|
HC RECOVERY LEVL II EA ADDL 30 MIN
|
Facility
|
OP
|
$907.00
|
|
| Hospital Charge Code |
907201704
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$164.17 |
| Max. Negotiated Rate |
$770.95 |
| Rate for Payer: Adventist Health Commercial |
$181.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$560.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$770.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$498.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$680.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.68
|
| Rate for Payer: Blue Shield of California Commercial |
$553.27
|
| Rate for Payer: Blue Shield of California EPN |
$442.62
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$589.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$770.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$770.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$770.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$561.43
|
| Rate for Payer: Heritage Provider Network Senior |
$561.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$432.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$634.90
|
| Rate for Payer: Multiplan Commercial |
$680.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$453.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$453.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$770.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$770.95
|
| Rate for Payer: Vantage Medical Group Senior |
$770.95
|
|
|
HC RECOVERY LEVL IV EA ADDL 30 MIN
|
Facility
|
OP
|
$1,507.00
|
|
| Hospital Charge Code |
907201708
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$272.77 |
| Max. Negotiated Rate |
$1,280.95 |
| Rate for Payer: Adventist Health Commercial |
$301.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$931.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,280.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$828.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,130.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$753.80
|
| Rate for Payer: Blue Shield of California Commercial |
$919.27
|
| Rate for Payer: Blue Shield of California EPN |
$735.42
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$979.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,280.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,280.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,280.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$932.83
|
| Rate for Payer: Heritage Provider Network Senior |
$932.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$718.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$272.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,054.90
|
| Rate for Payer: Multiplan Commercial |
$1,130.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$753.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$753.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,280.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,280.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,280.95
|
|
|
HC RECOVERY LEVL IV EA ADDL 30 MIN
|
Facility
|
IP
|
$1,507.00
|
|
| Hospital Charge Code |
907201708
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$272.77 |
| Max. Negotiated Rate |
$1,130.25 |
| Rate for Payer: Adventist Health Commercial |
$301.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$970.51
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,020.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1,020.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$272.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.75
|
| Rate for Payer: Multiplan Commercial |
$1,130.25
|
|
|
HC RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 91124
|
| Hospital Charge Code |
906791120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$110.59 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$393.48
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$413.65
|
| Rate for Payer: Heritage Provider Network Senior |
$413.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.75
|
| Rate for Payer: Multiplan Commercial |
$458.25
|
|
|
HC RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 91124
|
| Hospital Charge Code |
906791120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$110.59 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$377.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$165.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.62
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| 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: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$397.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$174.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$277.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$277.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$378.21
|
| Rate for Payer: Heritage Provider Network Senior |
$341.58
|
| Rate for Payer: Heritage Provider Network Senior |
$341.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$127.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$291.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Multiplan Commercial |
$458.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$134.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$305.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$305.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$134.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC RED CELL MASS
|
Facility
|
OP
|
$1,802.00
|
|
|
Service Code
|
CPT 78122
|
| Hospital Charge Code |
909301332
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$326.16 |
| Max. Negotiated Rate |
$1,351.50 |
| Rate for Payer: Adventist Health Commercial |
$360.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,113.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$901.36
|
| Rate for Payer: Blue Shield of California Commercial |
$967.87
|
| Rate for Payer: Blue Shield of California EPN |
$778.33
|
| Rate for Payer: Cash Price |
$810.90
|
| Rate for Payer: Cash Price |
$810.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,171.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,171.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$698.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,115.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1,115.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$859.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$803.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$1,351.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$768.18
|
| Rate for Payer: TriValley Medical Group Senior |
$698.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$901.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$901.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC RED CELL MASS
|
Facility
|
IP
|
$1,802.00
|
|
|
Service Code
|
CPT 78122
|
| Hospital Charge Code |
909301332
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$326.16 |
| Max. Negotiated Rate |
$1,351.50 |
| Rate for Payer: Adventist Health Commercial |
$360.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,160.49
|
| Rate for Payer: Cash Price |
$810.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,219.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1,219.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.50
|
| Rate for Payer: Multiplan Commercial |
$1,351.50
|
|
|
HC RED CELL SUR/HEP SEQ
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
CPT 78140
|
| Hospital Charge Code |
909301336
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$269.33 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$919.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$744.30
|
| Rate for Payer: Blue Shield of California Commercial |
$828.24
|
| Rate for Payer: Blue Shield of California EPN |
$666.04
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$967.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$921.07
|
| Rate for Payer: Heritage Provider Network Senior |
$921.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$709.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$269.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$744.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$744.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC RED CELL SUR/HEP SEQ
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT 78140
|
| Hospital Charge Code |
909301336
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$269.33 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$958.27
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,007.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,007.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$269.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.00
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
|
|
HC RED CELL SURVIVAL
|
Facility
|
IP
|
$1,358.00
|
|
|
Service Code
|
CPT 78130
|
| Hospital Charge Code |
909301334
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$245.80 |
| Max. Negotiated Rate |
$1,018.50 |
| Rate for Payer: Adventist Health Commercial |
$271.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$874.55
|
| Rate for Payer: Cash Price |
$611.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$919.37
|
| Rate for Payer: Heritage Provider Network Senior |
$919.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.50
|
| Rate for Payer: Multiplan Commercial |
$1,018.50
|
|
|
HC RED CELL SURVIVAL
|
Facility
|
OP
|
$1,358.00
|
|
|
Service Code
|
CPT 78130
|
| Hospital Charge Code |
909301334
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$245.80 |
| Max. Negotiated Rate |
$1,018.50 |
| Rate for Payer: Adventist Health Commercial |
$271.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$839.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$679.27
|
| Rate for Payer: Blue Shield of California Commercial |
$597.94
|
| Rate for Payer: Blue Shield of California EPN |
$480.84
|
| Rate for Payer: Cash Price |
$611.10
|
| Rate for Payer: Cash Price |
$611.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$882.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$882.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$840.60
|
| Rate for Payer: Heritage Provider Network Senior |
$840.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$647.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,018.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$679.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$679.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC RED CELL SURV - SEQ
|
Facility
|
IP
|
$1,358.00
|
|
|
Service Code
|
CPT 78135
|
| Hospital Charge Code |
909301335
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$245.80 |
| Max. Negotiated Rate |
$1,018.50 |
| Rate for Payer: Adventist Health Commercial |
$271.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$874.55
|
| Rate for Payer: Cash Price |
$611.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$919.37
|
| Rate for Payer: Heritage Provider Network Senior |
$919.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.50
|
| Rate for Payer: Multiplan Commercial |
$1,018.50
|
|
|
HC RED CELL SURV - SEQ
|
Facility
|
OP
|
$1,358.00
|
|
|
Service Code
|
CPT 78135
|
| Hospital Charge Code |
909301335
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$245.80 |
| Max. Negotiated Rate |
$1,154.30 |
| Rate for Payer: Adventist Health Commercial |
$271.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$839.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,154.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$746.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,018.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$679.27
|
| Rate for Payer: Blue Shield of California Commercial |
$828.38
|
| Rate for Payer: Blue Shield of California EPN |
$662.70
|
| Rate for Payer: Cash Price |
$611.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$882.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,154.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,154.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,154.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$882.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$840.60
|
| Rate for Payer: Heritage Provider Network Senior |
$840.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$647.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$950.60
|
| Rate for Payer: Multiplan Commercial |
$1,018.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$679.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$679.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,154.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,154.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,154.30
|
|
|
HC RED OF PROCIDENTIA UND ANESTH
|
Facility
|
IP
|
$1,404.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
900501155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$254.12 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$904.18
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$950.51
|
| Rate for Payer: Heritage Provider Network Senior |
$950.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$254.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
|
|
HC RED OF PROCIDENTIA UND ANESTH
|
Facility
|
OP
|
$1,404.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
900501155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$254.12 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$867.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$666.90
|
| Rate for Payer: Blue Shield of California EPN |
$530.71
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$912.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,196.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$950.51
|
| Rate for Payer: Heritage Provider Network Senior |
$950.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$669.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$254.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,375.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$842.40
|
| Rate for Payer: TriValley Medical Group Senior |
$842.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
HC REDUCING SUBSTANCE
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
900910318
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.03
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.90
|
| Rate for Payer: Heritage Provider Network Senior |
$58.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
|
|
HC REDUCING SUBSTANCE
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
900910318
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.52
|
| Rate for Payer: Blue Shield of California Commercial |
$17.45
|
| Rate for Payer: Blue Shield of California Commercial |
$17.45
|
| Rate for Payer: Blue Shield of California EPN |
$14.00
|
| Rate for Payer: Blue Shield of California EPN |
$14.00
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.17
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.85
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$53.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.17
|
| Rate for Payer: TriValley Medical Group Senior |
$2.17
|
| Rate for Payer: TriValley Medical Group Senior |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2.17
|
| Rate for Payer: Vantage Medical Group Senior |
$2.17
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$1,002.75 |
| Rate for Payer: Adventist Health Commercial |
$267.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$861.03
|
| Rate for Payer: Cash Price |
$601.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$905.15
|
| Rate for Payer: Heritage Provider Network Senior |
$905.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$242.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.25
|
| Rate for Payer: Multiplan Commercial |
$1,002.75
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$267.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$826.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$635.08
|
| Rate for Payer: Blue Shield of California EPN |
$505.39
|
| Rate for Payer: Cash Price |
$601.65
|
| Rate for Payer: Cash Price |
$601.65
|
| Rate for Payer: Cash Price |
$601.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$869.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,068.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$905.15
|
| Rate for Payer: Heritage Provider Network Senior |
$905.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$637.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$242.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$1,002.75
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$802.20
|
| Rate for Payer: TriValley Medical Group Senior |
$802.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
|
OP
|
$892.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.33 |
| Max. Negotiated Rate |
$669.00 |
| Rate for Payer: Adventist Health Commercial |
$178.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$551.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.76
|
| Rate for Payer: Blue Shield of California Commercial |
$541.39
|
| Rate for Payer: Blue Shield of California EPN |
$435.37
|
| Rate for Payer: Cash Price |
$401.40
|
| Rate for Payer: Cash Price |
$401.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$579.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$526.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$552.15
|
| Rate for Payer: Heritage Provider Network Senior |
$552.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$425.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$161.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$669.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.59
|
| Rate for Payer: TriValley Medical Group Senior |
$225.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
|
IP
|
$892.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.45 |
| Max. Negotiated Rate |
$669.00 |
| Rate for Payer: Adventist Health Commercial |
$178.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$574.45
|
| Rate for Payer: Cash Price |
$401.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$603.88
|
| Rate for Payer: Heritage Provider Network Senior |
$603.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$161.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.00
|
| Rate for Payer: Multiplan Commercial |
$669.00
|
|
|
HC REFILL/MAIN IMPL PUMP/RESV
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 95990
|
| Hospital Charge Code |
911801003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$394.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$424.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$394.92
|
| Rate for Payer: Heritage Provider Network Senior |
$394.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$424.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$304.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$488.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$467.31
|
| Rate for Payer: TriValley Medical Group Senior |
$424.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$764.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$641.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC REFILL/MAIN IMPL PUMP/RESV
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 95990
|
| Hospital Charge Code |
911801003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$478.50 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$410.87
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$431.93
|
| Rate for Payer: Heritage Provider Network Senior |
$431.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
IP
|
$10,302.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,864.66 |
| Max. Negotiated Rate |
$7,726.50 |
| Rate for Payer: Adventist Health Commercial |
$2,060.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,634.49
|
| Rate for Payer: Cash Price |
$4,635.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,974.45
|
| Rate for Payer: Heritage Provider Network Senior |
$6,974.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,864.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,575.50
|
| Rate for Payer: Multiplan Commercial |
$7,726.50
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
OP
|
$10,302.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,864.66 |
| Max. Negotiated Rate |
$7,726.50 |
| Rate for Payer: Adventist Health Commercial |
$2,060.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,366.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,893.45
|
| Rate for Payer: Blue Shield of California EPN |
$3,894.16
|
| Rate for Payer: Cash Price |
$4,635.90
|
| Rate for Payer: Cash Price |
$4,635.90
|
| Rate for Payer: Cash Price |
$4,635.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,696.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,696.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,968.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,974.45
|
| Rate for Payer: Heritage Provider Network Senior |
$6,974.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,914.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,864.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,413.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,575.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$7,726.50
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,181.20
|
| Rate for Payer: TriValley Medical Group Senior |
$6,181.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
