|
HC SIGMOIDOSCOPY W STENT PLCMNT
|
Facility
|
OP
|
$5,143.00
|
|
|
Service Code
|
CPT 45347
|
| Hospital Charge Code |
906745347
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$11,712.28 |
| Rate for Payer: Adventist Health Commercial |
$1,028.60
|
| Rate for Payer: Adventist Health Commercial |
$884.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,734.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,178.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California 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 |
$2,314.35
|
| Rate for Payer: Cash Price |
$2,314.35
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$2,314.35
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,875.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,342.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,808.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,808.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,183.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,738.46
|
| Rate for Payer: Heritage Provider Network Senior |
$9,604.07
|
| Rate for Payer: Heritage Provider Network Senior |
$9,604.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,110.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,453.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$930.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$800.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,979.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,979.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,106.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Multiplan Commercial |
$3,857.25
|
| Rate for Payer: Multiplan Commercial |
$3,318.00
|
| 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 |
$3,544.00
|
| 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: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
|
|
HC SIGMOIDOSCOPY W SUBMUC INJ
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
906745335
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$268.79 |
| Max. Negotiated Rate |
$1,113.75 |
| Rate for Payer: Adventist Health Commercial |
$297.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$956.34
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,005.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,005.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$268.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
|
|
HC SIGMOIDOSCOPY W SUBMUC INJ
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
906745335
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$268.79 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$297.00
|
| Rate for Payer: Adventist Health Commercial |
$277.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$857.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$917.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| 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 Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California 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 |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$902.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$965.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| 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 Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| 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 Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,196.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,196.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$919.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$859.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,471.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,471.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$662.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$708.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$268.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,375.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,375.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Multiplan Commercial |
$1,041.00
|
| 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 |
$2,731.00
|
| 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: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| 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 Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
HC SIGMOIDSCPY FLX DIAG W BND LIG
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
CPT 45350
|
| Hospital Charge Code |
906745350
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$398.20 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Adventist Health Commercial |
$440.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,416.80
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,489.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,489.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$398.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.00
|
| Rate for Payer: Multiplan Commercial |
$1,650.00
|
|
|
HC SIGMOIDSCPY FLX DIAG W BND LIG
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
CPT 45350
|
| Hospital Charge Code |
906745350
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$398.20 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$440.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,359.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,430.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,539.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,361.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1,893.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,049.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$398.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,769.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$1,650.00
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
HC SILVERBIRCHE
|
Facility
|
OP
|
$8.87
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913721
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$150.09 |
| Rate for Payer: Adventist Health Commercial |
$1.77
|
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.09
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.49
|
| Rate for Payer: Heritage Provider Network Senior |
$4.57
|
| Rate for Payer: Heritage Provider Network Senior |
$5.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$5.54
|
| Rate for Payer: Multiplan Commercial |
$6.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SILVERBIRCHE
|
Facility
|
IP
|
$8.87
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913721
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Adventist Health Commercial |
$1.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.71
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Senior |
$6.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: Multiplan Commercial |
$6.65
|
|
|
HC SILVERHAWK THROMB CATH
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$746.62 |
| Max. Negotiated Rate |
$3,093.75 |
| Rate for Payer: Adventist Health Commercial |
$825.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,656.50
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,792.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2,792.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$746.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,031.25
|
| Rate for Payer: Multiplan Commercial |
$3,093.75
|
|
|
HC SILVERHAWK THROMB CATH
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$746.62 |
| Max. Negotiated Rate |
$3,506.25 |
| Rate for Payer: Adventist Health Commercial |
$825.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,549.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,268.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,093.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,063.32
|
| Rate for Payer: Blue Shield of California Commercial |
$2,516.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,013.00
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,681.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,506.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,506.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,433.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,553.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,553.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,967.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$746.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,031.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,887.50
|
| Rate for Payer: Multiplan Commercial |
$3,093.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,062.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,062.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,506.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,506.25
|
|
|
HC SIMP REP SUP WND 12.6-20.0 CM
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
900501023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$228.97 |
| Max. Negotiated Rate |
$948.75 |
| Rate for Payer: Adventist Health Commercial |
$253.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$814.66
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$856.40
|
| Rate for Payer: Heritage Provider Network Senior |
$856.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$228.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.25
|
| Rate for Payer: Multiplan Commercial |
$948.75
|
|
|
HC SIMP REP SUP WND 12.6-20.0 CM
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
900501023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$228.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$253.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$781.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$600.88
|
| Rate for Payer: Blue Shield of California EPN |
$478.17
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$822.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$856.40
|
| Rate for Payer: Heritage Provider Network Senior |
$856.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$603.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$228.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$948.75
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$759.00
|
| Rate for Payer: TriValley Medical Group Senior |
$759.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC SIMP REP SUP WND 20.1-30.0 CM
|
Facility
|
OP
|
$1,395.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
900501408
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$252.50 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$279.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$862.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$662.62
|
| Rate for Payer: Blue Shield of California EPN |
$527.31
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$906.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$944.41
|
| Rate for Payer: Heritage Provider Network Senior |
$944.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$665.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$252.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,046.25
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$837.00
|
| Rate for Payer: TriValley Medical Group Senior |
$837.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC SIMP REP SUP WND 20.1-30.0 CM
|
Facility
|
IP
|
$1,395.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
900501408
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$252.50 |
| Max. Negotiated Rate |
$1,046.25 |
| Rate for Payer: Adventist Health Commercial |
$279.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$898.38
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$944.41
|
| Rate for Payer: Heritage Provider Network Senior |
$944.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$252.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.75
|
| Rate for Payer: Multiplan Commercial |
$1,046.25
|
|
|
HC SIMP REP SUP WND 2.6 - 5.0 CM
|
Facility
|
IP
|
$1,107.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
900501026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.37 |
| Max. Negotiated Rate |
$830.25 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$712.91
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.44
|
| Rate for Payer: Heritage Provider Network Senior |
$749.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$200.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.75
|
| Rate for Payer: Multiplan Commercial |
$830.25
|
|
|
HC SIMP REP SUP WND 2.6 - 5.0 CM
|
Facility
|
OP
|
$1,107.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
900501026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.37 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$684.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$525.83
|
| Rate for Payer: Blue Shield of California EPN |
$418.45
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$719.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.44
|
| Rate for Payer: Heritage Provider Network Senior |
$749.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$528.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$200.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$830.25
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$664.20
|
| Rate for Payer: TriValley Medical Group Senior |
$664.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND 2.6-7.5 CM
|
Facility
|
IP
|
$966.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
900501021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.85 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Adventist Health Commercial |
$193.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$622.10
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$653.98
|
| Rate for Payer: Heritage Provider Network Senior |
$653.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.50
|
| Rate for Payer: Multiplan Commercial |
$724.50
|
|
|
HC SIMP REP SUP WND 2.6-7.5 CM
|
Facility
|
OP
|
$966.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
900501021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.85 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$193.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$596.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$458.85
|
| Rate for Payer: Blue Shield of California EPN |
$365.15
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$627.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$653.98
|
| Rate for Payer: Heritage Provider Network Senior |
$653.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$460.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$724.50
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$579.60
|
| Rate for Payer: TriValley Medical Group Senior |
$579.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND 5.1 - 7.5 CM
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
900501027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.17 |
| Max. Negotiated Rate |
$924.75 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$794.05
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$834.74
|
| Rate for Payer: Heritage Provider Network Senior |
$834.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$223.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.25
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
|
|
HC SIMP REP SUP WND 5.1 - 7.5 CM
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
900501027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.17 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$761.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$585.67
|
| Rate for Payer: Blue Shield of California EPN |
$466.07
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$801.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$834.74
|
| Rate for Payer: Heritage Provider Network Senior |
$834.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$588.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$223.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$739.80
|
| Rate for Payer: TriValley Medical Group Senior |
$739.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND 7.6 - 12.5 CM
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
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: Aetna of CA Non-Gatekeeper |
$701.32
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.25
|
| Rate for Payer: Heritage Provider Network Senior |
$737.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.25
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
|
|
HC SIMP REP SUP WND 7.6 - 12.5 CM
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.11 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$217.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$673.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$517.27
|
| Rate for Payer: Blue Shield of California EPN |
$411.64
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$707.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| 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) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$519.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$653.40
|
| Rate for Payer: TriValley Medical Group Senior |
$653.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND 7.6-12.5CM FACE
|
Facility
|
IP
|
$1,356.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.44 |
| Max. Negotiated Rate |
$1,017.00 |
| Rate for Payer: Adventist Health Commercial |
$271.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$873.26
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$918.01
|
| Rate for Payer: Heritage Provider Network Senior |
$918.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.00
|
| Rate for Payer: Multiplan Commercial |
$1,017.00
|
|
|
HC SIMP REP SUP WND 7.6-12.5CM FACE
|
Facility
|
OP
|
$1,356.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.44 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$271.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$838.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$644.10
|
| Rate for Payer: Blue Shield of California EPN |
$512.57
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$881.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$918.01
|
| Rate for Payer: Heritage Provider Network Senior |
$918.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$646.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,017.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$813.60
|
| Rate for Payer: TriValley Medical Group Senior |
$813.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND GT 30.0CM
|
Facility
|
OP
|
$1,931.00
|
|
|
Service Code
|
CPT 12018
|
| Hospital Charge Code |
900501732
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$386.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,193.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$917.23
|
| Rate for Payer: Blue Shield of California EPN |
$729.92
|
| Rate for Payer: Cash Price |
$868.95
|
| Rate for Payer: Cash Price |
$868.95
|
| Rate for Payer: Cash Price |
$868.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,255.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,307.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,307.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$921.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$349.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,448.25
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,158.60
|
| Rate for Payer: TriValley Medical Group Senior |
$1,158.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND GT 30.0CM
|
Facility
|
IP
|
$1,931.00
|
|
|
Service Code
|
CPT 12018
|
| Hospital Charge Code |
900501732
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$349.51 |
| Max. Negotiated Rate |
$1,448.25 |
| Rate for Payer: Adventist Health Commercial |
$386.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,243.56
|
| Rate for Payer: Cash Price |
$868.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,307.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,307.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$349.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.75
|
| Rate for Payer: Multiplan Commercial |
$1,448.25
|
|
