|
HC LUMBAR SPINE LIMITED
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.62 |
| Max. Negotiated Rate |
$180.75 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.20
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$163.16
|
| Rate for Payer: Heritage Provider Network Senior |
$163.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.25
|
| Rate for Payer: Multiplan Commercial |
$180.75
|
|
|
HC LUM/SAC ABL EA ADD LEVEL
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909000263
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$790.97 |
| Max. Negotiated Rate |
$3,277.50 |
| Rate for Payer: Adventist Health Commercial |
$874.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,814.28
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,958.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2,958.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$790.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,092.50
|
| Rate for Payer: Multiplan Commercial |
$3,277.50
|
|
|
HC LUM/SAC ABL EA ADD LEVEL
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909000263
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$790.97 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Multiplan Commercial |
$3,277.50
|
| Rate for Payer: Adventist Health Commercial |
$874.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,700.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,714.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,403.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,277.50
|
| 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 |
$1,966.50
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,840.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,714.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,714.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,714.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,622.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,705.03
|
| Rate for Payer: Heritage Provider Network Senior |
$2,705.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,084.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$790.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,092.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,059.00
|
| 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 |
$3,714.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,714.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,714.50
|
|
|
HC LUM SPINE BEND ONLY/4 VIEWS
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
909001318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$190.96 |
| Max. Negotiated Rate |
$791.25 |
| Rate for Payer: Adventist Health Commercial |
$211.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$679.42
|
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$714.24
|
| Rate for Payer: Heritage Provider Network Senior |
$714.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.75
|
| Rate for Payer: Multiplan Commercial |
$791.25
|
|
|
HC LUM SPINE BEND ONLY/4 VIEWS
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
909001318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$791.25 |
| Rate for Payer: Adventist Health Commercial |
$211.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$651.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.46
|
| Rate for Payer: Blue Shield of California Commercial |
$188.45
|
| Rate for Payer: Blue Shield of California EPN |
$151.54
|
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$685.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$653.04
|
| Rate for Payer: Heritage Provider Network Senior |
$653.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$503.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$791.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC LUM SPINE COMP W/BENDING VIEWS
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
909001316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$945.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$321.46
|
| Rate for Payer: Blue Shield of California Commercial |
$249.02
|
| Rate for Payer: Blue Shield of California EPN |
$200.26
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$994.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$902.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$947.07
|
| Rate for Payer: Heritage Provider Network Senior |
$947.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$729.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$276.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC LUM SPINE COMP W/BENDING VIEWS
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
909001316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$276.93 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$985.32
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,035.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,035.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$276.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.50
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
|
|
HC LUM SPINE W/OBLIQUES
|
Facility
|
OP
|
$1,010.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
909001317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$757.50 |
| Rate for Payer: Adventist Health Commercial |
$202.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$624.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.66
|
| Rate for Payer: Blue Shield of California Commercial |
$192.48
|
| Rate for Payer: Blue Shield of California EPN |
$154.79
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$656.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$625.19
|
| Rate for Payer: Heritage Provider Network Senior |
$625.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$481.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$757.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC LUM SPINE W/OBLIQUES
|
Facility
|
IP
|
$1,010.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
909001317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.81 |
| Max. Negotiated Rate |
$757.50 |
| Rate for Payer: Adventist Health Commercial |
$202.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$650.44
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$683.77
|
| Rate for Payer: Heritage Provider Network Senior |
$683.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.50
|
| Rate for Payer: Multiplan Commercial |
$757.50
|
|
|
HC LUNG BIOPSY, PERCUTANEOUS
|
Facility
|
OP
|
$4,488.00
|
|
|
Service Code
|
CPT 32405
|
| Hospital Charge Code |
909000124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$812.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$897.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,773.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,814.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,468.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,366.00
|
| 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 EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,019.60
|
| Rate for Payer: Cash Price |
$2,019.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,917.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,814.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,814.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,814.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,778.07
|
| Rate for Payer: Heritage Provider Network Senior |
$2,778.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,140.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$812.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,141.60
|
| Rate for Payer: Multiplan Commercial |
$3,366.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,244.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,244.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,814.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,814.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,814.80
|
|
|
HC LUNG BIOPSY, PERCUTANEOUS
|
Facility
|
IP
|
$4,488.00
|
|
|
Service Code
|
CPT 32405
|
| Hospital Charge Code |
909000124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$812.33 |
| Max. Negotiated Rate |
$3,366.00 |
| Rate for Payer: Adventist Health Commercial |
$897.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,890.27
|
| Rate for Payer: Cash Price |
$2,019.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,038.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,038.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$812.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.00
|
| Rate for Payer: Multiplan Commercial |
$3,366.00
|
|
|
HC LUNG DIFFER PERF & VENTILATION
|
Facility
|
OP
|
$4,060.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
909301402
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$698.35 |
| Max. Negotiated Rate |
$3,045.00 |
| Rate for Payer: Adventist Health Commercial |
$812.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,509.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,066.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,559.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,254.23
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,639.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,639.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$698.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,513.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2,513.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,936.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$734.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$803.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,015.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$3,045.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$768.18
|
| Rate for Payer: TriValley Medical Group Senior |
$698.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,030.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,030.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC LUNG DIFFER PERF & VENTILATION
|
Facility
|
IP
|
$4,060.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
909301402
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$734.86 |
| Max. Negotiated Rate |
$3,045.00 |
| Rate for Payer: Adventist Health Commercial |
$812.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,614.64
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,748.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2,748.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$734.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,015.00
|
| Rate for Payer: Multiplan Commercial |
$3,045.00
|
|
|
HC LUPUS SCREEN PTT
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900912006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.50
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.57
|
| Rate for Payer: Heritage Provider Network Senior |
$124.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
|
|
HC LUPUS SCREEN PTT
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900912006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$57.02 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.02
|
| Rate for Payer: Blue Shield of California Commercial |
$48.27
|
| Rate for Payer: Blue Shield of California Commercial |
$48.27
|
| Rate for Payer: Blue Shield of California EPN |
$38.72
|
| Rate for Payer: Blue Shield of California EPN |
$38.72
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.14
|
| Rate for Payer: Heritage Provider Network Senior |
$113.90
|
| Rate for Payer: Heritage Provider Network Senior |
$37.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$87.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.05
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Senior |
$6.01
|
| Rate for Payer: TriValley Medical Group Senior |
$6.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC LUTEINIZING HORMON
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
900910886
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.66 |
| Max. Negotiated Rate |
$226.50 |
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$194.49
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.45
|
| Rate for Payer: Heritage Provider Network Senior |
$204.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.50
|
| Rate for Payer: Multiplan Commercial |
$226.50
|
|
|
HC LUTEINIZING HORMON
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
900910886
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$175.85 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.85
|
| Rate for Payer: Blue Shield of California Commercial |
$149.07
|
| Rate for Payer: Blue Shield of California Commercial |
$149.07
|
| Rate for Payer: Blue Shield of California EPN |
$119.57
|
| Rate for Payer: Blue Shield of California EPN |
$119.57
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$196.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.95
|
| Rate for Payer: Heritage Provider Network Senior |
$186.94
|
| Rate for Payer: Heritage Provider Network Senior |
$56.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$144.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$43.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.82
|
| Rate for Payer: Multiplan Commercial |
$226.50
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.52
|
| Rate for Payer: TriValley Medical Group Senior |
$18.52
|
| Rate for Payer: TriValley Medical Group Senior |
$18.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.37
|
| Rate for Payer: Vantage Medical Group Senior |
$18.52
|
| Rate for Payer: Vantage Medical Group Senior |
$18.52
|
|
|
HC LYMPHANGIOGRAM, ABD/PLV UL
|
Facility
|
IP
|
$1,722.00
|
|
|
Service Code
|
CPT 75805
|
| Hospital Charge Code |
909001374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$311.68 |
| Max. Negotiated Rate |
$1,291.50 |
| Rate for Payer: Adventist Health Commercial |
$344.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,108.97
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,165.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,165.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$311.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$430.50
|
| Rate for Payer: Multiplan Commercial |
$1,291.50
|
|
|
HC LYMPHANGIOGRAM, ABD/PLV UL
|
Facility
|
OP
|
$1,722.00
|
|
|
Service Code
|
CPT 75805
|
| Hospital Charge Code |
909001374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$311.68 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Adventist Health Commercial |
$344.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,064.20
|
| 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 |
$1,657.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,283.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,032.47
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,119.30
|
| 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 |
$1,015.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,065.92
|
| Rate for Payer: Heritage Provider Network Senior |
$1,065.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$821.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$311.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$430.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$1,291.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$680.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$680.08
|
| 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 LYMPHANGIOGRAM EXT BILAT
|
Facility
|
IP
|
$2,426.00
|
|
|
Service Code
|
CPT 75803
|
| Hospital Charge Code |
909001373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$439.11 |
| Max. Negotiated Rate |
$1,819.50 |
| Rate for Payer: Adventist Health Commercial |
$485.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,642.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,642.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$439.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$606.50
|
| Rate for Payer: Multiplan Commercial |
$1,819.50
|
|
|
HC LYMPHANGIOGRAM EXT BILAT
|
Facility
|
OP
|
$2,426.00
|
|
|
Service Code
|
CPT 75803
|
| Hospital Charge Code |
909001373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$439.11 |
| Max. Negotiated Rate |
$3,036.95 |
| Rate for Payer: Adventist Health Commercial |
$485.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,499.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,472.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,140.77
|
| Rate for Payer: Blue Shield of California EPN |
$917.37
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,576.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,431.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,024.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,501.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,501.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,157.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$439.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,328.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$606.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$1,819.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,024.63
|
| Rate for Payer: TriValley Medical Group Senior |
$2,024.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$680.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$680.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC LYMPHANGIOGRAM EXT UNILAT
|
Facility
|
IP
|
$1,719.00
|
|
|
Service Code
|
CPT 75801
|
| Hospital Charge Code |
909001375
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$311.14 |
| Max. Negotiated Rate |
$1,289.25 |
| Rate for Payer: Adventist Health Commercial |
$343.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,107.04
|
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,163.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,163.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$311.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.75
|
| Rate for Payer: Multiplan Commercial |
$1,289.25
|
|
|
HC LYMPHANGIOGRAM EXT UNILAT
|
Facility
|
OP
|
$1,719.00
|
|
|
Service Code
|
CPT 75801
|
| Hospital Charge Code |
909001375
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$311.14 |
| Max. Negotiated Rate |
$1,472.06 |
| Rate for Payer: Adventist Health Commercial |
$343.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,062.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,472.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,140.77
|
| Rate for Payer: Blue Shield of California EPN |
$917.37
|
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,117.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$806.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,064.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,064.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$819.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$311.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$927.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$1,289.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$806.82
|
| Rate for Payer: TriValley Medical Group Senior |
$806.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$680.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$680.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC LYMPHANGIOGRAM, PELV BILAT
|
Facility
|
IP
|
$2,583.00
|
|
|
Service Code
|
CPT 75807
|
| Hospital Charge Code |
909001365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$467.52 |
| Max. Negotiated Rate |
$1,937.25 |
| Rate for Payer: Adventist Health Commercial |
$516.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,663.45
|
| Rate for Payer: Cash Price |
$1,162.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,748.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,748.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$467.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$645.75
|
| Rate for Payer: Multiplan Commercial |
$1,937.25
|
|
|
HC LYMPHANGIOGRAM, PELV BILAT
|
Facility
|
OP
|
$2,583.00
|
|
|
Service Code
|
CPT 75807
|
| Hospital Charge Code |
909001365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$467.52 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Adventist Health Commercial |
$516.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,596.29
|
| 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 |
$1,648.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,283.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,032.47
|
| Rate for Payer: Cash Price |
$1,162.35
|
| Rate for Payer: Cash Price |
$1,162.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,678.95
|
| 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 |
$1,523.97
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,598.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,598.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,232.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$467.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$645.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$1,937.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$680.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$680.08
|
| 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
|
|
