|
HC SIGMDSCPY W TRNS-EN US
|
Facility
|
IP
|
$3,225.00
|
|
|
Service Code
|
CPT 45342
|
| Hospital Charge Code |
906745342
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$583.72 |
| Max. Negotiated Rate |
$2,418.75 |
| Rate for Payer: Adventist Health Commercial |
$645.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,215.58
|
| Rate for Payer: Cash Price |
$1,451.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,183.32
|
| Rate for Payer: Heritage Provider Network Senior |
$2,183.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$583.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$806.25
|
| Rate for Payer: Multiplan Commercial |
$2,418.75
|
|
|
HC SIGMDSCPY W TRNS-EN US
|
Facility
|
OP
|
$3,066.00
|
|
|
Service Code
|
CPT 45342
|
| Hospital Charge Code |
906745342
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$309.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$613.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,106.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,379.70
|
| Rate for Payer: Cash Price |
$1,379.70
|
| Rate for Payer: Cash Price |
$1,379.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,992.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: Dignity Health Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,474.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,897.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,813.54
|
| Rate for Payer: Humana Medicare |
$1,474.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$309.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,801.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$554.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,857.77
|
| Rate for Payer: Multiplan Commercial |
$2,299.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC SIGMDSCPY W TUMOR ABLATION
|
Facility
|
OP
|
$2,647.00
|
|
|
Service Code
|
CPT 45346
|
| Hospital Charge Code |
906745346
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$529.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,818.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,191.15
|
| Rate for Payer: Cash Price |
$1,191.15
|
| Rate for Payer: Cash Price |
$1,191.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,720.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: Dignity Health Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,474.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,638.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,813.54
|
| Rate for Payer: Humana Medicare |
$1,474.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,801.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$661.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,857.77
|
| Rate for Payer: Multiplan Commercial |
$1,985.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC SIGMDSCPY W TUMOR ABLATION
|
Facility
|
IP
|
$2,784.00
|
|
|
Service Code
|
CPT 45346
|
| Hospital Charge Code |
906745346
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$503.90 |
| Max. Negotiated Rate |
$2,088.00 |
| Rate for Payer: Adventist Health Commercial |
$556.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,912.61
|
| Rate for Payer: Cash Price |
$1,252.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,884.77
|
| Rate for Payer: Heritage Provider Network Senior |
$1,884.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$696.00
|
| Rate for Payer: Multiplan Commercial |
$2,088.00
|
|
|
HC SIGMDSCPY W TUMOR SNARE RMVL
|
Facility
|
OP
|
$2,909.00
|
|
|
Service Code
|
CPT 45338
|
| Hospital Charge Code |
906745338
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$223.61 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$581.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,998.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,309.05
|
| Rate for Payer: Cash Price |
$1,309.05
|
| Rate for Payer: Cash Price |
$1,309.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,890.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: Dignity Health Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,474.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,800.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,813.54
|
| Rate for Payer: Humana Medicare |
$1,474.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$223.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,801.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$727.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,857.77
|
| Rate for Payer: Multiplan Commercial |
$2,181.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC SIGMDSCPY W TUMOR SNARE RMVL
|
Facility
|
IP
|
$2,868.00
|
|
|
Service Code
|
CPT 45338
|
| Hospital Charge Code |
906745338
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$519.11 |
| Max. Negotiated Rate |
$2,151.00 |
| Rate for Payer: Adventist Health Commercial |
$573.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,970.32
|
| Rate for Payer: Cash Price |
$1,290.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,941.64
|
| Rate for Payer: Heritage Provider Network Senior |
$1,941.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$519.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.00
|
| Rate for Payer: Multiplan Commercial |
$2,151.00
|
|
|
HC SIGMOIDOSCOPY W ENDO MCSL RESC
|
Facility
|
OP
|
$2,606.00
|
|
|
Service Code
|
CPT 45349
|
| Hospital Charge Code |
906745349
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$521.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,790.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,508.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,172.70
|
| Rate for Payer: Cash Price |
$1,172.70
|
| Rate for Payer: Cash Price |
$1,172.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,693.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,858.96
|
| Rate for Payer: Dignity Health Senior |
$3,508.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,508.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,613.11
|
| Rate for Payer: Heritage Provider Network Senior |
$4,315.02
|
| Rate for Payer: Humana Medicare |
$3,508.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,508.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,665.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,139.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$651.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,420.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,420.27
|
| Rate for Payer: Multiplan Commercial |
$1,954.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,508.15
|
|
|
HC SIGMOIDOSCOPY W ENDO MCSL RESC
|
Facility
|
IP
|
$2,606.00
|
|
|
Service Code
|
CPT 45349
|
| Hospital Charge Code |
906745349
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$471.69 |
| Max. Negotiated Rate |
$1,954.50 |
| Rate for Payer: Adventist Health Commercial |
$521.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,790.32
|
| Rate for Payer: Cash Price |
$1,172.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,764.26
|
| Rate for Payer: Heritage Provider Network Senior |
$1,764.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$651.50
|
| Rate for Payer: Multiplan Commercial |
$1,954.50
|
|
|
HC SIGMOIDOSCOPY W STENT PLCMNT
|
Facility
|
OP
|
$5,205.00
|
|
|
Service Code
|
CPT 45347
|
| Hospital Charge Code |
906745347
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$13,529.58 |
| Rate for Payer: Adventist Health Commercial |
$1,041.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,575.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,120.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$2,342.25
|
| Rate for Payer: Cash Price |
$2,342.25
|
| Rate for Payer: Cash Price |
$2,342.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,383.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,832.91
|
| Rate for Payer: Dignity Health Senior |
$7,120.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,120.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,221.90
|
| Rate for Payer: Heritage Provider Network Senior |
$8,758.62
|
| Rate for Payer: Humana Medicare |
$7,120.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,120.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,529.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$942.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,402.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,301.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,972.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,972.25
|
| Rate for Payer: Multiplan Commercial |
$3,903.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Vantage Medical Group Senior |
$7,120.83
|
|
|
HC SIGMOIDOSCOPY W STENT PLCMNT
|
Facility
|
IP
|
$5,414.00
|
|
|
Service Code
|
CPT 45347
|
| Hospital Charge Code |
906745347
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$979.93 |
| Max. Negotiated Rate |
$4,060.50 |
| Rate for Payer: Adventist Health Commercial |
$1,082.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,719.42
|
| Rate for Payer: Cash Price |
$2,436.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,665.28
|
| Rate for Payer: Heritage Provider Network Senior |
$3,665.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$979.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,353.50
|
| Rate for Payer: Multiplan Commercial |
$4,060.50
|
|
|
HC SIGMOIDOSCOPY W SUBMUC INJ
|
Facility
|
OP
|
$1,633.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
906745335
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$239.48 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$326.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,121.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$734.85
|
| Rate for Payer: Cash Price |
$734.85
|
| Rate for Payer: Cash Price |
$734.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,061.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,010.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,404.57
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$239.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$1,224.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC SIGMOIDOSCOPY W SUBMUC INJ
|
Facility
|
IP
|
$1,563.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
906745335
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$282.90 |
| Max. Negotiated Rate |
$1,172.25 |
| Rate for Payer: Adventist Health Commercial |
$312.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,073.78
|
| Rate for Payer: Cash Price |
$703.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,058.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1,058.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.75
|
| Rate for Payer: Multiplan Commercial |
$1,172.25
|
|
|
HC SIGMOIDSCPY FLX DIAG W BND LIG
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT 45350
|
| Hospital Charge Code |
906745350
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$517.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,777.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,164.60
|
| Rate for Payer: Cash Price |
$1,164.60
|
| Rate for Payer: Cash Price |
$1,164.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,682.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: Dignity Health Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,474.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,601.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,813.54
|
| Rate for Payer: Humana Medicare |
$1,474.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,801.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$468.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,857.77
|
| Rate for Payer: Multiplan Commercial |
$1,941.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC SIGMOIDSCPY FLX DIAG W BND LIG
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT 45350
|
| Hospital Charge Code |
906745350
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$468.43 |
| Max. Negotiated Rate |
$1,941.00 |
| Rate for Payer: Adventist Health Commercial |
$517.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,777.96
|
| Rate for Payer: Cash Price |
$1,164.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,752.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,752.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$468.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.00
|
| Rate for Payer: Multiplan Commercial |
$1,941.00
|
|
|
HC SILVERHAWK THROMB CATH
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$746.62 |
| Max. Negotiated Rate |
$3,093.75 |
| Rate for Payer: Adventist Health Commercial |
$825.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,833.88
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,792.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2,792.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$746.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,031.25
|
| Rate for Payer: Multiplan Commercial |
$3,093.75
|
|
|
HC SILVERHAWK THROMB CATH
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$746.62 |
| Max. Negotiated Rate |
$9,389.21 |
| Rate for Payer: Adventist Health Commercial |
$825.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9,389.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,833.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,268.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,093.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,561.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,421.38
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,681.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,506.25
|
| Rate for Payer: Dignity Health Senior |
$3,506.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,681.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,553.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,553.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,988.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$746.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,031.25
|
| Rate for Payer: Multiplan Commercial |
$3,093.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,506.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,506.25
|
|
|
HC SIMP REP SUP WND 12.6-20.0 CM
|
Facility
|
OP
|
$1,158.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
900501023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$231.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$795.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$752.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$783.97
|
| Rate for Payer: Heritage Provider Network Senior |
$783.97
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$558.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$868.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$420.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$386.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC SIMP REP SUP WND 12.6-20.0 CM
|
Facility
|
IP
|
$1,158.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
900501023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$868.50 |
| Rate for Payer: Adventist Health Commercial |
$231.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$795.55
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$783.97
|
| Rate for Payer: Heritage Provider Network Senior |
$783.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.50
|
| Rate for Payer: Multiplan Commercial |
$868.50
|
|
|
HC SIMP REP SUP WND 20.1-30.0 CM
|
Facility
|
OP
|
$1,277.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
900501408
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$231.14 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$255.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$877.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$574.65
|
| Rate for Payer: Cash Price |
$574.65
|
| Rate for Payer: Cash Price |
$574.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$830.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$864.53
|
| Rate for Payer: Heritage Provider Network Senior |
$864.53
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$615.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$319.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$957.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$463.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$426.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC SIMP REP SUP WND 20.1-30.0 CM
|
Facility
|
IP
|
$1,277.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
900501408
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$231.14 |
| Max. Negotiated Rate |
$957.75 |
| Rate for Payer: Adventist Health Commercial |
$255.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$877.30
|
| Rate for Payer: Cash Price |
$574.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$864.53
|
| Rate for Payer: Heritage Provider Network Senior |
$864.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$319.25
|
| Rate for Payer: Multiplan Commercial |
$957.75
|
|
|
HC SIMP REP SUP WND 2.6 - 5.0 CM
|
Facility
|
OP
|
$1,014.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
900501026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.44 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$202.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$696.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$456.30
|
| Rate for Payer: Cash Price |
$456.30
|
| Rate for Payer: Cash Price |
$456.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$659.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$686.48
|
| Rate for Payer: Heritage Provider Network Senior |
$686.48
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$488.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$760.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$368.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$338.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC SIMP REP SUP WND 2.6 - 5.0 CM
|
Facility
|
IP
|
$1,014.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
900501026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$183.53 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Adventist Health Commercial |
$202.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$696.62
|
| Rate for Payer: Cash Price |
$456.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$686.48
|
| Rate for Payer: Heritage Provider Network Senior |
$686.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.50
|
| Rate for Payer: Multiplan Commercial |
$760.50
|
|
|
HC SIMP REP SUP WND 2.6-7.5 CM
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
900501021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$176.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$142.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$607.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$574.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$598.47
|
| Rate for Payer: Heritage Provider Network Senior |
$598.47
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$426.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$663.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$320.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$295.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC SIMP REP SUP WND 2.6-7.5 CM
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
900501021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Adventist Health Commercial |
$176.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$607.31
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$598.47
|
| Rate for Payer: Heritage Provider Network Senior |
$598.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.00
|
| Rate for Payer: Multiplan Commercial |
$663.00
|
|
|
HC SIMP REP SUP WND 5.1 - 7.5 CM
|
Facility
|
OP
|
$1,128.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
900501027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.17 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$225.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$774.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$733.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$763.66
|
| Rate for Payer: Heritage Provider Network Senior |
$763.66
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$543.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$846.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$409.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$376.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
