|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
OP
|
$2,204.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
906601143
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$1,653.00 |
| Rate for Payer: Adventist Health Commercial |
$440.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,178.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,514.15
|
| 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 |
$884.54
|
| Rate for Payer: Blue Shield of California EPN |
$711.32
|
| Rate for Payer: Cash Price |
$1,212.20
|
| Rate for Payer: Cash Price |
$1,212.20
|
| Rate for Payer: Cash Price |
$1,212.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,432.60
|
| 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 |
$1,432.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,364.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,364.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$317.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,051.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.00
|
| 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 |
$1,653.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$337.84
|
| Rate for Payer: TriValley Medical Group Senior |
$307.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| 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 TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
IP
|
$2,204.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
906601143
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$398.92 |
| Max. Negotiated Rate |
$1,653.00 |
| Rate for Payer: Adventist Health Commercial |
$440.80
|
| Rate for Payer: Cash Price |
$1,212.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,492.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1,492.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.00
|
| Rate for Payer: Multiplan Commercial |
$1,653.00
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
IP
|
$1,090.00
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
906601144
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$197.29 |
| Max. Negotiated Rate |
$817.50 |
| Rate for Payer: Adventist Health Commercial |
$218.00
|
| Rate for Payer: Cash Price |
$599.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.93
|
| Rate for Payer: Heritage Provider Network Senior |
$737.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.50
|
| Rate for Payer: Multiplan Commercial |
$817.50
|
|
|
HC TRANSESOPHOGEAL CARDIAC OUTPUT
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
900800525
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$331.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Blue Shield of California Commercial |
$378.20
|
| Rate for Payer: Blue Shield of California EPN |
$302.56
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$403.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$403.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$383.78
|
| Rate for Payer: Heritage Provider Network Senior |
$383.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$295.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$218.68
|
| Rate for Payer: TriValley Medical Group Senior |
$198.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$310.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$310.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC TRANSESOPHOGEAL CARDIAC OUTPUT
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
900800525
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.74
|
| Rate for Payer: Heritage Provider Network Senior |
$419.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
|
|
HC TRANSFERRIN
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900910854
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$179.25 |
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$127.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.98
|
| Rate for Payer: Blue Shield of California Commercial |
$102.76
|
| Rate for Payer: Blue Shield of California EPN |
$82.42
|
| Rate for Payer: Cash Price |
$131.45
|
| Rate for Payer: Cash Price |
$131.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$155.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.04
|
| Rate for Payer: Dignity Health Senior |
$12.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.94
|
| Rate for Payer: Heritage Provider Network Senior |
$147.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$114.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$179.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.76
|
| Rate for Payer: TriValley Medical Group Senior |
$12.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
|
|
HC TRANSFERRIN
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900910854
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.26 |
| Max. Negotiated Rate |
$179.25 |
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| Rate for Payer: Cash Price |
$131.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$161.80
|
| Rate for Payer: Heritage Provider Network Senior |
$161.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.75
|
| Rate for Payer: Multiplan Commercial |
$179.25
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$1,593.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.33 |
| Max. Negotiated Rate |
$1,194.75 |
| Rate for Payer: Adventist Health Commercial |
$318.60
|
| Rate for Payer: Cash Price |
$876.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,078.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,078.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.25
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$1,593.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
906536430
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$318.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,094.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$971.73
|
| Rate for Payer: Blue Shield of California EPN |
$777.38
|
| Rate for Payer: Cash Price |
$876.15
|
| Rate for Payer: Cash Price |
$876.15
|
| Rate for Payer: Cash Price |
$876.15
|
| Rate for Payer: Cash Price |
$876.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,035.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Senior |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$555.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$986.07
|
| Rate for Payer: Heritage Provider Network Senior |
$986.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$759.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$638.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$699.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$699.90
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$611.03
|
| Rate for Payer: TriValley Medical Group Senior |
$555.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$1,593.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
906536430
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$288.33 |
| Max. Negotiated Rate |
$1,194.75 |
| Rate for Payer: Adventist Health Commercial |
$318.60
|
| Rate for Payer: Cash Price |
$876.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,078.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,078.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.25
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$1,593.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$318.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,094.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$876.15
|
| Rate for Payer: Cash Price |
$876.15
|
| Rate for Payer: Cash Price |
$876.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,035.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Senior |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$555.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,078.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,078.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$759.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$638.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$699.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$699.90
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
| Rate for Payer: Multiplan WC |
$885.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$573.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$527.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$1,593.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$288.33 |
| Max. Negotiated Rate |
$1,194.75 |
| Rate for Payer: Adventist Health Commercial |
$318.60
|
| Rate for Payer: Cash Price |
$876.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,078.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,078.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.25
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$1,593.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$318.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,094.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$971.73
|
| Rate for Payer: Blue Shield of California EPN |
$777.38
|
| Rate for Payer: Cash Price |
$876.15
|
| Rate for Payer: Cash Price |
$876.15
|
| Rate for Payer: Cash Price |
$876.15
|
| Rate for Payer: Cash Price |
$876.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,035.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Senior |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$555.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$986.07
|
| Rate for Payer: Heritage Provider Network Senior |
$986.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$759.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$638.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$699.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$699.90
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$611.03
|
| Rate for Payer: TriValley Medical Group Senior |
$555.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSFUS INTRAUTERINE ADDL FETUS
|
Facility
|
OP
|
$1,357.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400022
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$932.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$827.77
|
| Rate for Payer: Blue Shield of California EPN |
$662.22
|
| Rate for Payer: Cash Price |
$746.35
|
| Rate for Payer: Cash Price |
$746.35
|
| Rate for Payer: Cash Price |
$746.35
|
| Rate for Payer: Cash Price |
$746.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$882.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Senior |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$555.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$839.98
|
| Rate for Payer: Heritage Provider Network Senior |
$839.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$501.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$647.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$638.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$699.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$699.90
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$611.03
|
| Rate for Payer: TriValley Medical Group Senior |
$555.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSFUS INTRAUTERINE ADDL FETUS
|
Facility
|
IP
|
$1,357.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400022
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$1,017.75 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Cash Price |
$746.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$918.69
|
| Rate for Payer: Heritage Provider Network Senior |
$918.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.25
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
|
|
HC TRANSFUS INTRAUTERINE FETUS
|
Facility
|
IP
|
$1,231.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400021
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$222.81 |
| Max. Negotiated Rate |
$923.25 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$833.39
|
| Rate for Payer: Heritage Provider Network Senior |
$833.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.75
|
| Rate for Payer: Multiplan Commercial |
$923.25
|
|
|
HC TRANSFUS INTRAUTERINE FETUS
|
Facility
|
OP
|
$1,231.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400021
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$845.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$750.91
|
| Rate for Payer: Blue Shield of California EPN |
$600.73
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$800.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Senior |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$555.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$761.99
|
| Rate for Payer: Heritage Provider Network Senior |
$761.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$501.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$587.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$638.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$699.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$699.90
|
| Rate for Payer: Multiplan Commercial |
$923.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$611.03
|
| Rate for Payer: TriValley Medical Group Senior |
$555.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC TRANSGLUTAMINASE IGA AB
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913555
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$213.58 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.58
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.28
|
| Rate for Payer: Heritage Provider Network Senior |
$48.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC TRANSGLUTAMINASE IGA AB
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913555
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.81
|
| Rate for Payer: Heritage Provider Network Senior |
$52.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
|
|
HC TRANSTHYRETIN
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
900910925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.43 |
| Max. Negotiated Rate |
$275.25 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Cash Price |
$201.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$248.46
|
| Rate for Payer: Heritage Provider Network Senior |
$248.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.75
|
| Rate for Payer: Multiplan Commercial |
$275.25
|
|
|
HC TRANSTHYRETIN
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
900910925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$275.25 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$196.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$252.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.56
|
| Rate for Payer: Blue Shield of California Commercial |
$117.39
|
| Rate for Payer: Blue Shield of California EPN |
$94.16
|
| Rate for Payer: Cash Price |
$201.85
|
| Rate for Payer: Cash Price |
$201.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$238.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.05
|
| Rate for Payer: Dignity Health Senior |
$14.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$227.17
|
| Rate for Payer: Heritage Provider Network Senior |
$227.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$175.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.38
|
| Rate for Payer: Multiplan Commercial |
$275.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.59
|
| Rate for Payer: TriValley Medical Group Senior |
$14.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Vantage Medical Group Senior |
$14.59
|
|
|
HC TRAY SUTURE REMOVAL
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
900101278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$106.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$122.00
|
| Rate for Payer: Blue Shield of California EPN |
$97.60
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Senior |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC TRAY SUTURE REMOVAL
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
900101278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC TREAT CLAVICLE FRACTURE
|
Facility
|
OP
|
$18,844.00
|
|
|
Service Code
|
CPT 23515
|
| Hospital Charge Code |
900501799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,462.30 |
| Rate for Payer: Adventist Health Commercial |
$3,768.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,945.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$10,364.20
|
| Rate for Payer: Cash Price |
$10,364.20
|
| Rate for Payer: Cash Price |
$10,364.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,248.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Senior |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,076.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,757.39
|
| Rate for Payer: Heritage Provider Network Senior |
$12,757.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,988.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,410.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,438.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,711.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,436.79
|
| Rate for Payer: Multiplan Commercial |
$14,133.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,780.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,239.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC TREAT CLAVICLE FRACTURE
|
Facility
|
IP
|
$18,844.00
|
|
|
Service Code
|
CPT 23515
|
| Hospital Charge Code |
900501799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,410.76 |
| Max. Negotiated Rate |
$14,133.00 |
| Rate for Payer: Adventist Health Commercial |
$3,768.80
|
| Rate for Payer: Cash Price |
$10,364.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,757.39
|
| Rate for Payer: Heritage Provider Network Senior |
$12,757.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,410.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,711.00
|
| Rate for Payer: Multiplan Commercial |
$14,133.00
|
|
