|
HC LEVEL III- GROSS & MICRO EXAM
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
903800059
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$91.04 |
| Max. Negotiated Rate |
$377.25 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$340.53
|
| Rate for Payer: Heritage Provider Network Senior |
$340.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.75
|
| Rate for Payer: Multiplan Commercial |
$377.25
|
|
|
HC LEVEL III- GROSS & MICRO EXAM
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
903800059
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.38 |
| Max. Negotiated Rate |
$377.25 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$268.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$345.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.74
|
| Rate for Payer: Blue Shield of California Commercial |
$158.45
|
| Rate for Payer: Blue Shield of California EPN |
$127.42
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$326.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Senior |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$311.36
|
| Rate for Payer: Heritage Provider Network Senior |
$311.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$49.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$239.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.54
|
| Rate for Payer: Multiplan Commercial |
$377.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.89
|
| Rate for Payer: TriValley Medical Group Senior |
$67.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC LEVEL IV-GROSS & MICRO EXAM
|
Facility
|
IP
|
$934.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
903800060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$700.50 |
| Rate for Payer: Adventist Health Commercial |
$186.80
|
| Rate for Payer: Cash Price |
$513.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$632.32
|
| Rate for Payer: Heritage Provider Network Senior |
$632.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.50
|
| Rate for Payer: Multiplan Commercial |
$700.50
|
|
|
HC LEVEL IV-GROSS & MICRO EXAM
|
Facility
|
OP
|
$934.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
903800060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$54.82 |
| Max. Negotiated Rate |
$700.50 |
| Rate for Payer: Adventist Health Commercial |
$186.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$499.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$641.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.17
|
| Rate for Payer: Blue Shield of California Commercial |
$288.58
|
| Rate for Payer: Blue Shield of California EPN |
$232.06
|
| Rate for Payer: Cash Price |
$513.70
|
| Rate for Payer: Cash Price |
$513.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$607.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Senior |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$607.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$578.15
|
| Rate for Payer: Heritage Provider Network Senior |
$578.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$66.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$445.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.54
|
| Rate for Payer: Multiplan Commercial |
$700.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.89
|
| Rate for Payer: TriValley Medical Group Senior |
$67.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC LEVEL V- GROSS & MICRO EXAM
|
Facility
|
OP
|
$1,289.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
903800061
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$141.98 |
| Max. Negotiated Rate |
$966.75 |
| Rate for Payer: Adventist Health Commercial |
$257.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$688.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$885.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.04
|
| Rate for Payer: Blue Shield of California Commercial |
$404.59
|
| Rate for Payer: Blue Shield of California EPN |
$325.36
|
| Rate for Payer: Cash Price |
$708.95
|
| Rate for Payer: Cash Price |
$708.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$837.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Senior |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$837.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$457.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$797.89
|
| Rate for Payer: Heritage Provider Network Senior |
$797.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$141.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$614.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$575.90
|
| Rate for Payer: Multiplan Commercial |
$966.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$457.06
|
| Rate for Payer: TriValley Medical Group Senior |
$457.06
|
| 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 |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC LEVEL V- GROSS & MICRO EXAM
|
Facility
|
IP
|
$1,289.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
903800061
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$233.31 |
| Max. Negotiated Rate |
$966.75 |
| Rate for Payer: Adventist Health Commercial |
$257.80
|
| Rate for Payer: Cash Price |
$708.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$872.65
|
| Rate for Payer: Heritage Provider Network Senior |
$872.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.25
|
| Rate for Payer: Multiplan Commercial |
$966.75
|
|
|
HC LEVEL VI-GROSS & MICRO EXAM
|
Facility
|
IP
|
$1,487.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
903800062
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$269.15 |
| Max. Negotiated Rate |
$1,115.25 |
| Rate for Payer: Adventist Health Commercial |
$297.40
|
| Rate for Payer: Cash Price |
$817.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,006.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,006.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$269.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.75
|
| Rate for Payer: Multiplan Commercial |
$1,115.25
|
|
|
HC LEVEL VI-GROSS & MICRO EXAM
|
Facility
|
OP
|
$1,487.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
903800062
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$249.79 |
| Max. Negotiated Rate |
$1,556.92 |
| Rate for Payer: Adventist Health Commercial |
$297.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$794.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,021.57
|
| 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 |
$249.79
|
| Rate for Payer: Blue Shield of California Commercial |
$463.15
|
| Rate for Payer: Blue Shield of California EPN |
$372.45
|
| Rate for Payer: Cash Price |
$817.85
|
| Rate for Payer: Cash Price |
$817.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$966.55
|
| 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 |
$966.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,037.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$920.45
|
| Rate for Payer: Heritage Provider Network Senior |
$920.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$300.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$709.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$269.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,193.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.75
|
| 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 |
$1,115.25
|
| 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 LHC,CORO ANGIO,W/WO LV,GRFT,IM
|
Facility
|
IP
|
$16,209.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
906820064
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,933.83 |
| Max. Negotiated Rate |
$12,156.75 |
| Rate for Payer: Adventist Health Commercial |
$3,241.80
|
| Rate for Payer: Cash Price |
$8,914.95
|
| Rate for Payer: Cash Price |
$8,914.95
|
| 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 |
$2,933.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,052.25
|
| Rate for Payer: Multiplan Commercial |
$12,156.75
|
|
|
HC LHC,CORO ANGIO,W/WO LV,GRFT,IM
|
Facility
|
IP
|
$14,562.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
906811406
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,635.72 |
| Max. Negotiated Rate |
$10,921.50 |
| Rate for Payer: Adventist Health Commercial |
$2,912.40
|
| Rate for Payer: Cash Price |
$8,009.10
|
| Rate for Payer: Cash Price |
$8,009.10
|
| 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 |
$2,635.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,640.50
|
| Rate for Payer: Multiplan Commercial |
$10,921.50
|
|
|
HC LHC,CORO ANGIO,W/WO LV,GRFT,IM
|
Facility
|
OP
|
$14,562.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
906811406
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,698.68 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$2,912.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,004.09
|
| 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 |
$14,720.00
|
| 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 |
$8,009.10
|
| Rate for Payer: Cash Price |
$8,009.10
|
| Rate for Payer: Cash Price |
$8,009.10
|
| 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 |
$9,465.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,086.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,013.88
|
| Rate for Payer: Heritage Provider Network Senior |
$5,026.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,698.68
|
| 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 |
$2,635.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,640.50
|
| 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 |
$10,921.50
|
| 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 LHC,CORO ANGIO,W/WO LV,GRFT,IM
|
Facility
|
OP
|
$16,209.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
906820064
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,698.68 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$3,241.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,135.58
|
| 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 |
$14,720.00
|
| 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 |
$8,914.95
|
| Rate for Payer: Cash Price |
$8,914.95
|
| Rate for Payer: Cash Price |
$8,914.95
|
| 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 |
$10,535.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,086.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,033.37
|
| Rate for Payer: Heritage Provider Network Senior |
$5,026.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,698.68
|
| 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 |
$2,933.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,052.25
|
| 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 |
$12,156.75
|
| 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 LHC, CORONARY ANGIO, W/WO LV
|
Facility
|
IP
|
$19,110.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
906820063
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,458.91 |
| Max. Negotiated Rate |
$14,332.50 |
| Rate for Payer: Adventist Health Commercial |
$3,822.00
|
| Rate for Payer: Cash Price |
$10,510.50
|
| Rate for Payer: Cash Price |
$10,510.50
|
| 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 |
$3,458.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,777.50
|
| Rate for Payer: Multiplan Commercial |
$14,332.50
|
|
|
HC LHC, CORONARY ANGIO, W/WO LV
|
Facility
|
OP
|
$16,046.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
906811405
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,539.02 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$3,209.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,023.60
|
| 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 |
$14,720.00
|
| 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 |
$8,825.30
|
| Rate for Payer: Cash Price |
$8,825.30
|
| Rate for Payer: Cash Price |
$8,825.30
|
| 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 |
$10,429.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,086.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,932.47
|
| Rate for Payer: Heritage Provider Network Senior |
$5,026.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,539.02
|
| 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 |
$2,904.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,011.50
|
| 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 |
$12,034.50
|
| 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 LHC, CORONARY ANGIO, W/WO LV
|
Facility
|
IP
|
$16,046.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
906811405
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,904.33 |
| Max. Negotiated Rate |
$12,034.50 |
| Rate for Payer: Adventist Health Commercial |
$3,209.20
|
| Rate for Payer: Cash Price |
$8,825.30
|
| Rate for Payer: Cash Price |
$8,825.30
|
| 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 |
$2,904.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,011.50
|
| Rate for Payer: Multiplan Commercial |
$12,034.50
|
|
|
HC LHC, CORONARY ANGIO, W/WO LV
|
Facility
|
OP
|
$19,110.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
906820063
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,539.02 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$3,822.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,128.57
|
| 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 |
$14,720.00
|
| 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 |
$10,510.50
|
| Rate for Payer: Cash Price |
$10,510.50
|
| Rate for Payer: Cash Price |
$10,510.50
|
| 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 |
$12,421.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,086.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,829.09
|
| Rate for Payer: Heritage Provider Network Senior |
$5,026.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,539.02
|
| 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 |
$3,458.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,777.50
|
| 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 |
$14,332.50
|
| 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 LIAT BETA STREP A
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 87651
|
| Hospital Charge Code |
900913696
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC LIAT BETA STREP A
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 87651
|
| Hospital Charge Code |
900913696
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.43
|
| Rate for Payer: Heritage Provider Network Senior |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
|
|
HC LIAT COVID-19 RNA
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913692
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$329.38 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$329.38
|
| Rate for Payer: Blue Shield of California Commercial |
$86.62
|
| Rate for Payer: Blue Shield of California EPN |
$69.30
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Senior |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.90
|
| Rate for Payer: Heritage Provider Network Senior |
$87.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$67.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.65
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Senior |
$51.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC LIAT COVID-19 RNA
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913692
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$106.50 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.13
|
| Rate for Payer: Heritage Provider Network Senior |
$96.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.50
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
|
|
HC LIGATION/BIOPSY,TEMP ARTERY
|
Facility
|
OP
|
$3,657.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
900501523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$731.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,512.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,011.35
|
| Rate for Payer: Cash Price |
$2,011.35
|
| Rate for Payer: Cash Price |
$2,011.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,377.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,475.79
|
| Rate for Payer: Heritage Provider Network Senior |
$2,475.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,744.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$2,742.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,315.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,210.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC LIGATION/BIOPSY,TEMP ARTERY
|
Facility
|
IP
|
$3,657.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
900501523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.92 |
| Max. Negotiated Rate |
$2,742.75 |
| Rate for Payer: Adventist Health Commercial |
$731.40
|
| Rate for Payer: Cash Price |
$2,011.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,475.79
|
| Rate for Payer: Heritage Provider Network Senior |
$2,475.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.25
|
| Rate for Payer: Multiplan Commercial |
$2,742.75
|
|
|
HC LIGATION DIV/EXC VARICOSEVEIN
|
Facility
|
OP
|
$8,352.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
900501325
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,670.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,737.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$4,593.60
|
| Rate for Payer: Cash Price |
$4,593.60
|
| Rate for Payer: Cash Price |
$4,593.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,428.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,654.30
|
| Rate for Payer: Heritage Provider Network Senior |
$5,654.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,983.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,511.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,088.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$6,264.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,005.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,765.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC LIGATION DIV/EXC VARICOSEVEIN
|
Facility
|
IP
|
$8,352.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
900501325
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,511.71 |
| Max. Negotiated Rate |
$6,264.00 |
| Rate for Payer: Adventist Health Commercial |
$1,670.40
|
| Rate for Payer: Cash Price |
$4,593.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,654.30
|
| Rate for Payer: Heritage Provider Network Senior |
$5,654.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,511.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,088.00
|
| Rate for Payer: Multiplan Commercial |
$6,264.00
|
|
|
HC LIGATION HEMORRHOID(S)
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
906746221
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$517.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,778.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$1,423.95
|
| Rate for Payer: Cash Price |
$1,423.95
|
| Rate for Payer: Cash Price |
$1,423.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,682.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Senior |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,158.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,752.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1,752.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,234.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$468.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,332.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,459.61
|
| Rate for Payer: Multiplan Commercial |
$1,941.75
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$931.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$857.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
