|
HC PERICARDIOCENTESIS
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT 76930
|
| Hospital Charge Code |
909001449
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.50 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Adventist Health Commercial |
$121.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$389.62
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$409.58
|
| Rate for Payer: Heritage Provider Network Senior |
$409.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.25
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
|
|
HC PERICARDIOCENTESIS
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT 76930
|
| Hospital Charge Code |
909001449
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.50 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: Adventist Health Commercial |
$121.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.98
|
| Rate for Payer: Blue Shield of California Commercial |
$369.05
|
| Rate for Payer: Blue Shield of California EPN |
$295.24
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$393.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$374.50
|
| Rate for Payer: Heritage Provider Network Senior |
$374.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$288.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$302.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$302.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.25
|
| Rate for Payer: Vantage Medical Group Senior |
$514.25
|
|
|
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 |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$820.70
|
| 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 |
$664.27
|
| 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 |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$633.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
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: Aetna of CA Non-Gatekeeper |
$855.23
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$899.06
|
| Rate for Payer: Heritage Provider Network Senior |
$899.06
|
| Rate for Payer: Kaiser Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$855.23
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$899.06
|
| Rate for Payer: Heritage Provider Network Senior |
$899.06
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
450
|
| Min. Negotiated Rate |
$240.37 |
| Max. Negotiated Rate |
$996.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$855.23
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$899.06
|
| Rate for Payer: Heritage Provider Network Senior |
$899.06
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
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 Non-Gatekeeper |
$820.70
|
| 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 |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$630.80
|
| Rate for Payer: Blue Shield of California EPN |
$501.98
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$633.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$796.80
|
| Rate for Payer: TriValley Medical Group Senior |
$796.80
|
| 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 |
909000125
|
|
Hospital Revenue Code
|
361
|
| 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 Non-Gatekeeper |
$820.70
|
| 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 |
$664.27
|
| 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 |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$633.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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: Aetna of CA Non-Gatekeeper |
$689.08
|
| Rate for Payer: Cash Price |
$481.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.39
|
| Rate for Payer: Heritage Provider Network Senior |
$724.39
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$1,070.00
|
|
|
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 Non-Gatekeeper |
$661.26
|
| 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 |
$347.00
|
| 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 |
$481.50
|
| Rate for Payer: Cash Price |
$481.50
|
| Rate for Payer: Cash Price |
$481.50
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$510.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
OP
|
$1,030.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
909000126
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$186.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$206.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$636.54
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$515.21
|
| 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 |
$463.50
|
| Rate for Payer: Cash Price |
$463.50
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$491.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$186.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$663.32
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$697.31
|
| Rate for Payer: Heritage Provider Network Senior |
$697.31
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
OP
|
$3,639.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
900503016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$658.66 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$727.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,248.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$1,637.55
|
| Rate for Payer: Cash Price |
$1,637.55
|
| Rate for Payer: Cash Price |
$1,637.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,365.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,024.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,252.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,490.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,846.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$658.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,328.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$909.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$2,729.25
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,227.09
|
| Rate for Payer: TriValley Medical Group Senior |
$2,227.09
|
| 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 |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC 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: Aetna of CA Non-Gatekeeper |
$2,343.52
|
| Rate for Payer: Cash Price |
$1,637.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,463.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,463.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$658.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$909.75
|
| Rate for Payer: Multiplan Commercial |
$2,729.25
|
|
|
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: Aetna of CA Non-Gatekeeper |
$408.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800258
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.61 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: Adventist Health Commercial |
$85.60
|
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$264.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.61
|
| Rate for Payer: Blue Shield of California Commercial |
$199.39
|
| Rate for Payer: Blue Shield of California Commercial |
$199.39
|
| Rate for Payer: Blue Shield of California EPN |
$160.34
|
| Rate for Payer: Blue Shield of California EPN |
$160.34
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$88.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$278.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$264.93
|
| Rate for Payer: Heritage Provider Network Senior |
$84.18
|
| Rate for Payer: Heritage Provider Network Senior |
$264.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$204.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$171.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$171.12
|
| Rate for Payer: TriValley Medical Group Senior |
$171.12
|
| Rate for Payer: TriValley Medical Group Senior |
$171.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.33
|
| 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: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800258
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.47 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: Adventist Health Commercial |
$85.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$275.63
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$289.76
|
| Rate for Payer: Heritage Provider Network Senior |
$289.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.61 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$391.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.61
|
| Rate for Payer: Blue Shield of California Commercial |
$199.39
|
| Rate for Payer: Blue Shield of California Commercial |
$199.39
|
| Rate for Payer: Blue Shield of California EPN |
$160.34
|
| Rate for Payer: Blue Shield of California EPN |
$160.34
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$88.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.45
|
| Rate for Payer: Heritage Provider Network Senior |
$84.18
|
| Rate for Payer: Heritage Provider Network Senior |
$392.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$302.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$171.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$171.12
|
| Rate for Payer: TriValley Medical Group Senior |
$171.12
|
| Rate for Payer: TriValley Medical Group Senior |
$171.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.33
|
| 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: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
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: Aetna of CA Non-Gatekeeper |
$423.75
|
| Rate for Payer: Cash Price |
$296.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$445.47
|
| Rate for Payer: Heritage Provider Network Senior |
$445.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.50
|
| Rate for Payer: Multiplan Commercial |
$493.50
|
|
|
HC PERITONEOGRAM
|
Facility
|
OP
|
$658.00
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
909000190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$131.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$406.64
|
| 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 |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$296.10
|
| Rate for Payer: Cash Price |
$296.10
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$313.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$1,935.22
|
| Rate for Payer: Cash Price |
$1,352.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,034.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,034.38
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
OP
|
$3,005.00
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
909001474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$220.91 |
| Max. Negotiated Rate |
$2,253.75 |
| Rate for Payer: Adventist Health Commercial |
$601.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,857.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.08
|
| 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 |
$1,352.25
|
| Rate for Payer: Cash Price |
$1,352.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,953.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,772.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$702.78
|
| 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) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,433.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$808.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$751.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$2,253.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$702.78
|
| Rate for Payer: TriValley Medical Group Senior |
$702.78
|
| 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 |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$223.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$689.69
|
| 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 |
$13,770.00
|
| 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 |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$558.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$558.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$558.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$223.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$718.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| 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 Foundation Hospitals Commercial |
$558.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$558.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 PEROXIDASE STAIN
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.08 |
| Max. Negotiated Rate |
$1,554.36 |
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$652.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$236.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.08
|
| Rate for Payer: Blue Shield of California Commercial |
$338.21
|
| Rate for Payer: Blue Shield of California Commercial |
$338.21
|
| Rate for Payer: Blue Shield of California EPN |
$271.98
|
| Rate for Payer: Blue Shield of California EPN |
$271.98
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$686.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$248.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,036.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,036.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$653.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$237.08
|
| Rate for Payer: Heritage Provider Network Senior |
$653.66
|
| Rate for Payer: Heritage Provider Network Senior |
$237.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$503.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$182.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Multiplan Commercial |
$287.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,036.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,036.24
|
| Rate for Payer: TriValley Medical Group Senior |
$1,036.24
|
| Rate for Payer: TriValley Medical Group Senior |
$1,036.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$722.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$722.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$722.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$722.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
|
