|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
OP
|
$20,918.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906811463
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Adventist Health Commercial |
$4,183.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,927.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,185.00
|
| 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 |
$9,413.10
|
| Rate for Payer: Cash Price |
$9,413.10
|
| Rate for Payer: Cash Price |
$9,413.10
|
| Rate for Payer: Cash Price |
$9,413.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,596.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,341.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,948.24
|
| Rate for Payer: Heritage Provider Network Senior |
$18,262.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,210.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,786.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,229.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$15,688.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$14,847.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
IP
|
$20,918.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906811463
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,786.16 |
| Max. Negotiated Rate |
$15,688.50 |
| Rate for Payer: Adventist Health Commercial |
$4,183.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,471.19
|
| Rate for Payer: Cash Price |
$9,413.10
|
| Rate for Payer: Cash Price |
$9,413.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,786.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,229.50
|
| Rate for Payer: Multiplan Commercial |
$15,688.50
|
|
|
HC PDL TUBE
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
900800709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$135.24
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC PDL TUBE
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
900800709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.04
|
| Rate for Payer: Blue Shield of California Commercial |
$128.10
|
| Rate for Payer: Blue Shield of California EPN |
$102.48
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$100.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$105.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$105.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC PEEL AWAY INTRODUCER SET
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$152.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$184.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.05
|
| Rate for Payer: Blue Shield of California Commercial |
$150.06
|
| Rate for Payer: Blue Shield of California EPN |
$120.05
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$159.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.27
|
| Rate for Payer: Heritage Provider Network Senior |
$152.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$117.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$123.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$123.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
|
HC PEEL AWAY INTRODUCER SET
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$158.42
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$166.54
|
| Rate for Payer: Heritage Provider Network Senior |
$166.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
|
|
HC PEL OVULATION STUDY
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.06
|
| 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 |
$585.23
|
| Rate for Payer: Blue Shield of California Commercial |
$325.78
|
| Rate for Payer: Blue Shield of California EPN |
$261.98
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$760.50
|
| 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 |
$690.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.23
|
| Rate for Payer: Heritage Provider Network Senior |
$724.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$558.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| 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 |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| 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 PEL OVULATION STUDY
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$211.77 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$753.48
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$792.09
|
| Rate for Payer: Heritage Provider Network Senior |
$792.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
IP
|
$4,641.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$840.02 |
| Max. Negotiated Rate |
$3,480.75 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,988.80
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,141.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,141.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
OP
|
$4,641.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$840.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,868.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,204.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,754.30
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,016.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,163.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,141.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,141.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,213.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,788.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,784.60
|
| Rate for Payer: TriValley Medical Group Senior |
$2,784.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC PELVIMMETRY
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
CPT 74710
|
| Hospital Charge Code |
909001915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.02 |
| Max. Negotiated Rate |
$455.60 |
| Rate for Payer: Adventist Health Commercial |
$107.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$331.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$455.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$402.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$285.80
|
| Rate for Payer: Blue Shield of California Commercial |
$326.96
|
| Rate for Payer: Blue Shield of California EPN |
$261.57
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$348.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$455.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$455.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$455.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$331.78
|
| Rate for Payer: Heritage Provider Network Senior |
$331.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$255.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$375.20
|
| Rate for Payer: Multiplan Commercial |
$402.00
|
| 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 |
$455.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$455.60
|
| Rate for Payer: Vantage Medical Group Senior |
$455.60
|
|
|
HC PELVIMMETRY
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
CPT 74710
|
| Hospital Charge Code |
909001915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.02 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Adventist Health Commercial |
$107.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$345.18
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$362.87
|
| Rate for Payer: Heritage Provider Network Senior |
$362.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.00
|
| Rate for Payer: Multiplan Commercial |
$402.00
|
|
|
HC PELVIS 1 OR 2 VIEWS
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$471.00 |
| Rate for Payer: Adventist Health Commercial |
$125.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.10
|
| 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 |
$141.78
|
| Rate for Payer: Blue Shield of California Commercial |
$107.90
|
| Rate for Payer: Blue Shield of California EPN |
$86.77
|
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$408.20
|
| 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 |
$370.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$388.73
|
| Rate for Payer: Heritage Provider Network Senior |
$388.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$299.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$471.00
|
| 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 PELVIS 1 OR 2 VIEWS
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.67 |
| Max. Negotiated Rate |
$471.00 |
| Rate for Payer: Adventist Health Commercial |
$125.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$404.43
|
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$425.16
|
| Rate for Payer: Heritage Provider Network Senior |
$425.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.00
|
| Rate for Payer: Multiplan Commercial |
$471.00
|
|
|
HC PELVIS COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
909001342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.35 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$652.37
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$685.80
|
| Rate for Payer: Heritage Provider Network Senior |
$685.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.25
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
|
|
HC PELVIS COMPLETE MIN 3 VIEWS
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
909001342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$626.03
|
| 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 |
$182.05
|
| Rate for Payer: Blue Shield of California Commercial |
$141.12
|
| Rate for Payer: Blue Shield of California EPN |
$113.48
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$658.45
|
| 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 |
$597.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$627.05
|
| Rate for Payer: Heritage Provider Network Senior |
$627.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$483.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
| 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 PEN A 1 (SHRIMP), IGE
|
Facility
|
OP
|
$16.29
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913751
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$3.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.08
|
| Rate for Payer: Heritage Provider Network Senior |
$10.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$12.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC PENILE INJECTION
|
Facility
|
IP
|
$1,291.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
900501609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.67 |
| Max. Negotiated Rate |
$968.25 |
| Rate for Payer: Adventist Health Commercial |
$258.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$831.40
|
| Rate for Payer: Cash Price |
$580.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.01
|
| Rate for Payer: Heritage Provider Network Senior |
$874.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.75
|
| Rate for Payer: Multiplan Commercial |
$968.25
|
|
|
HC PENILE INJECTION
|
Facility
|
OP
|
$1,291.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
900501609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$258.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$797.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$613.23
|
| Rate for Payer: Blue Shield of California EPN |
$488.00
|
| Rate for Payer: Cash Price |
$580.95
|
| Rate for Payer: Cash Price |
$580.95
|
| Rate for Payer: Cash Price |
$580.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$839.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$321.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.01
|
| Rate for Payer: Heritage Provider Network Senior |
$874.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$615.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$968.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$774.60
|
| Rate for Payer: TriValley Medical Group Senior |
$774.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC PENILE VASC STUDIES COMPLETE
|
Facility
|
OP
|
$1,741.00
|
|
|
Service Code
|
CPT 93980
|
| Hospital Charge Code |
908100111
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,305.75 |
| Rate for Payer: Adventist Health Commercial |
$348.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,075.94
|
| 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 |
$870.85
|
| Rate for Payer: Blue Shield of California Commercial |
$931.87
|
| Rate for Payer: Blue Shield of California EPN |
$749.38
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,131.65
|
| 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 |
$1,027.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,077.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,077.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$830.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$315.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,305.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.91
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| 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 PENILE VASC STUDIES COMPLETE
|
Facility
|
IP
|
$1,741.00
|
|
|
Service Code
|
CPT 93980
|
| Hospital Charge Code |
908100111
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$315.12 |
| Max. Negotiated Rate |
$1,305.75 |
| Rate for Payer: Adventist Health Commercial |
$348.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,121.20
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,178.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,178.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$315.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.25
|
| Rate for Payer: Multiplan Commercial |
$1,305.75
|
|
|
HC PERC BILIARY DRAINAGE EXT
|
Facility
|
IP
|
$11,242.00
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
909000145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,034.80 |
| Max. Negotiated Rate |
$8,431.50 |
| Rate for Payer: Adventist Health Commercial |
$2,248.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,239.85
|
| Rate for Payer: Cash Price |
$5,058.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,610.83
|
| Rate for Payer: Heritage Provider Network Senior |
$7,610.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,034.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,810.50
|
| Rate for Payer: Multiplan Commercial |
$8,431.50
|
|
|
HC PERC BILIARY DRAINAGE EXT
|
Facility
|
OP
|
$11,242.00
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
909000145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,034.80 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,248.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,947.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$5,058.90
|
| Rate for Payer: Cash Price |
$5,058.90
|
| Rate for Payer: Cash Price |
$5,058.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,307.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,604.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,958.80
|
| Rate for Payer: Heritage Provider Network Senior |
$5,664.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,749.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,034.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,295.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,810.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,170.69
|
| Rate for Payer: Multiplan Commercial |
$8,431.50
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,065.49
|
| Rate for Payer: TriValley Medical Group Senior |
$5,065.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
HC PERC BILIARY DRAIN INT & EX
|
Facility
|
IP
|
$11,242.00
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
909000146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,034.80 |
| Max. Negotiated Rate |
$8,431.50 |
| Rate for Payer: Adventist Health Commercial |
$2,248.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,239.85
|
| Rate for Payer: Cash Price |
$5,058.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,610.83
|
| Rate for Payer: Heritage Provider Network Senior |
$7,610.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,034.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,810.50
|
| Rate for Payer: Multiplan Commercial |
$8,431.50
|
|
|
HC PERC BILIARY DRAIN INT & EX
|
Facility
|
OP
|
$11,242.00
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
909000146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,034.80 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,248.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,947.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$5,058.90
|
| Rate for Payer: Cash Price |
$5,058.90
|
| Rate for Payer: Cash Price |
$5,058.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,307.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,604.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,958.80
|
| Rate for Payer: Heritage Provider Network Senior |
$5,664.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,749.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,034.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,295.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,810.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,170.69
|
| Rate for Payer: Multiplan Commercial |
$8,431.50
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,065.49
|
| Rate for Payer: TriValley Medical Group Senior |
$5,065.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
