|
HC SYPHILIS TOTAL
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913674
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| 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 Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.13
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.91
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$30.33
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$30.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SYPHILIS TOTAL
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913674
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.22
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
|
|
HC SYPHILLIS IGG
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900913561
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$164.73 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.73
|
| Rate for Payer: Blue Shield of California Commercial |
$109.27
|
| Rate for Payer: Blue Shield of California Commercial |
$109.27
|
| Rate for Payer: Blue Shield of California EPN |
$87.64
|
| Rate for Payer: Blue Shield of California EPN |
$87.64
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.57
|
| Rate for Payer: Heritage Provider Network Senior |
$115.13
|
| Rate for Payer: Heritage Provider Network Senior |
$44.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$34.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Senior |
$13.24
|
| Rate for Payer: TriValley Medical Group Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SYPHILLIS IGG
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900913561
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.92
|
| Rate for Payer: Heritage Provider Network Senior |
$125.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
|
|
HC SYPHILLIS IGG INDIVIDUAL
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900913563
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$164.73 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.73
|
| Rate for Payer: Blue Shield of California Commercial |
$109.27
|
| Rate for Payer: Blue Shield of California EPN |
$87.64
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.13
|
| Rate for Payer: Heritage Provider Network Senior |
$115.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SYPHILLIS IGG INDIVIDUAL
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900913563
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.92
|
| Rate for Payer: Heritage Provider Network Senior |
$125.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
|
|
HC SYPHILLIS TEST RPR
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900910892
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$40.53 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.53
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$118.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$112.66
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$86.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SYPHILLIS TEST RPR
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900910892
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.21
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.21
|
| Rate for Payer: Heritage Provider Network Senior |
$123.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.50
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
|
|
HC SYPHILLIS TEST RPR INDIVIDUAL
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900912331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.21
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.21
|
| Rate for Payer: Heritage Provider Network Senior |
$123.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.50
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
|
|
HC SYPHILLIS TEST RPR INDIVIDUAL
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900912331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$40.53 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.53
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$118.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$112.66
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$86.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SYPHILLIS TEST VDRL/ CSF
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900910861
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.21
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.21
|
| Rate for Payer: Heritage Provider Network Senior |
$123.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.50
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
|
|
HC SYPHILLIS TEST VDRL/ CSF
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900910861
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$40.53 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.53
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$118.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$112.66
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$86.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC TANGNTL BX SKIN EA SEP/ADD LSN
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
900511103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$165.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.27
|
| Rate for Payer: Heritage Provider Network Senior |
$165.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$127.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$186.90
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC TANGNTL BX SKIN EA SEP/ADD LSN
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
900511103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$200.25 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.95
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.76
|
| Rate for Payer: Heritage Provider Network Senior |
$180.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
|
|
HC TANGNTL BX SKIN SINGLE LESION
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
900511102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$106.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$328.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$345.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.31
|
| Rate for Payer: Heritage Provider Network Senior |
$643.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$993.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$399.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$575.13
|
| Rate for Payer: TriValley Medical Group Senior |
$575.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC TANGNTL BX SKIN SINGLE LESION
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
900511102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.29 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Adventist Health Commercial |
$106.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$342.61
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$360.16
|
| Rate for Payer: Heritage Provider Network Senior |
$360.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$399.00
|
|
|
HC TARSORRHAPHY
|
Facility
|
IP
|
$4,018.00
|
|
|
Service Code
|
CPT 67880
|
| Hospital Charge Code |
900501730
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$727.26 |
| Max. Negotiated Rate |
$3,013.50 |
| Rate for Payer: Adventist Health Commercial |
$803.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,587.59
|
| Rate for Payer: Cash Price |
$1,808.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,720.19
|
| Rate for Payer: Heritage Provider Network Senior |
$2,720.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$727.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,004.50
|
| Rate for Payer: Multiplan Commercial |
$3,013.50
|
|
|
HC TARSORRHAPHY
|
Facility
|
OP
|
$4,018.00
|
|
|
Service Code
|
CPT 67880
|
| Hospital Charge Code |
900501730
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$727.26 |
| Max. Negotiated Rate |
$6,245.00 |
| Rate for Payer: Adventist Health Commercial |
$803.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,483.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,908.55
|
| Rate for Payer: Blue Shield of California EPN |
$1,518.80
|
| Rate for Payer: Cash Price |
$1,808.10
|
| Rate for Payer: Cash Price |
$1,808.10
|
| Rate for Payer: Cash Price |
$1,808.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,611.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,611.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,057.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,720.19
|
| Rate for Payer: Heritage Provider Network Senior |
$2,720.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,916.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$727.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,004.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$3,013.50
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,410.80
|
| Rate for Payer: TriValley Medical Group Senior |
$2,410.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC TAVR W PROS VALVE CAROTID
|
Facility
|
OP
|
$53,164.00
|
|
|
Service Code
|
CPT 33999
|
| Hospital Charge Code |
906813416
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$806.82 |
| Max. Negotiated Rate |
$39,873.00 |
| Rate for Payer: Adventist Health Commercial |
$10,632.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32,855.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,592.63
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$23,923.80
|
| Rate for Payer: Cash Price |
$23,923.80
|
| Rate for Payer: Cash Price |
$23,923.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34,556.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$806.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$32,908.52
|
| Rate for Payer: Heritage Provider Network Senior |
$992.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,532.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,622.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$927.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,291.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$39,873.00
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$887.50
|
| Rate for Payer: TriValley Medical Group Senior |
$887.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC TAVR W PROS VALVE CAROTID
|
Facility
|
IP
|
$53,164.00
|
|
|
Service Code
|
CPT 33999
|
| Hospital Charge Code |
906813416
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,622.68 |
| Max. Negotiated Rate |
$39,873.00 |
| Rate for Payer: Adventist Health Commercial |
$10,632.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34,237.62
|
| Rate for Payer: Cash Price |
$23,923.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,992.03
|
| Rate for Payer: Heritage Provider Network Senior |
$35,992.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,622.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,291.00
|
| Rate for Payer: Multiplan Commercial |
$39,873.00
|
|
|
HC TAVR W PROS VALVE OPN AXLRY
|
Facility
|
OP
|
$53,983.00
|
|
|
Service Code
|
CPT 33363
|
| Hospital Charge Code |
906813410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$45,885.55 |
| Rate for Payer: Adventist Health Commercial |
$10,796.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,361.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45,885.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,487.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$24,292.35
|
| Rate for Payer: Cash Price |
$24,292.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35,088.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45,885.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$45,885.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45,885.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33,415.48
|
| Rate for Payer: Heritage Provider Network Senior |
$33,415.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25,749.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,770.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,495.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37,788.10
|
| Rate for Payer: Multiplan Commercial |
$40,487.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45,885.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,885.55
|
| Rate for Payer: Vantage Medical Group Senior |
$45,885.55
|
|
|
HC TAVR W PROS VALVE OPN AXLRY
|
Facility
|
IP
|
$53,983.00
|
|
|
Service Code
|
CPT 33363
|
| Hospital Charge Code |
906813410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,770.92 |
| Max. Negotiated Rate |
$40,487.25 |
| Rate for Payer: Adventist Health Commercial |
$10,796.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34,765.05
|
| Rate for Payer: Cash Price |
$24,292.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,546.49
|
| Rate for Payer: Heritage Provider Network Senior |
$36,546.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,770.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,495.75
|
| Rate for Payer: Multiplan Commercial |
$40,487.25
|
|
|
HC TAVR W PROS VALVE OPN FMRL
|
Facility
|
OP
|
$52,428.00
|
|
|
Service Code
|
CPT 33362
|
| Hospital Charge Code |
906813409
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$44,563.80 |
| Rate for Payer: Adventist Health Commercial |
$10,485.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32,400.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44,563.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28,835.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39,321.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$23,592.60
|
| Rate for Payer: Cash Price |
$23,592.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34,078.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44,563.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,563.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44,563.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$32,452.93
|
| Rate for Payer: Heritage Provider Network Senior |
$32,452.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25,008.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,489.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,107.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36,699.60
|
| Rate for Payer: Multiplan Commercial |
$39,321.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44,563.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,563.80
|
| Rate for Payer: Vantage Medical Group Senior |
$44,563.80
|
|
|
HC TAVR W PROS VALVE OPN FMRL
|
Facility
|
IP
|
$52,428.00
|
|
|
Service Code
|
CPT 33362
|
| Hospital Charge Code |
906813409
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,489.47 |
| Max. Negotiated Rate |
$39,321.00 |
| Rate for Payer: Adventist Health Commercial |
$10,485.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,763.63
|
| Rate for Payer: Cash Price |
$23,592.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,493.76
|
| Rate for Payer: Heritage Provider Network Senior |
$35,493.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,489.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,107.00
|
| Rate for Payer: Multiplan Commercial |
$39,321.00
|
|
|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
OP
|
$54,354.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906813412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$46,200.90 |
| Rate for Payer: Adventist Health Commercial |
$10,870.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,590.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46,200.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29,894.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,765.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$24,459.30
|
| Rate for Payer: Cash Price |
$24,459.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35,330.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46,200.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$46,200.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46,200.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33,645.13
|
| Rate for Payer: Heritage Provider Network Senior |
$33,645.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25,926.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,838.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,588.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38,047.80
|
| Rate for Payer: Multiplan Commercial |
$40,765.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46,200.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46,200.90
|
| Rate for Payer: Vantage Medical Group Senior |
$46,200.90
|
|
