|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
909000125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.37 |
| Max. Negotiated Rate |
$996.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$899.06
|
| Rate for Payer: Heritage Provider Network Senior |
$899.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
OP
|
$1,328.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
900501128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.37 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$912.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$730.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$996.00
|
| 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 |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$863.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,128.80
|
| Rate for Payer: Dignity Health Senior |
$1,128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$822.03
|
| Rate for Payer: Heritage Provider Network Senior |
$822.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$633.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$929.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$664.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$664.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,128.80
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
OP
|
$1,328.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
900501128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$240.37 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$709.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$912.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$730.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$996.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$863.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,128.80
|
| Rate for Payer: Dignity Health Senior |
$1,128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$899.06
|
| Rate for Payer: Heritage Provider Network Senior |
$899.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$633.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$929.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$477.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$439.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,128.80
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
900501128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$240.37 |
| Max. Negotiated Rate |
$996.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$899.06
|
| Rate for Payer: Heritage Provider Network Senior |
$899.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
900501128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.37 |
| Max. Negotiated Rate |
$996.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$899.06
|
| Rate for Payer: Heritage Provider Network Senior |
$899.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
|
|
HC PERICARDIOCENTESIS SUBSEQNT
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
900501518
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$214.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$571.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$735.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$909.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$588.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$802.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$588.50
|
| Rate for Payer: Cash Price |
$588.50
|
| Rate for Payer: Cash Price |
$588.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$695.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$909.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$909.50
|
| Rate for Payer: Dignity Health Senior |
$909.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$662.33
|
| Rate for Payer: Heritage Provider Network Senior |
$662.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$510.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$749.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$749.00
|
| Rate for Payer: Multiplan Commercial |
$802.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$909.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$909.50
|
| Rate for Payer: Vantage Medical Group Senior |
$909.50
|
|
|
HC PERICARDIOCENTESIS SUBSEQNT
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
900501518
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$193.67 |
| Max. Negotiated Rate |
$802.50 |
| Rate for Payer: Adventist Health Commercial |
$214.00
|
| Rate for Payer: Cash Price |
$588.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.39
|
| Rate for Payer: Heritage Provider Network Senior |
$724.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.50
|
| Rate for Payer: Multiplan Commercial |
$802.50
|
|
|
HC PERICARDIOCENTESIS SUBSEQNT
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
909000126
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$186.43 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$206.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$707.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$875.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$772.50
|
| 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 |
$566.50
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$669.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$875.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$875.50
|
| Rate for Payer: Dignity Health Senior |
$875.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$637.57
|
| Rate for Payer: Heritage Provider Network Senior |
$637.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$721.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$721.00
|
| Rate for Payer: Multiplan Commercial |
$772.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$515.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$515.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$875.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$875.50
|
| Rate for Payer: Vantage Medical Group Senior |
$875.50
|
|
|
HC PERICARDIOCENTESIS SUBSEQNT
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
909000126
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$186.43 |
| Max. Negotiated Rate |
$772.50 |
| Rate for Payer: Adventist Health Commercial |
$206.00
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$697.31
|
| Rate for Payer: Heritage Provider Network Senior |
$697.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.50
|
| Rate for Payer: Multiplan Commercial |
$772.50
|
|
|
HC PERICARDIOCENTESIS W/IMAGING
|
Facility
|
IP
|
$4,775.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
906820267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$864.27 |
| Max. Negotiated Rate |
$3,581.25 |
| Rate for Payer: Adventist Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$2,626.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,232.68
|
| Rate for Payer: Heritage Provider Network Senior |
$3,232.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$864.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,193.75
|
| Rate for Payer: Multiplan Commercial |
$3,581.25
|
|
|
HC PERICARDIOCENTESIS W/IMAGING
|
Facility
|
OP
|
$4,775.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
906820267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$955.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,280.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$2,626.25
|
| Rate for Payer: Cash Price |
$2,626.25
|
| Rate for Payer: Cash Price |
$2,626.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,103.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,955.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,427.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$325.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,750.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$864.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,193.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$3,581.25
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,171.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2,171.18
|
| 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: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC PERICARDIOCENTESIS W/IMAGING
|
Facility
|
IP
|
$3,639.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
900503016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$658.66 |
| Max. Negotiated Rate |
$2,729.25 |
| Rate for Payer: Adventist Health Commercial |
$727.80
|
| Rate for Payer: Cash Price |
$2,001.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,463.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,463.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$658.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$909.75
|
| Rate for Payer: Multiplan Commercial |
$2,729.25
|
|
|
HC PERICARDIOCENTESIS W/IMAGING
|
Facility
|
OP
|
$3,639.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
900503016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$727.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,499.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$2,001.45
|
| Rate for Payer: Cash Price |
$2,001.45
|
| Rate for Payer: Cash Price |
$2,001.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,365.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,252.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,427.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$325.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,750.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$658.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$909.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$2,729.25
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,171.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2,171.18
|
| 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: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$338.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$435.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.55
|
| Rate for Payer: Blue Shield of California Commercial |
$199.39
|
| Rate for Payer: Blue Shield of California EPN |
$160.34
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Senior |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.45
|
| Rate for Payer: Heritage Provider Network Senior |
$392.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$55.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$302.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.36
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$163.78
|
| Rate for Payer: TriValley Medical Group Senior |
$163.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
|
|
HC PERITONEOGRAM
|
Facility
|
OP
|
$3,005.00
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
909001474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.94 |
| Max. Negotiated Rate |
$2,253.75 |
| Rate for Payer: Adventist Health Commercial |
$601.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,606.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,064.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.54
|
| Rate for Payer: Blue Shield of California Commercial |
$274.70
|
| Rate for Payer: Blue Shield of California EPN |
$220.91
|
| Rate for Payer: Cash Price |
$1,652.75
|
| Rate for Payer: Cash Price |
$1,652.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,953.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Senior |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,953.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$696.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,860.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,860.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$55.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,433.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$801.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$751.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$877.80
|
| Rate for Payer: Multiplan Commercial |
$2,253.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$696.67
|
| Rate for Payer: TriValley Medical Group Senior |
$696.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC PERITONEOGRAM
|
Facility
|
OP
|
$658.00
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
909000190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$131.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$452.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$559.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$361.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$493.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$361.90
|
| Rate for Payer: Cash Price |
$361.90
|
| Rate for Payer: Cash Price |
$361.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$427.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$559.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$559.30
|
| Rate for Payer: Dignity Health Senior |
$559.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$407.30
|
| Rate for Payer: Heritage Provider Network Senior |
$407.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$313.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$460.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$460.60
|
| Rate for Payer: Multiplan Commercial |
$493.50
|
| 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 |
$559.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$559.30
|
| Rate for Payer: Vantage Medical Group Senior |
$559.30
|
|
|
HC PERITONEOGRAM
|
Facility
|
IP
|
$3,005.00
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
909001474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$543.90 |
| Max. Negotiated Rate |
$2,253.75 |
| Rate for Payer: Adventist Health Commercial |
$601.00
|
| Rate for Payer: Cash Price |
$1,652.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,034.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,034.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$751.25
|
| Rate for Payer: Multiplan Commercial |
$2,253.75
|
|
|
HC PERITONEOGRAM
|
Facility
|
IP
|
$658.00
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
909000190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$493.50 |
| Rate for Payer: Adventist Health Commercial |
$131.60
|
| Rate for Payer: Cash Price |
$361.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$445.47
|
| Rate for Payer: Heritage Provider Network Senior |
$445.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.50
|
| Rate for Payer: Multiplan Commercial |
$493.50
|
|
|
HC PERM DIALYSIS CATH
|
Facility
|
IP
|
$1,116.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$223.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$535.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$448.63
|
| Rate for Payer: Blue Shield of California EPN |
$448.63
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$513.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$516.71
|
| Rate for Payer: Heritage Provider Network Senior |
$516.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$558.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.00
|
| Rate for Payer: Multiplan Commercial |
$837.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$403.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$369.51
|
|
|
HC PERM DIALYSIS CATH
|
Facility
|
OP
|
$1,116.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$223.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$535.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$766.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$948.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$613.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$837.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$448.63
|
| Rate for Payer: Blue Shield of California EPN |
$448.63
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$513.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$948.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$948.60
|
| Rate for Payer: Dignity Health Senior |
$948.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$714.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$516.71
|
| Rate for Payer: Heritage Provider Network Senior |
$516.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$558.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$781.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$781.20
|
| Rate for Payer: Multiplan Commercial |
$837.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$403.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$369.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$948.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$948.60
|
| Rate for Payer: Vantage Medical Group Senior |
$948.60
|
|
|
HC PEROXIDASE STAIN
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$191.14 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$714.91
|
| Rate for Payer: Heritage Provider Network Senior |
$714.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
|
|
HC PEROXIDASE STAIN
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.46 |
| Max. Negotiated Rate |
$1,556.92 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$564.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$725.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.46
|
| Rate for Payer: Blue Shield of California Commercial |
$338.21
|
| Rate for Payer: Blue Shield of California EPN |
$271.98
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$686.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Senior |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,037.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$653.66
|
| Rate for Payer: Heritage Provider Network Senior |
$653.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$111.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$503.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,193.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,307.82
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,037.95
|
| Rate for Payer: TriValley Medical Group Senior |
$1,037.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$722.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$722.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
|
HC PERQ ABLTJ LIVER CRYOABLATION
|
Facility
|
IP
|
$24,886.00
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
909047383
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,504.37 |
| Max. Negotiated Rate |
$18,664.50 |
| Rate for Payer: Adventist Health Commercial |
$4,977.20
|
| Rate for Payer: Cash Price |
$13,687.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,847.82
|
| Rate for Payer: Heritage Provider Network Senior |
$16,847.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,504.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,221.50
|
| Rate for Payer: Multiplan Commercial |
$18,664.50
|
|
|
HC PERQ ABLTJ LIVER CRYOABLATION
|
Facility
|
OP
|
$24,886.00
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
909047383
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$25,134.15 |
| Rate for Payer: Adventist Health Commercial |
$4,977.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,096.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,228.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| 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 |
$13,687.30
|
| Rate for Payer: Cash Price |
$13,687.30
|
| Rate for Payer: Cash Price |
$13,687.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,175.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,551.35
|
| Rate for Payer: Dignity Health Senior |
$13,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,228.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,404.43
|
| Rate for Payer: Heritage Provider Network Senior |
$16,271.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$675.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,228.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25,134.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,504.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,212.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,221.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,667.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,667.91
|
| Rate for Payer: Multiplan Commercial |
$18,664.50
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,551.35
|
| Rate for Payer: TriValley Medical Group Senior |
$14,551.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Vantage Medical Group Senior |
$13,228.50
|
|
