|
HC SCL 70 AB
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913525
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$144.35 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.03
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.85
|
| Rate for Payer: Heritage Provider Network Senior |
$105.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.59
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SCL 70 AB
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913525
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.77
|
| Rate for Payer: Heritage Provider Network Senior |
$115.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION
|
Facility
|
IP
|
$3,879.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
909049185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$702.10 |
| Max. Negotiated Rate |
$2,909.25 |
| Rate for Payer: Adventist Health Commercial |
$775.80
|
| Rate for Payer: Cash Price |
$2,133.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,626.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,626.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$702.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$969.75
|
| Rate for Payer: Multiplan Commercial |
$2,909.25
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION
|
Facility
|
OP
|
$3,879.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
909049185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$775.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,664.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| 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 |
$2,133.45
|
| Rate for Payer: Cash Price |
$2,133.45
|
| Rate for Payer: Cash Price |
$2,133.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,521.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,401.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,491.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$702.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$969.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$2,909.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| 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 |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$177.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Senior |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$638.85
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$119.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$109.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
|
IP
|
$1,172.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$212.13 |
| Max. Negotiated Rate |
$879.00 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Cash Price |
$644.60
|
| Rate for Payer: Cash Price |
$644.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$793.44
|
| Rate for Payer: Heritage Provider Network Senior |
$793.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.00
|
| Rate for Payer: Multiplan Commercial |
$879.00
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$212.13 |
| Max. Negotiated Rate |
$3,301.97 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$805.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,301.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,655.33
|
| Rate for Payer: Cash Price |
$644.60
|
| Rate for Payer: Cash Price |
$644.60
|
| Rate for Payer: Cash Price |
$644.60
|
| Rate for Payer: Cash Price |
$644.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$559.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$879.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,113.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,113.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC SD RECOVERY ADDL 30 MIN
|
Facility
|
OP
|
$684.00
|
|
| Hospital Charge Code |
907201508
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$365.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$469.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$376.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$513.00
|
| Rate for Payer: Blue Shield of California Commercial |
$417.24
|
| Rate for Payer: Blue Shield of California EPN |
$333.79
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$444.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$581.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.40
|
| Rate for Payer: Dignity Health Senior |
$581.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$444.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.40
|
| Rate for Payer: Heritage Provider Network Senior |
$423.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$326.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.80
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$342.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$342.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.40
|
| Rate for Payer: Vantage Medical Group Senior |
$581.40
|
|
|
HC SD RECOVERY ADDL 30 MIN
|
Facility
|
IP
|
$684.00
|
|
| Hospital Charge Code |
907201508
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.07
|
| Rate for Payer: Heritage Provider Network Senior |
$463.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.00
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
|
|
HC SD RECOVERY LEVEL IV FIRST HR
|
Facility
|
IP
|
$1,628.00
|
|
| Hospital Charge Code |
906500107
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$294.67 |
| Max. Negotiated Rate |
$1,221.00 |
| Rate for Payer: Adventist Health Commercial |
$325.60
|
| Rate for Payer: Cash Price |
$895.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,102.16
|
| Rate for Payer: Heritage Provider Network Senior |
$1,102.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.00
|
| Rate for Payer: Multiplan Commercial |
$1,221.00
|
|
|
HC SD RECOVERY LEVEL IV FIRST HR
|
Facility
|
OP
|
$1,628.00
|
|
| Hospital Charge Code |
906500107
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$294.67 |
| Max. Negotiated Rate |
$1,383.80 |
| Rate for Payer: Adventist Health Commercial |
$325.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$870.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,118.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,383.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$895.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,221.00
|
| Rate for Payer: Blue Shield of California Commercial |
$993.08
|
| Rate for Payer: Blue Shield of California EPN |
$794.46
|
| Rate for Payer: Cash Price |
$895.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,058.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,383.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,383.80
|
| Rate for Payer: Dignity Health Senior |
$1,383.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,058.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,007.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,007.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$776.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,139.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,139.60
|
| Rate for Payer: Multiplan Commercial |
$1,221.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$814.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$814.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,383.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,383.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,383.80
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
OP
|
$16,468.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
909081845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$13,997.80 |
| Rate for Payer: Adventist Health Commercial |
$3,293.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,313.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,997.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,057.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,351.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$9,057.40
|
| Rate for Payer: Cash Price |
$9,057.40
|
| Rate for Payer: Cash Price |
$9,057.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,704.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,997.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,997.80
|
| Rate for Payer: Dignity Health Senior |
$13,997.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,193.69
|
| Rate for Payer: Heritage Provider Network Senior |
$10,193.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$577.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,855.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,980.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,117.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,527.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,527.60
|
| Rate for Payer: Multiplan Commercial |
$12,351.00
|
| 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 |
$13,997.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,997.80
|
| Rate for Payer: Vantage Medical Group Senior |
$13,997.80
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
OP
|
$14,320.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
906820199
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$12,172.00 |
| Rate for Payer: Adventist Health Commercial |
$2,864.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,837.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,876.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,740.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,308.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,172.00
|
| Rate for Payer: Dignity Health Senior |
$12,172.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,864.08
|
| Rate for Payer: Heritage Provider Network Senior |
$8,864.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$577.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,830.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,591.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,580.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,024.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,024.00
|
| Rate for Payer: Multiplan Commercial |
$10,740.00
|
| 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 |
$12,172.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,172.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,172.00
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
IP
|
$14,320.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
906820199
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,591.92 |
| Max. Negotiated Rate |
$10,740.00 |
| Rate for Payer: Adventist Health Commercial |
$2,864.00
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,694.64
|
| Rate for Payer: Heritage Provider Network Senior |
$9,694.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,591.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,580.00
|
| Rate for Payer: Multiplan Commercial |
$10,740.00
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
IP
|
$16,468.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
909081845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,980.71 |
| Max. Negotiated Rate |
$12,351.00 |
| Rate for Payer: Adventist Health Commercial |
$3,293.60
|
| Rate for Payer: Cash Price |
$9,057.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,148.84
|
| Rate for Payer: Heritage Provider Network Senior |
$11,148.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,980.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,117.00
|
| Rate for Payer: Multiplan Commercial |
$12,351.00
|
|
|
HC SEDATION EA ADDL 15 MIN
|
Facility
|
IP
|
$481.00
|
|
| Hospital Charge Code |
906820142
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$87.06 |
| Max. Negotiated Rate |
$360.75 |
| Rate for Payer: Adventist Health Commercial |
$96.20
|
| Rate for Payer: Cash Price |
$264.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$325.64
|
| Rate for Payer: Heritage Provider Network Senior |
$325.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.25
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
|
|
HC SEDATION EA ADDL 15 MIN
|
Facility
|
OP
|
$491.00
|
|
| Hospital Charge Code |
907201215
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$88.87 |
| Max. Negotiated Rate |
$417.35 |
| Rate for Payer: Adventist Health Commercial |
$98.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$262.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$337.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$417.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$270.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$368.25
|
| Rate for Payer: Blue Shield of California Commercial |
$299.51
|
| Rate for Payer: Blue Shield of California EPN |
$239.61
|
| Rate for Payer: Cash Price |
$270.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$319.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$417.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.35
|
| Rate for Payer: Dignity Health Senior |
$417.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$319.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$303.93
|
| Rate for Payer: Heritage Provider Network Senior |
$303.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$234.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$343.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$343.70
|
| Rate for Payer: Multiplan Commercial |
$368.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$245.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$245.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$417.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.35
|
| Rate for Payer: Vantage Medical Group Senior |
$417.35
|
|
|
HC SEDATION EA ADDL 15 MIN
|
Facility
|
IP
|
$491.00
|
|
| Hospital Charge Code |
907201215
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$88.87 |
| Max. Negotiated Rate |
$368.25 |
| Rate for Payer: Adventist Health Commercial |
$98.20
|
| Rate for Payer: Cash Price |
$270.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$332.41
|
| Rate for Payer: Heritage Provider Network Senior |
$332.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.75
|
| Rate for Payer: Multiplan Commercial |
$368.25
|
|
|
HC SEDATION EA ADDL 15 MIN
|
Facility
|
OP
|
$481.00
|
|
| Hospital Charge Code |
906820142
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$87.06 |
| Max. Negotiated Rate |
$408.85 |
| Rate for Payer: Adventist Health Commercial |
$96.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$257.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$330.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$408.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$360.75
|
| Rate for Payer: Blue Shield of California Commercial |
$293.41
|
| Rate for Payer: Blue Shield of California EPN |
$234.73
|
| Rate for Payer: Cash Price |
$264.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$312.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$408.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$408.85
|
| Rate for Payer: Dignity Health Senior |
$408.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$297.74
|
| Rate for Payer: Heritage Provider Network Senior |
$297.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$229.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$336.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$336.70
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$240.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$240.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$408.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$408.85
|
| Rate for Payer: Vantage Medical Group Senior |
$408.85
|
|
|
HC SEDATION GT 5 YRS FIRST 15 MIN
|
Facility
|
OP
|
$1,292.00
|
|
| Hospital Charge Code |
907201214
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$233.85 |
| Max. Negotiated Rate |
$1,098.20 |
| Rate for Payer: Adventist Health Commercial |
$258.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$690.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$887.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,098.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$710.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$969.00
|
| Rate for Payer: Blue Shield of California Commercial |
$788.12
|
| Rate for Payer: Blue Shield of California EPN |
$630.50
|
| Rate for Payer: Cash Price |
$710.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$839.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,098.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,098.20
|
| Rate for Payer: Dignity Health Senior |
$1,098.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$839.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$799.75
|
| Rate for Payer: Heritage Provider Network Senior |
$799.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$616.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$904.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.40
|
| Rate for Payer: Multiplan Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$646.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$646.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,098.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,098.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,098.20
|
|
|
HC SEDATION GT 5 YRS FIRST 15 MIN
|
Facility
|
IP
|
$1,292.00
|
|
| Hospital Charge Code |
907201214
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$233.85 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Adventist Health Commercial |
$258.40
|
| Rate for Payer: Cash Price |
$710.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.68
|
| Rate for Payer: Heritage Provider Network Senior |
$874.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.00
|
| Rate for Payer: Multiplan Commercial |
$969.00
|
|
|
HC SEDATION GT 5 YRS FIRST 30 MIN
|
Facility
|
OP
|
$869.00
|
|
| Hospital Charge Code |
906820141
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$738.65 |
| Rate for Payer: Adventist Health Commercial |
$173.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$464.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$597.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$477.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$651.75
|
| Rate for Payer: Blue Shield of California Commercial |
$530.09
|
| Rate for Payer: Blue Shield of California EPN |
$424.07
|
| Rate for Payer: Cash Price |
$477.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$564.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$738.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$738.65
|
| Rate for Payer: Dignity Health Senior |
$738.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$564.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$537.91
|
| Rate for Payer: Heritage Provider Network Senior |
$537.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$414.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.30
|
| Rate for Payer: Multiplan Commercial |
$651.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$434.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$434.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$738.65
|
| Rate for Payer: Vantage Medical Group Senior |
$738.65
|
|
|
HC SEDATION GT 5 YRS FIRST 30 MIN
|
Facility
|
IP
|
$869.00
|
|
| Hospital Charge Code |
906820141
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$651.75 |
| Rate for Payer: Adventist Health Commercial |
$173.80
|
| Rate for Payer: Cash Price |
$477.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$588.31
|
| Rate for Payer: Heritage Provider Network Senior |
$588.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.25
|
| Rate for Payer: Multiplan Commercial |
$651.75
|
|
|
HC SEDATION LT 5 YRS FIRST 15 MIN
|
Facility
|
IP
|
$1,292.00
|
|
| Hospital Charge Code |
907201213
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$233.85 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Adventist Health Commercial |
$258.40
|
| Rate for Payer: Cash Price |
$710.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.68
|
| Rate for Payer: Heritage Provider Network Senior |
$874.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.00
|
| Rate for Payer: Multiplan Commercial |
$969.00
|
|
