|
HC US GUIDE VISCERAL TISS ABLATN
|
Facility
|
OP
|
$1,383.00
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
909001920
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$140.90 |
| Max. Negotiated Rate |
$1,175.55 |
| Rate for Payer: Adventist Health Commercial |
$276.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$140.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$950.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,175.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$760.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.25
|
| Rate for Payer: Blue Shield of California Commercial |
$338.78
|
| Rate for Payer: Blue Shield of California EPN |
$192.66
|
| Rate for Payer: Cash Price |
$622.35
|
| Rate for Payer: Cash Price |
$622.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$898.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,175.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,175.55
|
| Rate for Payer: Dignity Health Senior |
$1,175.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$898.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$856.08
|
| Rate for Payer: Heritage Provider Network Senior |
$856.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$217.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$666.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.75
|
| Rate for Payer: Multiplan Commercial |
$1,037.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,175.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,175.55
|
|
|
HC US GUIDE VISCERAL TISS ABLATN
|
Facility
|
IP
|
$1,383.00
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
909001920
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$250.32 |
| Max. Negotiated Rate |
$1,037.25 |
| Rate for Payer: Adventist Health Commercial |
$276.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$950.12
|
| Rate for Payer: Cash Price |
$622.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$936.29
|
| Rate for Payer: Heritage Provider Network Senior |
$936.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.75
|
| Rate for Payer: Multiplan Commercial |
$1,037.25
|
|
|
HC US SOFT TISS EXT COMP
|
Facility
|
IP
|
$1,219.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
906601419
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$220.64 |
| Max. Negotiated Rate |
$914.25 |
| Rate for Payer: Adventist Health Commercial |
$243.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$837.45
|
| Rate for Payer: Cash Price |
$548.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$825.26
|
| Rate for Payer: Heritage Provider Network Senior |
$825.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.75
|
| Rate for Payer: Multiplan Commercial |
$914.25
|
|
|
HC US SOFT TISS EXT COMP
|
Facility
|
OP
|
$1,219.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
906601419
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$83.13 |
| Max. Negotiated Rate |
$914.25 |
| Rate for Payer: Adventist Health Commercial |
$243.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$191.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$837.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$497.55
|
| Rate for Payer: Blue Shield of California EPN |
$282.94
|
| Rate for Payer: Cash Price |
$548.55
|
| Rate for Payer: Cash Price |
$548.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$792.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$792.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$754.56
|
| Rate for Payer: Heritage Provider Network Senior |
$754.56
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$914.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US SOFT TISS EXT LMTD
|
Facility
|
OP
|
$1,219.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
906601421
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$914.25 |
| Rate for Payer: Adventist Health Commercial |
$243.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$837.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$58.25
|
| Rate for Payer: Blue Shield of California EPN |
$33.12
|
| Rate for Payer: Cash Price |
$548.55
|
| Rate for Payer: Cash Price |
$548.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$792.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$792.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$754.56
|
| Rate for Payer: Heritage Provider Network Senior |
$754.56
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$914.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US SOFT TISS EXT LMTD
|
Facility
|
IP
|
$1,219.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
906601421
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$220.64 |
| Max. Negotiated Rate |
$914.25 |
| Rate for Payer: Adventist Health Commercial |
$243.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$837.45
|
| Rate for Payer: Cash Price |
$548.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$825.26
|
| Rate for Payer: Heritage Provider Network Senior |
$825.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.75
|
| Rate for Payer: Multiplan Commercial |
$914.25
|
|
|
HC US SOFT TISSUE MASS,HEAD/NECK
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
906601405
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$219.01 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Adventist Health Commercial |
$242.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$831.27
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$819.17
|
| Rate for Payer: Heritage Provider Network Senior |
$819.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.50
|
| Rate for Payer: Multiplan Commercial |
$907.50
|
|
|
HC US SOFT TISSUE MASS,HEAD/NECK
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
906601405
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$93.19 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Adventist Health Commercial |
$242.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$202.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$831.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$291.67
|
| Rate for Payer: Blue Shield of California EPN |
$165.86
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$786.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$786.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$748.99
|
| Rate for Payer: Heritage Provider Network Senior |
$748.99
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$93.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$907.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US TRANSRECTAL
|
Facility
|
IP
|
$1,576.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
906601408
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$285.26 |
| Max. Negotiated Rate |
$1,182.00 |
| Rate for Payer: Adventist Health Commercial |
$315.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,082.71
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,066.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1,066.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.00
|
| Rate for Payer: Multiplan Commercial |
$1,182.00
|
|
|
HC US TRANSRECTAL
|
Facility
|
OP
|
$1,576.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
906601408
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$105.53 |
| Max. Negotiated Rate |
$1,182.00 |
| Rate for Payer: Adventist Health Commercial |
$315.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$213.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,082.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$378.76
|
| Rate for Payer: Blue Shield of California EPN |
$215.39
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,024.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,024.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$975.54
|
| Rate for Payer: Heritage Provider Network Senior |
$975.54
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,182.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC US TRGT DYN MBUBB 1ST LSN
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 76978
|
| Hospital Charge Code |
906676978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$111.50 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.19
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$417.03
|
| Rate for Payer: Heritage Provider Network Senior |
$417.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.00
|
| Rate for Payer: Multiplan Commercial |
$462.00
|
|
|
HC US TRGT DYN MBUBB 1ST LSN
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 76978
|
| Hospital Charge Code |
906676978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$111.50 |
| Max. Negotiated Rate |
$1,348.60 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$550.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,348.60
|
| Rate for Payer: Blue Shield of California EPN |
$766.91
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$400.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$381.30
|
| Rate for Payer: Heritage Provider Network Senior |
$381.30
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$435.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$462.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$322.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$322.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC US TRGT DYN MBUBB EA ADD LSN
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
CPT 76979
|
| Hospital Charge Code |
906676979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.57 |
| Max. Negotiated Rate |
$984.42 |
| Rate for Payer: Adventist Health Commercial |
$61.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$401.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$210.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$168.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$230.25
|
| Rate for Payer: Blue Shield of California Commercial |
$984.42
|
| Rate for Payer: Blue Shield of California EPN |
$559.81
|
| Rate for Payer: Cash Price |
$138.15
|
| Rate for Payer: Cash Price |
$138.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$199.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.95
|
| Rate for Payer: Dignity Health Senior |
$260.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.03
|
| Rate for Payer: Heritage Provider Network Senior |
$190.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$290.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$147.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.75
|
| Rate for Payer: Multiplan Commercial |
$230.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.95
|
| Rate for Payer: Vantage Medical Group Senior |
$260.95
|
|
|
HC US TRGT DYN MBUBB EA ADD LSN
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
CPT 76979
|
| Hospital Charge Code |
906676979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.57 |
| Max. Negotiated Rate |
$230.25 |
| Rate for Payer: Adventist Health Commercial |
$61.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$210.91
|
| Rate for Payer: Cash Price |
$138.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$207.84
|
| Rate for Payer: Heritage Provider Network Senior |
$207.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.75
|
| Rate for Payer: Multiplan Commercial |
$230.25
|
|
|
HC US ULTRA GUIDE/PSEU.AVFISTULA
|
Facility
|
IP
|
$2,034.00
|
|
|
Service Code
|
CPT 76936
|
| Hospital Charge Code |
909001485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$368.15 |
| Max. Negotiated Rate |
$1,525.50 |
| Rate for Payer: Adventist Health Commercial |
$406.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,397.36
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,377.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,377.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.50
|
| Rate for Payer: Multiplan Commercial |
$1,525.50
|
|
|
HC US ULTRA GUIDE/PSEU.AVFISTULA
|
Facility
|
OP
|
$2,034.00
|
|
|
Service Code
|
CPT 76936
|
| Hospital Charge Code |
909001485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$170.66 |
| Max. Negotiated Rate |
$1,525.50 |
| Rate for Payer: Adventist Health Commercial |
$406.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$237.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,397.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,287.05
|
| Rate for Payer: Blue Shield of California EPN |
$731.90
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,322.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,322.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,259.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1,259.05
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$745.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$1,525.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$392.17
|
| Rate for Payer: TriValley Medical Group Senior |
$392.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$170.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$170.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC UTRAVERSE BALLOON
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909000018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$386.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$603.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$499.90
|
| Rate for Payer: Blue Shield of California EPN |
$472.54
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$370.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: Dignity Health Senior |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$515.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$372.72
|
| Rate for Payer: Heritage Provider Network Senior |
$372.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$293.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$268.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC UTRAVERSE BALLOON
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909000018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$386.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$544.98
|
| Rate for Payer: Heritage Provider Network Senior |
$544.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$293.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$268.95
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.81 |
| Max. Negotiated Rate |
$844.50 |
| Rate for Payer: Adventist Health Commercial |
$225.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$773.56
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$762.30
|
| Rate for Payer: Heritage Provider Network Senior |
$762.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.50
|
| Rate for Payer: Multiplan Commercial |
$844.50
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$203.81 |
| Max. Negotiated Rate |
$844.50 |
| Rate for Payer: Adventist Health Commercial |
$225.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$773.56
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$762.30
|
| Rate for Payer: Heritage Provider Network Senior |
$762.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.50
|
| Rate for Payer: Multiplan Commercial |
$844.50
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$203.81 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$225.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$773.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$731.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: Dignity Health Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$423.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$762.30
|
| Rate for Payer: Heritage Provider Network Senior |
$762.30
|
| Rate for Payer: Humana Medicare |
$423.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$423.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$542.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$499.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$533.16
|
| Rate for Payer: Multiplan Commercial |
$844.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$408.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$376.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$52.28 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$225.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$773.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$731.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: Dignity Health Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$423.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$696.99
|
| Rate for Payer: Heritage Provider Network Senior |
$520.46
|
| Rate for Payer: Humana Medicare |
$423.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$423.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$803.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$499.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$533.16
|
| Rate for Payer: Multiplan Commercial |
$844.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$465.45
|
| Rate for Payer: TriValley Medical Group Senior |
$465.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC VAG DEL PLUS ANTE/POST PARTUM
|
Facility
|
OP
|
$2,816.00
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
902400310
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$563.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,107.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,934.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,393.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,548.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,112.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,105.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,748.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,652.99
|
| Rate for Payer: Cash Price |
$1,267.20
|
| Rate for Payer: Cash Price |
$1,267.20
|
| Rate for Payer: Cash Price |
$1,267.20
|
| Rate for Payer: Cash Price |
$1,267.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,830.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,393.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,393.60
|
| Rate for Payer: Dignity Health Senior |
$2,393.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,743.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,743.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,168.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,357.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$509.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.00
|
| Rate for Payer: Multiplan Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,393.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,393.60
|
|
|
HC VAG DEL PLUS ANTE/POST PARTUM
|
Facility
|
IP
|
$2,816.00
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
902400310
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Adventist Health Commercial |
$563.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,934.59
|
| Rate for Payer: Cash Price |
$1,267.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,906.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,906.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$509.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.00
|
| Rate for Payer: Multiplan Commercial |
$2,112.00
|
|
|
HC VAGINAL DELIVERY ONLY
|
Facility
|
IP
|
$6,474.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
900501171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,171.79 |
| Max. Negotiated Rate |
$4,855.50 |
| Rate for Payer: Adventist Health Commercial |
$1,294.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,447.64
|
| Rate for Payer: Cash Price |
$2,913.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,382.90
|
| Rate for Payer: Heritage Provider Network Senior |
$4,382.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,171.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,618.50
|
| Rate for Payer: Multiplan Commercial |
$4,855.50
|
|
