|
HC ROOM TRAUMA DOU/INTEREDIATE ISOLATION
|
Facility
|
IP
|
$13,214.00
|
|
| Hospital Charge Code |
902311719
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,391.73 |
| Max. Negotiated Rate |
$9,910.50 |
| Rate for Payer: Adventist Health Commercial |
$2,642.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$7,267.70
|
| Rate for Payer: Cash Price |
$7,267.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,606.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,758.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,418.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,434.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,391.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,303.50
|
| Rate for Payer: Multiplan Commercial |
$9,910.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM TRAUMA DOU/INTERMEDIATE
|
Facility
|
IP
|
$11,027.00
|
|
| Hospital Charge Code |
902311717
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,995.89 |
| Max. Negotiated Rate |
$8,270.25 |
| Rate for Payer: Adventist Health Commercial |
$2,205.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$6,064.85
|
| Rate for Payer: Cash Price |
$6,064.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,606.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,758.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,418.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,434.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,995.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,756.75
|
| Rate for Payer: Multiplan Commercial |
$8,270.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM TRAUMA ICU
|
Facility
|
IP
|
$30,363.00
|
|
| Hospital Charge Code |
902314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$22,772.25 |
| Rate for Payer: Adventist Health Commercial |
$6,072.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,166.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$16,699.65
|
| Rate for Payer: Cash Price |
$16,699.65
|
| Rate for Payer: Cash Price |
$16,699.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,495.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,590.75
|
| Rate for Payer: Multiplan Commercial |
$22,772.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM TRAUMA ICU 1:1
|
Facility
|
IP
|
$30,363.00
|
|
| Hospital Charge Code |
992314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$22,772.25 |
| Rate for Payer: Adventist Health Commercial |
$6,072.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,166.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$16,699.65
|
| Rate for Payer: Cash Price |
$16,699.65
|
| Rate for Payer: Cash Price |
$16,699.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,495.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,590.75
|
| Rate for Payer: Multiplan Commercial |
$22,772.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM TRAUMA ICU ISOLATION
|
Facility
|
IP
|
$28,732.00
|
|
| Hospital Charge Code |
902314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$21,549.00 |
| Rate for Payer: Adventist Health Commercial |
$5,746.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,166.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$15,802.60
|
| Rate for Payer: Cash Price |
$15,802.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,183.00
|
| Rate for Payer: Multiplan Commercial |
$21,549.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM TRAUMA ICU ISOLATION 1:1
|
Facility
|
IP
|
$28,732.00
|
|
| Hospital Charge Code |
992314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$21,549.00 |
| Rate for Payer: Adventist Health Commercial |
$5,746.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,166.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$15,802.60
|
| Rate for Payer: Cash Price |
$15,802.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,183.00
|
| Rate for Payer: Multiplan Commercial |
$21,549.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
|
IP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,056.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$884.80
|
| Rate for Payer: Blue Shield of California EPN |
$884.80
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,012.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,188.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,019.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,019.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,100.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,100.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,100.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.25
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$795.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$728.75
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
|
OP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,056.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,512.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$884.80
|
| Rate for Payer: Blue Shield of California EPN |
$884.80
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,012.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.85
|
| Rate for Payer: Dignity Health Senior |
$1,870.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,408.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,019.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,019.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,100.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,100.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,100.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,540.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,540.70
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$795.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$728.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.85
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.83 |
| Max. Negotiated Rate |
$454.75 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$285.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$367.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$401.25
|
| Rate for Payer: Blue Shield of California Commercial |
$326.35
|
| Rate for Payer: Blue Shield of California EPN |
$261.08
|
| Rate for Payer: Cash Price |
$294.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$347.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$454.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$454.75
|
| Rate for Payer: Dignity Health Senior |
$454.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$331.17
|
| Rate for Payer: Heritage Provider Network Senior |
$331.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$255.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$374.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$374.50
|
| Rate for Payer: Multiplan Commercial |
$401.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$267.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$267.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$454.75
|
| Rate for Payer: Vantage Medical Group Senior |
$454.75
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.83 |
| Max. Negotiated Rate |
$401.25 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Cash Price |
$294.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$362.19
|
| Rate for Payer: Heritage Provider Network Senior |
$362.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.75
|
| Rate for Payer: Multiplan Commercial |
$401.25
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
|
IP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.12 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$950.51
|
| Rate for Payer: Heritage Provider Network Senior |
$950.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
|
OP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.12 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$750.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$964.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$772.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,053.00
|
| Rate for Payer: Blue Shield of California Commercial |
$856.44
|
| Rate for Payer: Blue Shield of California EPN |
$685.15
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$912.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,193.40
|
| Rate for Payer: Dignity Health Senior |
$1,193.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$912.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$869.08
|
| Rate for Payer: Heritage Provider Network Senior |
$869.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$669.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$982.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$982.80
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$702.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$702.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,193.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,193.40
|
|
|
HC ROTOVIRUS AG
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.44
|
| Rate for Payer: Heritage Provider Network Senior |
$116.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
|
|
HC ROTOVIRUS AG
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.05
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.47
|
| Rate for Payer: Heritage Provider Network Senior |
$106.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC ROUTINE URINALYSIS
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
900910167
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$72.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.90
|
| Rate for Payer: Blue Shield of California Commercial |
$25.52
|
| Rate for Payer: Blue Shield of California EPN |
$20.47
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.49
|
| Rate for Payer: Dignity Health Senior |
$3.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.56
|
| Rate for Payer: Heritage Provider Network Senior |
$83.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$64.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.99
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.17
|
| Rate for Payer: TriValley Medical Group Senior |
$3.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
HC ROUTINE URINALYSIS
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
900910167
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.39
|
| Rate for Payer: Heritage Provider Network Senior |
$91.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
|
|
HC RPLCMT TRICUSPID VALVE W CARDIOPLMNRY BYPASS
|
Facility
|
IP
|
$48,473.00
|
|
|
Service Code
|
CPT 33465
|
| Hospital Charge Code |
906813465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,773.61 |
| Max. Negotiated Rate |
$36,354.75 |
| Rate for Payer: Adventist Health Commercial |
$9,694.60
|
| Rate for Payer: Cash Price |
$26,660.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$32,816.22
|
| Rate for Payer: Heritage Provider Network Senior |
$32,816.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,773.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,118.25
|
| Rate for Payer: Multiplan Commercial |
$36,354.75
|
|
|
HC RPLCMT TRICUSPID VALVE W CARDIOPLMNRY BYPASS
|
Facility
|
OP
|
$48,473.00
|
|
|
Service Code
|
CPT 33465
|
| Hospital Charge Code |
906813465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$41,202.05 |
| Rate for Payer: Adventist Health Commercial |
$9,694.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,300.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,202.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,660.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,354.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| 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 |
$26,660.15
|
| Rate for Payer: Cash Price |
$26,660.15
|
| Rate for Payer: Cash Price |
$26,660.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31,507.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,202.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,202.05
|
| Rate for Payer: Dignity Health Senior |
$41,202.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,004.79
|
| Rate for Payer: Heritage Provider Network Senior |
$30,004.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,136.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23,121.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,773.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,118.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,931.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,931.10
|
| Rate for Payer: Multiplan Commercial |
$36,354.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41,202.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,202.05
|
| Rate for Payer: Vantage Medical Group Senior |
$41,202.05
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.11 |
| Max. Negotiated Rate |
$816.75 |
| Rate for Payer: Adventist Health Commercial |
$217.80
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.25
|
| Rate for Payer: Heritage Provider Network Senior |
$737.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.25
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$217.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$748.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$707.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Senior |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$309.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.25
|
| Rate for Payer: Heritage Provider Network Senior |
$737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$519.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.37
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$391.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$360.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$217.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$748.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| 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 |
$598.95
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$707.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Senior |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$309.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$674.09
|
| Rate for Payer: Heritage Provider Network Senior |
$380.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$332.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$519.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.37
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$197.11 |
| Max. Negotiated Rate |
$816.75 |
| Rate for Payer: Adventist Health Commercial |
$217.80
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.25
|
| Rate for Payer: Heritage Provider Network Senior |
$737.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.25
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
|
|
HC RPL GTUBE REQ REV GSTRST TRC
|
Facility
|
OP
|
$664.00
|
|
|
Service Code
|
CPT 43763
|
| Hospital Charge Code |
906043763
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$132.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$456.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| 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 |
$365.20
|
| Rate for Payer: Cash Price |
$365.20
|
| Rate for Payer: Cash Price |
$365.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$431.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Senior |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$309.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$411.02
|
| Rate for Payer: Heritage Provider Network Senior |
$380.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$316.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.37
|
| Rate for Payer: Multiplan Commercial |
$498.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC RPL GTUBE REQ REV GSTRST TRC
|
Facility
|
IP
|
$664.00
|
|
|
Service Code
|
CPT 43763
|
| Hospital Charge Code |
906043763
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$120.18 |
| Max. Negotiated Rate |
$498.00 |
| Rate for Payer: Adventist Health Commercial |
$132.80
|
| Rate for Payer: Cash Price |
$365.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$449.53
|
| Rate for Payer: Heritage Provider Network Senior |
$449.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.00
|
| Rate for Payer: Multiplan Commercial |
$498.00
|
|
|
HC RPOS PRV CCM DFIB TRNSVNS ELTRD
|
Facility
|
OP
|
$1,784.00
|
|
|
Service Code
|
CPT 0924T
|
| Hospital Charge Code |
906811512
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$356.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,225.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| 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 |
$981.20
|
| Rate for Payer: Cash Price |
$981.20
|
| Rate for Payer: Cash Price |
$981.20
|
| Rate for Payer: Cash Price |
$981.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,159.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Senior |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$785.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,104.30
|
| Rate for Payer: Heritage Provider Network Senior |
$966.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,492.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$903.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.81
|
| Rate for Payer: Multiplan Commercial |
$1,338.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$864.12
|
| Rate for Payer: TriValley Medical Group Senior |
$785.56
|
| 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 |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
