rate for Payer: Cash Price |
$6,526.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,086.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,086.10
|
| Rate for Payer: Dignity Health Senior |
$10,086.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,712.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,345.05
|
| Rate for Payer: Heritage Provider Network Senior |
$7,345.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$267.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,660.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,147.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,966.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,306.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,306.20
|
| Rate for Payer: Multiplan Commercial |
$8,899.50
|
| 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 |
$10,086.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,086.10
|
| Rate for Payer: Vantage Medical Group Senior |
$10,086.10
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
IP
|
$11,866.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906820067
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,147.75 |
| Max. Negotiated Rate |
$8,899.50 |
| Rate for Payer: Adventist Health Commercial |
$2,373.20
|
| Rate for Payer: Cash Price |
$6,526.30
|
| Rate for Payer: Cash Price |
$6,526.30
|
| 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 |
$2,147.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,966.50
|
| Rate for Payer: Multiplan Commercial |
$8,899.50
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
IP
|
$10,783.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906820058
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,951.72 |
| Max. Negotiated Rate |
$8,087.25 |
| Rate for Payer: Adventist Health Commercial |
$2,156.60
|
| Rate for Payer: Cash Price |
$5,930.65
|
| Rate for Payer: Cash Price |
$5,930.65
|
| 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 |
$1,951.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,695.75
|
| Rate for Payer: Multiplan Commercial |
$8,087.25
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
OP
|
$9,166.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906811399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$12,150.00 |
| Rate for Payer: Adventist Health Commercial |
$1,833.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,297.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$5,041.30
|
| Rate for Payer: Cash Price |
$5,041.30
|
| Rate for Payer: Cash Price |
$5,041.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Senior |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,957.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,086.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,673.75
|
| Rate for Payer: Heritage Provider Network Senior |
$5,026.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,235.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,764.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,659.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,291.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,149.33
|
| Rate for Payer: Multiplan Commercial |
$6,874.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
IP
|
$9,166.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906811399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,659.05 |
| Max. Negotiated Rate |
$6,874.50 |
| Rate for Payer: Adventist Health Commercial |
$1,833.20
|
| Rate for Payer: Cash Price |
$5,041.30
|
| Rate for Payer: Cash Price |
$5,041.30
|
| 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 |
$1,659.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,291.50
|
| Rate for Payer: Multiplan Commercial |
$6,874.50
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
OP
|
$10,783.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906820058
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$12,150.00 |
| Rate for Payer: Adventist Health Commercial |
$2,156.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,407.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$5,930.65
|
| Rate for Payer: Cash Price |
$5,930.65
|
| Rate for Payer: Cash Price |
$5,930.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Senior |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,008.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,086.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,674.68
|
| Rate for Payer: Heritage Provider Network Senior |
$5,026.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,235.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,764.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,951.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,695.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,149.33
|
| Rate for Payer: Multiplan Commercial |
$8,087.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC LEG/ANKLE PROCEDURE UNLISTED
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
900501440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$563.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$533.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Senior |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$391.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.04
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$295.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$271.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC LEG/ANKLE PROCEDURE UNLISTED
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
900501440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
|
|
HC LEUK ACID PHOSP (TRAP STAIN)
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$191.14 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$714.91
|
| Rate for Payer: Heritage Provider Network Senior |
$714.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
|
|
HC LEUK ACID PHOSP (TRAP STAIN)
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.46 |
| Max. Negotiated Rate |
$1,556.92 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$564.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$725.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.46
|
| Rate for Payer: Blue Shield of California Commercial |
$338.21
|
| Rate for Payer: Blue Shield of California EPN |
$271.98
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$686.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Senior |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,037.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$653.66
|
| Rate for Payer: Heritage Provider Network Senior |
$653.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$111.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$503.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,193.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,307.82
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,037.95
|
| Rate for Payer: TriValley Medical Group Senior |
$1,037.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$722.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$722.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
|
HC LEUK ALK PHOS
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 85540
|
| Hospital Charge Code |
900910059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$89.41 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Adventist Health Commercial |
$98.80
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.44
|
| Rate for Payer: Heritage Provider Network Senior |
$334.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.50
|
| Rate for Payer: Multiplan Commercial |
$370.50
|
|
|
HC LEUK ALK PHOS
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 85540
|
| Hospital Charge Code |
900910059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Adventist Health Commercial |
$98.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$264.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$339.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.49
|
| Rate for Payer: Blue Shield of California Commercial |
$69.24
|
| Rate for Payer: Blue Shield of California EPN |
$55.53
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$321.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.46
|
| Rate for Payer: Dignity Health Senior |
$8.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$321.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.79
|
| Rate for Payer: Heritage Provider Network Senior |
$305.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$235.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.84
|
| Rate for Payer: Multiplan Commercial |
$370.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.60
|
| Rate for Payer: TriValley Medical Group Senior |
$8.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.46
|
| Rate for Payer: Vantage Medical Group Senior |
$8.60
|
|
|
HC LEUKOCYTES FECAL
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900911641
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.97
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.23
|
| Rate for Payer: Heritage Provider Network Senior |
$105.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC LEUKOCYTES FECAL
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900911641
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.09
|
| Rate for Payer: Heritage Provider Network Senior |
$115.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.50
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
|
|
HC LEVEEN SHUNT PATENCY TEST
|
Facility
|
OP
|
$1,113.00
|
|
|
Service Code
|
CPT 78291
|
| Hospital Charge Code |
909301414
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$201.45 |
| Max. Negotiated Rate |
$834.75 |
| Rate for Payer: Adventist Health Commercial |
$222.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$594.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$764.63
|
| 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 |
$645.26
|
| Rate for Payer: Blue Shield of California EPN |
$518.90
|
| Rate for Payer: Cash Price |
$612.15
|
| Rate for Payer: Cash Price |
$612.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$723.45
|
| 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 |
$723.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$688.95
|
| Rate for Payer: Heritage Provider Network Senior |
$688.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$228.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$530.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.25
|
| 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 |
$834.75
|
| 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 |
$556.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$556.50
|
| 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 LEVEEN SHUNT PATENCY TEST
|
Facility
|
IP
|
$1,113.00
|
|
|
Service Code
|
CPT 78291
|
| Hospital Charge Code |
909301414
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$201.45 |
| Max. Negotiated Rate |
$834.75 |
| Rate for Payer: Adventist Health Commercial |
$222.60
|
| Rate for Payer: Cash Price |
$612.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$753.50
|
| Rate for Payer: Heritage Provider Network Senior |
$753.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.25
|
| Rate for Payer: Multiplan Commercial |
$834.75
|
|
|
HC LEVEL I-GROSS EXAM ONLY
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
903800021
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.56 |
| Max. Negotiated Rate |
$177.75 |
| Rate for Payer: Adventist Health Commercial |
$47.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$126.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$162.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.88
|
| Rate for Payer: Blue Shield of California Commercial |
$49.92
|
| Rate for Payer: Blue Shield of California EPN |
$40.14
|
| Rate for Payer: Cash Price |
$130.35
|
| Rate for Payer: Cash Price |
$130.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$154.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Senior |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$31.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$146.70
|
| Rate for Payer: Heritage Provider Network Senior |
$146.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$113.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.21
|
| Rate for Payer: Multiplan Commercial |
$177.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$31.12
|
| Rate for Payer: TriValley Medical Group Senior |
$31.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC LEVEL I-GROSS EXAM ONLY
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
903800021
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$177.75 |
| Rate for Payer: Adventist Health Commercial |
$47.40
|
| Rate for Payer: Cash Price |
$130.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$160.45
|
| Rate for Payer: Heritage Provider Network Senior |
$160.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.25
|
| Rate for Payer: Multiplan Commercial |
$177.75
|
|
|
HC LEVEL II-GROSS & MICRO EXAM
|
Facility
|
OP
|
$496.00
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
903800058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.25 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Adventist Health Commercial |
$99.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$265.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$340.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.80
|
| Rate for Payer: Blue Shield of California Commercial |
$130.13
|
| Rate for Payer: Blue Shield of California EPN |
$104.64
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$322.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Senior |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$49.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$307.02
|
| Rate for Payer: Heritage Provider Network Senior |
$307.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$236.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.84
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$49.87
|
| Rate for Payer: TriValley Medical Group Senior |
$49.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC LEVEL II-GROSS & MICRO EXAM
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
903800058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$89.78 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Adventist Health Commercial |
$99.20
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$335.79
|
| Rate for Payer: Heritage Provider Network Senior |
$335.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.00
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
|
