|
HC LEVEL IV PG
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
903800204
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$288.58 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.10
|
| 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 |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.42
|
| Rate for Payer: Heritage Provider Network Senior |
$59.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$45.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.02
|
| Rate for Payer: TriValley Medical Group Senior |
$67.02
|
| 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 |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC LEVEL IV PG
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
903800204
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.82
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.99
|
| Rate for Payer: Heritage Provider Network Senior |
$64.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
|
|
HC LEVEL IV PG
|
Facility
|
IP
|
$1,024.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
903800206
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$185.34 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Adventist Health Commercial |
$204.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$659.46
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.25
|
| Rate for Payer: Heritage Provider Network Senior |
$693.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.00
|
| Rate for Payer: Multiplan Commercial |
$768.00
|
|
|
HC LEVEL IV PG
|
Facility
|
OP
|
$1,024.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
903800206
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$185.34 |
| Max. Negotiated Rate |
$1,554.36 |
| Rate for Payer: Adventist Health Commercial |
$204.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$632.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.78
|
| 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 |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$665.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$665.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,036.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Heritage Provider Network Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$488.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Multiplan Commercial |
$768.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,036.24
|
| Rate for Payer: TriValley Medical Group Senior |
$1,036.24
|
| 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 |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
|
|
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: Aetna of CA Non-Gatekeeper |
$830.12
|
| Rate for Payer: Cash Price |
$580.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$872.65
|
| Rate for Payer: Heritage Provider Network Senior |
$872.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.25
|
| Rate for Payer: Multiplan Commercial |
$966.75
|
|
|
HC LEVEL V- GROSS & MICRO EXAM
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
903800061
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$691.53 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Adventist Health Commercial |
$257.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$796.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.36
|
| Rate for Payer: Blue Shield of California Commercial |
$404.59
|
| Rate for Payer: Blue Shield of California Commercial |
$404.59
|
| Rate for Payer: Blue Shield of California EPN |
$325.36
|
| Rate for Payer: Blue Shield of California EPN |
$325.36
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$580.05
|
| Rate for Payer: Cash Price |
$580.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$837.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$837.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$461.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$461.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$797.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.60
|
| Rate for Payer: Heritage Provider Network Senior |
$797.89
|
| Rate for Payer: Heritage Provider Network Senior |
$247.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$614.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$190.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$530.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$530.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.77
|
| Rate for Payer: Multiplan Commercial |
$966.75
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$461.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$461.02
|
| Rate for Payer: TriValley Medical Group Senior |
$461.02
|
| Rate for Payer: TriValley Medical Group Senior |
$461.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| 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: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
HC LEVEL VI-GROSS & MICRO EXAM
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
903800062
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.46 |
| Max. Negotiated Rate |
$1,554.36 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Adventist Health Commercial |
$297.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$918.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$199.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.78
|
| Rate for Payer: Blue Shield of California Commercial |
$463.15
|
| Rate for Payer: Blue Shield of California Commercial |
$463.15
|
| Rate for Payer: Blue Shield of California EPN |
$372.45
|
| Rate for Payer: Blue Shield of California EPN |
$372.45
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cash Price |
$669.15
|
| Rate for Payer: Cash Price |
$669.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$966.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$209.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$966.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,036.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,036.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$920.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$199.94
|
| Rate for Payer: Heritage Provider Network Senior |
$920.45
|
| Rate for Payer: Heritage Provider Network Senior |
$199.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$709.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$154.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$269.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Multiplan Commercial |
$1,115.25
|
| Rate for Payer: Multiplan Commercial |
$242.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,036.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,036.24
|
| Rate for Payer: TriValley Medical Group Senior |
$1,036.24
|
| Rate for Payer: TriValley Medical Group Senior |
$1,036.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$722.83
|
| 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: United Healthcare Navigate/Select/Select+ |
$722.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
|
|
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: Aetna of CA Non-Gatekeeper |
$957.63
|
| Rate for Payer: Cash Price |
$669.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,006.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,006.70
|
| Rate for Payer: Kaiser Foundation Hospitals 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 V PG
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
903800205
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$328.44
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.27
|
| Rate for Payer: Heritage Provider Network Senior |
$345.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.50
|
| Rate for Payer: Multiplan Commercial |
$382.50
|
|
|
HC LEVEL V PG
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
903800205
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$691.53 |
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$315.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.36
|
| 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 |
$229.50
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$331.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$461.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.69
|
| Rate for Payer: Heritage Provider Network Senior |
$315.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$243.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$530.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.77
|
| Rate for Payer: Multiplan Commercial |
$382.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$461.02
|
| Rate for Payer: TriValley Medical Group Senior |
$461.02
|
| 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 |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
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 |
$2,635.72 |
| Max. Negotiated Rate |
$15,309.00 |
| Rate for Payer: Adventist Health Commercial |
$2,912.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,999.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| 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 |
$6,552.90
|
| Rate for Payer: Cash Price |
$6,552.90
|
| Rate for Payer: Cash Price |
$6,552.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,591.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,169.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,013.88
|
| Rate for Payer: Heritage Provider Network Senior |
$5,128.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,922.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,635.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,795.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,640.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,587.36
|
| 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 |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
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: Aetna of CA Non-Gatekeeper |
$9,377.93
|
| Rate for Payer: Cash Price |
$6,552.90
|
| Rate for Payer: Cash Price |
$6,552.90
|
| 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 |
$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, 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: Aetna of CA Non-Gatekeeper |
$10,333.62
|
| Rate for Payer: Cash Price |
$7,220.70
|
| Rate for Payer: Cash Price |
$7,220.70
|
| 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 |
$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
|
$16,046.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
906811405
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,904.33 |
| Max. Negotiated Rate |
$15,309.00 |
| Rate for Payer: Adventist Health Commercial |
$3,209.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,916.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| 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 |
$7,220.70
|
| Rate for Payer: Cash Price |
$7,220.70
|
| Rate for Payer: Cash Price |
$7,220.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,467.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,169.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,932.47
|
| Rate for Payer: Heritage Provider Network Senior |
$5,128.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,922.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,904.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,795.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,011.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,587.36
|
| 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 |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
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: Aetna of CA Non-Gatekeeper |
$27.05
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.43
|
| Rate for Payer: Heritage Provider Network Senior |
$28.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
|
|
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 |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| 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 Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.42
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
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: Aetna of CA Non-Gatekeeper |
$91.45
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.13
|
| Rate for Payer: Heritage Provider Network Senior |
$96.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.50
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
|
|
HC LIAT COVID-19 RNA
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913692
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$342.56 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| 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 Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.56
|
| Rate for Payer: Blue Shield of California Commercial |
$75.64
|
| Rate for Payer: Blue Shield of California Commercial |
$86.62
|
| Rate for Payer: Blue Shield of California EPN |
$69.30
|
| Rate for Payer: Blue Shield of California EPN |
$60.51
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.90
|
| Rate for Payer: Heritage Provider Network Senior |
$76.76
|
| Rate for Payer: Heritage Provider Network Senior |
$87.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$59.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$67.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$55.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
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: Cash Price |
$1,645.65
|
| Rate for Payer: Adventist Health Commercial |
$731.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,355.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,475.79
|
| Rate for Payer: Heritage Provider Network Senior |
$2,475.79
|
| Rate for Payer: Kaiser Foundation Hospitals 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/BIOPSY,TEMP ARTERY
|
Facility
|
OP
|
$3,657.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
900501523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.92 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$731.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,260.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,737.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,382.35
|
| Rate for Payer: Cash Price |
$1,645.65
|
| Rate for Payer: Cash Price |
$1,645.65
|
| Rate for Payer: Cash Price |
$1,645.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,377.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,475.79
|
| Rate for Payer: Heritage Provider Network Senior |
$2,475.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,744.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$661.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$2,742.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,194.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,194.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC 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: Aetna of CA Non-Gatekeeper |
$5,378.69
|
| Rate for Payer: Cash Price |
$3,758.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,654.30
|
| Rate for Payer: Heritage Provider Network Senior |
$5,654.30
|
| Rate for Payer: Kaiser Foundation Hospitals 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 DIV/EXC VARICOSEVEIN
|
Facility
|
OP
|
$8,352.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
900501325
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,511.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,670.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,161.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,967.20
|
| Rate for Payer: Blue Shield of California EPN |
$3,157.06
|
| Rate for Payer: Cash Price |
$3,758.40
|
| Rate for Payer: Cash Price |
$3,758.40
|
| Rate for Payer: Cash Price |
$3,758.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,428.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| 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) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,983.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,511.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,088.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$6,264.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,011.20
|
| Rate for Payer: TriValley Medical Group Senior |
$5,011.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC LIGATION HEMORRHOID(S)
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
906746221
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$468.61 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$517.80
|
| Rate for Payer: Adventist Health Commercial |
$593.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,834.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,600.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,229.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1,409.80
|
| Rate for Payer: Blue Shield of California EPN |
$978.64
|
| Rate for Payer: Blue Shield of California EPN |
$1,121.90
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,165.05
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,165.05
|
| Rate for Payer: Cash Price |
$1,165.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,682.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,929.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,196.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,196.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,009.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,752.75
|
| Rate for Payer: Heritage Provider Network Senior |
$2,009.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,752.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,415.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,234.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$537.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$468.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,375.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,375.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$742.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$2,226.00
|
| Rate for Payer: Multiplan Commercial |
$1,941.75
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,553.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,780.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,780.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,553.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
HC LIGATION HEMORRHOID(S)
|
Facility
|
OP
|
$2,968.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
906746221
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$593.60
|
| Rate for Payer: Adventist Health Commercial |
$517.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,600.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,834.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,165.05
|
| Rate for Payer: Cash Price |
$1,165.05
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,165.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,682.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,929.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,196.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,196.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,837.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,602.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,471.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,471.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,234.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,415.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$537.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$468.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,375.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,375.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$742.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$2,226.00
|
| Rate for Payer: Multiplan Commercial |
$1,941.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
HC LIGATION HEMORRHOID(S)
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
906746221
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$468.61 |
| Max. Negotiated Rate |
$1,941.75 |
| Rate for Payer: Adventist Health Commercial |
$517.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,667.32
|
| Rate for Payer: Cash Price |
$1,165.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,752.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1,752.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$468.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.25
|
| Rate for Payer: Multiplan Commercial |
$1,941.75
|
|
