|
HC T.I.P.S. (PORTOCAVAL SHUNT)
|
Facility
|
OP
|
$12,014.00
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
909081331
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,174.53 |
| Max. Negotiated Rate |
$44,797.35 |
| Rate for Payer: Adventist Health Commercial |
$2,402.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,424.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$5,406.30
|
| Rate for Payer: Cash Price |
$5,406.30
|
| Rate for Payer: Cash Price |
$5,406.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,809.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,577.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,436.67
|
| Rate for Payer: Heritage Provider Network Senior |
$29,000.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44,797.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,174.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,114.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,003.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$9,010.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,935.31
|
| Rate for Payer: TriValley Medical Group Senior |
$25,935.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC TIPS TX SHEATH
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.67 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$187.40
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.01
|
| Rate for Payer: Heritage Provider Network Senior |
$197.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.75
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
|
|
HC TIPS TX SHEATH
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.67 |
| Max. Negotiated Rate |
$247.35 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$247.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$218.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.56
|
| Rate for Payer: Blue Shield of California Commercial |
$177.51
|
| Rate for Payer: Blue Shield of California EPN |
$142.01
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$189.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$247.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$247.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$247.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.13
|
| Rate for Payer: Heritage Provider Network Senior |
$180.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$138.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$203.70
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$145.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$145.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$247.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$247.35
|
| Rate for Payer: Vantage Medical Group Senior |
$247.35
|
|
|
HC TISS CUL NEO BONE MARROW BLD
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900918003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$135.03 |
| Max. Negotiated Rate |
$1,018.09 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$400.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$461.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,018.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,018.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,016.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,016.47
|
| Rate for Payer: Blue Shield of California EPN |
$815.29
|
| Rate for Payer: Blue Shield of California EPN |
$815.29
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$421.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$484.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$143.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$143.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.77
|
| Rate for Payer: Heritage Provider Network Senior |
$401.11
|
| Rate for Payer: Heritage Provider Network Senior |
$461.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$309.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$355.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$192.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$192.62
|
| Rate for Payer: Multiplan Commercial |
$486.00
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$143.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$143.75
|
| Rate for Payer: TriValley Medical Group Senior |
$143.75
|
| Rate for Payer: TriValley Medical Group Senior |
$143.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$155.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$155.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$155.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$155.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
|
|
HC TISS CUL NEO BONE MARROW BLD
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900918003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$135.03 |
| Max. Negotiated Rate |
$559.50 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$480.42
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$505.04
|
| Rate for Payer: Heritage Provider Network Senior |
$505.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
|
|
HC TISS CUL NEOÂ SOLID TUMOR
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900918002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.21 |
| Max. Negotiated Rate |
$1,355.40 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Adventist Health Commercial |
$59.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$182.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$253.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,355.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,355.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,187.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,187.25
|
| Rate for Payer: Blue Shield of California EPN |
$952.27
|
| Rate for Payer: Blue Shield of California EPN |
$952.27
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$191.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$266.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$147.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$147.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.60
|
| Rate for Payer: Heritage Provider Network Senior |
$253.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$140.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$195.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$197.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$197.68
|
| Rate for Payer: Multiplan Commercial |
$221.25
|
| Rate for Payer: Multiplan Commercial |
$307.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.52
|
| Rate for Payer: TriValley Medical Group Senior |
$147.52
|
| Rate for Payer: TriValley Medical Group Senior |
$147.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$159.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$159.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC TISS CUL NEOÂ SOLID TUMOR
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900918002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.21 |
| Max. Negotiated Rate |
$307.50 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$264.04
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$277.57
|
| Rate for Payer: Heritage Provider Network Senior |
$277.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.50
|
| Rate for Payer: Multiplan Commercial |
$307.50
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
910408235
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$135.75 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.56
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.54
|
| Rate for Payer: Heritage Provider Network Senior |
$122.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.25
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900918004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.94 |
| Max. Negotiated Rate |
$1,185.06 |
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$249.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,048.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,048.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,185.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,185.06
|
| Rate for Payer: Blue Shield of California EPN |
$950.52
|
| Rate for Payer: Blue Shield of California EPN |
$950.52
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$189.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$261.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$150.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$150.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$249.46
|
| Rate for Payer: Heritage Provider Network Senior |
$180.13
|
| Rate for Payer: Heritage Provider Network Senior |
$249.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$138.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$192.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$201.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$150.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$150.30
|
| Rate for Payer: TriValley Medical Group Senior |
$150.30
|
| Rate for Payer: TriValley Medical Group Senior |
$150.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$162.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$162.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
910408235
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$1,185.06 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,048.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,185.06
|
| Rate for Payer: Blue Shield of California EPN |
$950.52
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$150.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.04
|
| Rate for Payer: Heritage Provider Network Senior |
$112.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$86.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$150.30
|
| Rate for Payer: TriValley Medical Group Senior |
$150.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$162.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900918004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.94 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.53
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$272.83
|
| Rate for Payer: Heritage Provider Network Senior |
$272.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.75
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
|
|
HC TISS CUL NON-NEO LYMPHOCYTE
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900918006
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$171.59 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$189.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$610.51
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$641.80
|
| Rate for Payer: Heritage Provider Network Senior |
$641.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$171.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.00
|
| Rate for Payer: Multiplan Commercial |
$711.00
|
|
|
HC TISS CUL NON-NEO LYMPHOCYTE
|
Facility
|
OP
|
$948.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900918006
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$116.49 |
| Max. Negotiated Rate |
$939.08 |
| Rate for Payer: Adventist Health Commercial |
$189.60
|
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$422.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$585.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$939.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$939.08
|
| Rate for Payer: Blue Shield of California Commercial |
$937.56
|
| Rate for Payer: Blue Shield of California Commercial |
$937.56
|
| Rate for Payer: Blue Shield of California EPN |
$752.00
|
| Rate for Payer: Blue Shield of California EPN |
$752.00
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$444.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$616.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$616.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$444.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$116.49
|
| Rate for Payer: EPIC Health Plan Medicare |
$116.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$586.81
|
| Rate for Payer: Heritage Provider Network Senior |
$423.40
|
| Rate for Payer: Heritage Provider Network Senior |
$586.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$326.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$452.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$171.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$156.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$156.10
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
| Rate for Payer: Multiplan Commercial |
$711.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$116.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$116.49
|
| Rate for Payer: TriValley Medical Group Senior |
$116.49
|
| Rate for Payer: TriValley Medical Group Senior |
$116.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$125.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$125.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
|
|
HC TISS CUL NON-NEO SKN/OTH BX
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.94 |
| Max. Negotiated Rate |
$1,134.30 |
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$249.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,134.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,134.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,132.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1,132.59
|
| Rate for Payer: Blue Shield of California EPN |
$908.43
|
| Rate for Payer: Blue Shield of California EPN |
$908.43
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$189.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$261.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$140.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$140.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$249.46
|
| Rate for Payer: Heritage Provider Network Senior |
$180.13
|
| Rate for Payer: Heritage Provider Network Senior |
$249.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$138.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$192.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$188.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$140.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$140.73
|
| Rate for Payer: TriValley Medical Group Senior |
$140.73
|
| Rate for Payer: TriValley Medical Group Senior |
$140.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$151.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$151.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$151.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$151.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC TISS CUL NON-NEO SKN/OTH BX
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.94 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.53
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$272.83
|
| Rate for Payer: Heritage Provider Network Senior |
$272.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.75
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
|
|
HC TISSEEL FIBRIN SEALANT/CATH
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT C2615
|
| Hospital Charge Code |
900803520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.80 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$438.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,355.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,206.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,645.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$881.99
|
| Rate for Payer: Blue Shield of California EPN |
$881.99
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,009.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,864.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,864.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,015.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,015.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,097.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,097.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,097.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,535.80
|
| Rate for Payer: Multiplan Commercial |
$1,645.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$792.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$726.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,864.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,864.90
|
|
|
HC TISSEEL FIBRIN SEALANT/CATH
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT C2615
|
| Hospital Charge Code |
900803520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.80 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$438.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,412.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$881.99
|
| Rate for Payer: Blue Shield of California EPN |
$881.99
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,009.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,015.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,015.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,097.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,097.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,097.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.50
|
| Rate for Payer: Multiplan Commercial |
$1,645.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$792.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$726.43
|
|
|
HC TISSUE HOMOGENIZATION, CULTR
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
900911804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.14
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.30
|
| Rate for Payer: Heritage Provider Network Senior |
$85.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
|
|
HC TISSUE HOMOGENIZATION, CULTR
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
900911804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$55.87 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.87
|
| Rate for Payer: Blue Shield of California Commercial |
$47.35
|
| Rate for Payer: Blue Shield of California Commercial |
$47.35
|
| Rate for Payer: Blue Shield of California EPN |
$37.98
|
| Rate for Payer: Blue Shield of California EPN |
$37.98
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.71
|
| Rate for Payer: Heritage Provider Network Senior |
$77.99
|
| Rate for Payer: Heritage Provider Network Senior |
$16.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$60.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.88
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.88
|
| Rate for Payer: TriValley Medical Group Senior |
$5.88
|
| Rate for Payer: TriValley Medical Group Senior |
$5.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$5.88
|
| Rate for Payer: Vantage Medical Group Senior |
$5.88
|
|
|
HC TISSUE MARKER 11 GA
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$265.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$235.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$172.46
|
| Rate for Payer: Blue Shield of California EPN |
$172.46
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$197.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$364.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$364.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$364.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$198.63
|
| Rate for Payer: Heritage Provider Network Senior |
$198.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$214.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$214.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$214.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$300.30
|
| Rate for Payer: Multiplan Commercial |
$321.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$155.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$142.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$364.65
|
| Rate for Payer: Vantage Medical Group Senior |
$364.65
|
|
|
HC TISSUE MARKER 11 GA
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$276.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$172.46
|
| Rate for Payer: Blue Shield of California EPN |
$172.46
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$197.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$231.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$198.63
|
| Rate for Payer: Heritage Provider Network Senior |
$198.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$214.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$214.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$214.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.25
|
| Rate for Payer: Multiplan Commercial |
$321.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$155.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$142.04
|
|
|
HC TISSUE MARKER 18GA
|
Facility
|
OP
|
$1,227.20
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.44 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$245.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$758.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,043.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$674.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$920.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$493.33
|
| Rate for Payer: Blue Shield of California EPN |
$493.33
|
| Rate for Payer: Cash Price |
$552.24
|
| Rate for Payer: Cash Price |
$552.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$564.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,043.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,043.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,043.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$568.19
|
| Rate for Payer: Heritage Provider Network Senior |
$568.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$613.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$613.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$613.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$859.04
|
| Rate for Payer: Multiplan Commercial |
$920.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$443.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$406.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,043.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,043.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,043.12
|
|
|
HC TISSUE MARKER 18GA
|
Facility
|
IP
|
$1,227.20
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.44 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$245.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$790.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$493.33
|
| Rate for Payer: Blue Shield of California EPN |
$493.33
|
| Rate for Payer: Cash Price |
$552.24
|
| Rate for Payer: Cash Price |
$552.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$564.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$568.19
|
| Rate for Payer: Heritage Provider Network Senior |
$568.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$613.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$613.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$613.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.80
|
| Rate for Payer: Multiplan Commercial |
$920.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$443.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$406.33
|
|
|
HC TISSUE MARKER 8 GA
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$81.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$262.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$163.61
|
| Rate for Payer: Blue Shield of California EPN |
$163.61
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.44
|
| Rate for Payer: Heritage Provider Network Senior |
$188.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$203.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$203.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$203.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.75
|
| Rate for Payer: Multiplan Commercial |
$305.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$134.76
|
|
|
HC TISSUE MARKER 8 GA
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$81.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$251.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$163.61
|
| Rate for Payer: Blue Shield of California EPN |
$163.61
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$345.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.44
|
| Rate for Payer: Heritage Provider Network Senior |
$188.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$203.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$203.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$203.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$284.90
|
| Rate for Payer: Multiplan Commercial |
$305.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$134.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.95
|
| Rate for Payer: Vantage Medical Group Senior |
$345.95
|
|
