|
HC IVU HYPERTENSIVE
|
Facility
|
IP
|
$1,516.00
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
909001911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$1,137.00 |
| Rate for Payer: Adventist Health Commercial |
$303.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$976.30
|
| Rate for Payer: Cash Price |
$682.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,026.33
|
| Rate for Payer: Heritage Provider Network Senior |
$1,026.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$274.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$379.00
|
| Rate for Payer: Multiplan Commercial |
$1,137.00
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
IP
|
$3,367.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906811210
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$609.43 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$673.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,168.35
|
| Rate for Payer: Cash Price |
$1,515.15
|
| Rate for Payer: Cash Price |
$1,515.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$609.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.75
|
| Rate for Payer: Multiplan Commercial |
$2,525.25
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
OP
|
$3,367.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906811210
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$609.43 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$673.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,080.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,861.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,851.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,525.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,515.15
|
| Rate for Payer: Cash Price |
$1,515.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,861.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,861.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,861.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,986.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,084.17
|
| Rate for Payer: Heritage Provider Network Senior |
$2,084.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,606.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$609.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,356.90
|
| Rate for Payer: Multiplan Commercial |
$2,525.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,861.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,861.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,861.95
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
OP
|
$5,951.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906811200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,190.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,677.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,058.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,273.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,463.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,677.95
|
| Rate for Payer: Cash Price |
$2,677.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,058.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,058.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,058.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,511.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,683.67
|
| Rate for Payer: Heritage Provider Network Senior |
$3,683.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,838.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,077.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,487.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,165.70
|
| Rate for Payer: Multiplan Commercial |
$4,463.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,058.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,058.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,058.35
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
IP
|
$5,951.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906811200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,077.13 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,190.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,832.44
|
| Rate for Payer: Cash Price |
$2,677.95
|
| Rate for Payer: Cash Price |
$2,677.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,077.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,487.75
|
| Rate for Payer: Multiplan Commercial |
$4,463.25
|
|
|
HC JEJUNOSTOMY PERC
|
Facility
|
OP
|
$1,918.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$347.16 |
| Max. Negotiated Rate |
$1,630.30 |
| Rate for Payer: Adventist Health Commercial |
$383.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,185.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,630.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,054.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,438.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$711.96
|
| Rate for Payer: Blue Shield of California Commercial |
$549.46
|
| Rate for Payer: Blue Shield of California EPN |
$441.85
|
| Rate for Payer: Cash Price |
$863.10
|
| Rate for Payer: Cash Price |
$863.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,246.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,630.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,630.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,630.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,187.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1,187.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$914.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,342.60
|
| Rate for Payer: Multiplan Commercial |
$1,438.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$959.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$959.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,630.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,630.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,630.30
|
|
|
HC JEJUNOSTOMY PERC
|
Facility
|
IP
|
$1,918.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$347.16 |
| Max. Negotiated Rate |
$1,438.50 |
| Rate for Payer: Adventist Health Commercial |
$383.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,235.19
|
| Rate for Payer: Cash Price |
$863.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,298.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,298.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.50
|
| Rate for Payer: Multiplan Commercial |
$1,438.50
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$176.47 |
| Max. Negotiated Rate |
$731.25 |
| Rate for Payer: Adventist Health Commercial |
$195.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$627.90
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$660.08
|
| Rate for Payer: Heritage Provider Network Senior |
$660.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.75
|
| Rate for Payer: Multiplan Commercial |
$731.25
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$120.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Adventist Health Commercial |
$195.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$602.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$412.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$828.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$536.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$501.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$731.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$633.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$434.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$828.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$828.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$828.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$413.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$603.52
|
| Rate for Payer: Heritage Provider Network Senior |
$603.52
|
| Rate for Payer: Heritage Provider Network Senior |
$413.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$318.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$465.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$467.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$682.50
|
| Rate for Payer: Multiplan Commercial |
$731.25
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$828.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$828.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$828.75
|
|
|
HC JO-1 AUTO AB
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$105.85
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$81.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC JO-1 AUTO AB
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.12
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.77
|
| Rate for Payer: Heritage Provider Network Senior |
$115.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
OP
|
$1,191.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$215.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$238.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$736.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$774.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.23
|
| Rate for Payer: Heritage Provider Network Senior |
$485.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$750.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$434.27
|
| Rate for Payer: TriValley Medical Group Senior |
$434.27
|
| 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 |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
IP
|
$1,191.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$215.57 |
| Max. Negotiated Rate |
$893.25 |
| Rate for Payer: Adventist Health Commercial |
$238.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$767.00
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$806.31
|
| Rate for Payer: Heritage Provider Network Senior |
$806.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.75
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
|
|
HC JUG R 1 (WALNUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913739
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.91
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.52
|
| Rate for Payer: Heritage Provider Network Senior |
$12.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
|
|
HC JUG R 1 (WALNUT), IGE
|
Facility
|
OP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913739
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.45
|
| Rate for Payer: Heritage Provider Network Senior |
$9.54
|
| Rate for Payer: Heritage Provider Network Senior |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC JUG R 3 (WALNUT), IGE
|
Facility
|
OP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913740
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.45
|
| Rate for Payer: Heritage Provider Network Senior |
$9.54
|
| Rate for Payer: Heritage Provider Network Senior |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC JUG R 3 (WALNUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913740
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.91
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.52
|
| Rate for Payer: Heritage Provider Network Senior |
$12.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
|
OP
|
$1,402.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,051.50 |
| Rate for Payer: Adventist Health Commercial |
$280.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$866.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$701.28
|
| Rate for Payer: Blue Shield of California Commercial |
$377.47
|
| Rate for Payer: Blue Shield of California EPN |
$303.55
|
| Rate for Payer: Cash Price |
$630.90
|
| Rate for Payer: Cash Price |
$630.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$911.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$867.84
|
| Rate for Payer: Heritage Provider Network Senior |
$867.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$668.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$253.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,051.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$701.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$701.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,051.50 |
| Rate for Payer: Adventist Health Commercial |
$280.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$902.89
|
| Rate for Payer: Cash Price |
$630.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$949.15
|
| Rate for Payer: Heritage Provider Network Senior |
$949.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$253.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.50
|
| Rate for Payer: Multiplan Commercial |
$1,051.50
|
|
|
HC KIDNEY SCAN
|
Facility
|
IP
|
$1,994.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$360.91 |
| Max. Negotiated Rate |
$1,495.50 |
| Rate for Payer: Adventist Health Commercial |
$398.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,284.14
|
| Rate for Payer: Cash Price |
$897.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,349.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1,349.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$360.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.50
|
| Rate for Payer: Multiplan Commercial |
$1,495.50
|
|
|
HC KIDNEY SCAN
|
Facility
|
OP
|
$1,994.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$360.91 |
| Max. Negotiated Rate |
$1,495.50 |
| Rate for Payer: Adventist Health Commercial |
$398.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,232.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$997.40
|
| Rate for Payer: Blue Shield of California Commercial |
$747.12
|
| Rate for Payer: Blue Shield of California EPN |
$600.81
|
| Rate for Payer: Cash Price |
$897.30
|
| Rate for Payer: Cash Price |
$897.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,296.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,296.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,234.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,234.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$951.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$360.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,495.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$997.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$997.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC KIT NDL BIOPSY TRAY 102MM
|
Facility
|
OP
|
$749.80
|
|
|
Service Code
|
CPT C1830
|
| Hospital Charge Code |
909081707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.71 |
| Max. Negotiated Rate |
$637.33 |
| Rate for Payer: Adventist Health Commercial |
$149.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$562.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$375.05
|
| Rate for Payer: Blue Shield of California Commercial |
$457.38
|
| Rate for Payer: Blue Shield of California EPN |
$365.90
|
| Rate for Payer: Cash Price |
$337.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$487.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$637.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$637.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$464.13
|
| Rate for Payer: Heritage Provider Network Senior |
$464.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$357.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$524.86
|
| Rate for Payer: Multiplan Commercial |
$562.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$374.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$374.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$637.33
|
| Rate for Payer: Vantage Medical Group Senior |
$637.33
|
|
|
HC KIT NDL BIOPSY TRAY 102MM
|
Facility
|
IP
|
$749.80
|
|
|
Service Code
|
CPT C1830
|
| Hospital Charge Code |
909081707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.71 |
| Max. Negotiated Rate |
$562.35 |
| Rate for Payer: Adventist Health Commercial |
$149.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$482.87
|
| Rate for Payer: Cash Price |
$337.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.61
|
| Rate for Payer: Heritage Provider Network Senior |
$507.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.45
|
| Rate for Payer: Multiplan Commercial |
$562.35
|
|
|
HC KIT NDL BIOPSY TRAY 152MM
|
Facility
|
OP
|
$89.04
|
|
|
Service Code
|
CPT C1830
|
| Hospital Charge Code |
909081706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$75.68 |
| Rate for Payer: Adventist Health Commercial |
$17.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.54
|
| Rate for Payer: Blue Shield of California Commercial |
$54.31
|
| Rate for Payer: Blue Shield of California EPN |
$43.45
|
| Rate for Payer: Cash Price |
$40.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.12
|
| Rate for Payer: Heritage Provider Network Senior |
$55.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$42.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$62.33
|
| Rate for Payer: Multiplan Commercial |
$66.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$44.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.68
|
| Rate for Payer: Vantage Medical Group Senior |
$75.68
|
|
|
HC KIT NDL BIOPSY TRAY 152MM
|
Facility
|
IP
|
$89.04
|
|
|
Service Code
|
CPT C1830
|
| Hospital Charge Code |
909081706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Adventist Health Commercial |
$17.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.34
|
| Rate for Payer: Cash Price |
$40.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.28
|
| Rate for Payer: Heritage Provider Network Senior |
$60.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.26
|
| Rate for Payer: Multiplan Commercial |
$66.78
|
|
