|
HC US GUIDE VISCERAL TISS ABLATN
|
Facility
|
IP
|
$1,616.00
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
909001920
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$1,212.00 |
| Rate for Payer: Adventist Health Commercial |
$323.20
|
| Rate for Payer: Cash Price |
$888.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,094.03
|
| Rate for Payer: Heritage Provider Network Senior |
$1,094.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.00
|
| Rate for Payer: Multiplan Commercial |
$1,212.00
|
|
|
HC US GUIDE VISCERAL TISS ABLATN
|
Facility
|
OP
|
$1,616.00
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
909001920
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$226.31 |
| Max. Negotiated Rate |
$1,373.60 |
| Rate for Payer: Adventist Health Commercial |
$323.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$863.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,110.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,373.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$888.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,212.00
|
| Rate for Payer: Blue Shield of California Commercial |
$348.96
|
| Rate for Payer: Blue Shield of California EPN |
$280.62
|
| Rate for Payer: Cash Price |
$888.80
|
| Rate for Payer: Cash Price |
$888.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,050.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,373.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,373.60
|
| Rate for Payer: Dignity Health Senior |
$1,373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,050.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,000.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,000.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$226.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$770.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,131.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,131.20
|
| Rate for Payer: Multiplan Commercial |
$1,212.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$808.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$808.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,373.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,373.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,373.60
|
|
|
HC US SOFT TISS EXT COMP
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
906601419
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$964.73
|
| Rate for Payer: Heritage Provider Network Senior |
$964.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.25
|
| Rate for Payer: Multiplan Commercial |
$1,068.75
|
|
|
HC US SOFT TISS EXT COMP
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
906601419
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$86.33 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$761.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$978.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$512.50
|
| Rate for Payer: Blue Shield of California EPN |
$412.13
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$926.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$882.08
|
| Rate for Payer: Heritage Provider Network Senior |
$882.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$679.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,068.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| 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 |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC US SOFT TISS EXT LMTD
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
906601421
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$964.73
|
| Rate for Payer: Heritage Provider Network Senior |
$964.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.25
|
| Rate for Payer: Multiplan Commercial |
$1,068.75
|
|
|
HC US SOFT TISS EXT LMTD
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
906601421
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$761.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$978.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$60.00
|
| Rate for Payer: Blue Shield of California EPN |
$48.25
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Cash Price |
$783.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$926.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$882.08
|
| Rate for Payer: Heritage Provider Network Senior |
$882.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$679.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,068.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| 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 |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC US SOFT TISSUE MASS,HEAD/NECK
|
Facility
|
IP
|
$1,414.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
906601405
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.93 |
| Max. Negotiated Rate |
$1,060.50 |
| Rate for Payer: Adventist Health Commercial |
$282.80
|
| Rate for Payer: Cash Price |
$777.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$957.28
|
| Rate for Payer: Heritage Provider Network Senior |
$957.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.50
|
| Rate for Payer: Multiplan Commercial |
$1,060.50
|
|
|
HC US SOFT TISSUE MASS,HEAD/NECK
|
Facility
|
OP
|
$1,414.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
906601405
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.78 |
| Max. Negotiated Rate |
$1,060.50 |
| Rate for Payer: Adventist Health Commercial |
$282.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$755.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$971.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$300.43
|
| Rate for Payer: Blue Shield of California EPN |
$241.60
|
| Rate for Payer: Cash Price |
$777.70
|
| Rate for Payer: Cash Price |
$777.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$919.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$919.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$875.27
|
| Rate for Payer: Heritage Provider Network Senior |
$875.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$674.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,060.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| 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 |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC US TRANSRECTAL
|
Facility
|
OP
|
$1,841.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
906601408
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$109.59 |
| Max. Negotiated Rate |
$1,380.75 |
| Rate for Payer: Adventist Health Commercial |
$368.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$984.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,264.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$390.14
|
| Rate for Payer: Blue Shield of California EPN |
$313.74
|
| Rate for Payer: Cash Price |
$1,012.55
|
| Rate for Payer: Cash Price |
$1,012.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,196.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,196.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,139.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,139.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$109.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$878.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,380.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| 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 |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC US TRANSRECTAL
|
Facility
|
IP
|
$1,841.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
906601408
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$333.22 |
| Max. Negotiated Rate |
$1,380.75 |
| Rate for Payer: Adventist Health Commercial |
$368.20
|
| Rate for Payer: Cash Price |
$1,012.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,246.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,246.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.25
|
| Rate for Payer: Multiplan Commercial |
$1,380.75
|
|
|
HC US TRGT DYN MBUBB 1ST LSN
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 76978
|
| Hospital Charge Code |
906676978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$118.01 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Cash Price |
$358.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$441.40
|
| Rate for Payer: Heritage Provider Network Senior |
$441.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.00
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
|
|
HC US TRGT DYN MBUBB 1ST LSN
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 76978
|
| Hospital Charge Code |
906676978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$118.01 |
| Max. Negotiated Rate |
$1,389.12 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$348.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$447.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,389.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,117.08
|
| Rate for Payer: Cash Price |
$358.60
|
| Rate for Payer: Cash Price |
$358.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$423.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$423.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$403.59
|
| Rate for Payer: Heritage Provider Network Senior |
$403.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$452.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$311.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$226.19
|
| Rate for Payer: TriValley Medical Group Senior |
$226.19
|
| 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 |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC US TRGT DYN MBUBB EA ADD LSN
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 76979
|
| Hospital Charge Code |
906676979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$59.01 |
| Max. Negotiated Rate |
$244.50 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.70
|
| Rate for Payer: Heritage Provider Network Senior |
$220.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.50
|
| Rate for Payer: Multiplan Commercial |
$244.50
|
|
|
HC US TRGT DYN MBUBB EA ADD LSN
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 76979
|
| Hospital Charge Code |
906676979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$59.01 |
| Max. Negotiated Rate |
$1,014.00 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$174.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$223.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$244.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,014.00
|
| Rate for Payer: Blue Shield of California EPN |
$815.42
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$211.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.10
|
| Rate for Payer: Dignity Health Senior |
$277.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.79
|
| Rate for Payer: Heritage Provider Network Senior |
$201.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$301.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$155.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$228.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$228.20
|
| Rate for Payer: Multiplan Commercial |
$244.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$163.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$163.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.10
|
| Rate for Payer: Vantage Medical Group Senior |
$277.10
|
|
|
HC US ULTRA GUIDE/PSEU.AVFISTULA
|
Facility
|
IP
|
$1,642.00
|
|
|
Service Code
|
CPT 76936
|
| Hospital Charge Code |
909001485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$297.20 |
| Max. Negotiated Rate |
$1,231.50 |
| Rate for Payer: Adventist Health Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$903.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,111.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,111.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$410.50
|
| Rate for Payer: Multiplan Commercial |
$1,231.50
|
|
|
HC US ULTRA GUIDE/PSEU.AVFISTULA
|
Facility
|
OP
|
$1,642.00
|
|
|
Service Code
|
CPT 76936
|
| Hospital Charge Code |
909001485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$170.66 |
| Max. Negotiated Rate |
$1,325.71 |
| Rate for Payer: Adventist Health Commercial |
$328.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$877.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,128.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,325.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,066.09
|
| Rate for Payer: Cash Price |
$903.10
|
| Rate for Payer: Cash Price |
$903.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,067.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Senior |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,067.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$395.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,016.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,016.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$783.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$455.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$410.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$498.53
|
| Rate for Payer: Multiplan Commercial |
$1,231.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$395.66
|
| Rate for Payer: TriValley Medical Group Senior |
$395.66
|
| 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 |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC US URINE CAPACITY MEASURE
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
900501798
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.41
|
| Rate for Payer: Heritage Provider Network Senior |
$114.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.25
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
|
|
HC US URINE CAPACITY MEASURE
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
900501798
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.41
|
| Rate for Payer: Heritage Provider Network Senior |
$114.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$60.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
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 |
$13,240.00 |
| 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 |
$553.03
|
| 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 |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$323.61
|
| Rate for Payer: Blue Shield of California EPN |
$323.61
|
| Rate for Payer: Cash Price |
$442.75
|
| Rate for Payer: Cash Price |
$442.75
|
| 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 |
$372.71
|
| Rate for Payer: Heritage Provider Network Senior |
$372.71
|
| 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: Molina Healthcare of CA Medi-Cal |
$563.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$563.50
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$290.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$266.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$684.25
|
| 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 |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$386.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$323.61
|
| Rate for Payer: Blue Shield of California EPN |
$323.61
|
| Rate for Payer: Cash Price |
$442.75
|
| Rate for Payer: Cash Price |
$442.75
|
| 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 |
$372.71
|
| Rate for Payer: Heritage Provider Network Senior |
$372.71
|
| 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 |
$290.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$266.54
|
|
|
HC VACCINE INFLUENZA VACCINE GT 3 YR
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
910400052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$51.85 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$32.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.78
|
| Rate for Payer: Blue Shield of California Commercial |
$20.00
|
| Rate for Payer: Blue Shield of California EPN |
$20.00
|
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.85
|
| Rate for Payer: Dignity Health Senior |
$51.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.24
|
| Rate for Payer: Heritage Provider Network Senior |
$28.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.70
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.40
|
| Rate for Payer: TriValley Medical Group Senior |
$24.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC VACCINE INFLUENZA VACCINE GT 3 YR
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
910400052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$45.75 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.24
|
| Rate for Payer: Heritage Provider Network Senior |
$28.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.25
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.20
|
|
|
HC VACCINE TDAP 7 YRS OR OLDER
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
900090715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.08
|
| Rate for Payer: Heritage Provider Network Senior |
$24.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.22
|
|
|
HC VACCINE TDAP 7 YRS OR OLDER
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
900090715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$121.81 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.81
|
| Rate for Payer: Blue Shield of California Commercial |
$46.78
|
| Rate for Payer: Blue Shield of California EPN |
$46.78
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.20
|
| Rate for Payer: Dignity Health Senior |
$44.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.08
|
| Rate for Payer: Heritage Provider Network Senior |
$24.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.80
|
| Rate for Payer: TriValley Medical Group Senior |
$20.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.20
|
| Rate for Payer: Vantage Medical Group Senior |
$44.20
|
|
|
HC VACCINIA VRS VAC 0.3 ML PERQ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90622
|
| Hospital Charge Code |
948000201
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Senior |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
|
