|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$1,593.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.33 |
| Max. Negotiated Rate |
$1,194.75 |
| Rate for Payer: Adventist Health Commercial |
$318.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,025.89
|
| Rate for Payer: Cash Price |
$716.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,078.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,078.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.25
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$1,593.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$288.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$318.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$984.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$971.73
|
| Rate for Payer: Blue Shield of California EPN |
$777.38
|
| Rate for Payer: Cash Price |
$716.85
|
| Rate for Payer: Cash Price |
$716.85
|
| Rate for Payer: Cash Price |
$716.85
|
| Rate for Payer: Cash Price |
$716.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,035.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$567.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$986.07
|
| Rate for Payer: Heritage Provider Network Senior |
$986.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$759.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$652.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$624.16
|
| Rate for Payer: TriValley Medical Group Senior |
$567.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$1,593.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$288.33 |
| Max. Negotiated Rate |
$1,194.75 |
| Rate for Payer: Adventist Health Commercial |
$318.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,025.89
|
| Rate for Payer: Cash Price |
$716.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,078.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,078.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.25
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
|
|
HC TRANSFUS INTRAUTERINE ADDL FETUS
|
Facility
|
OP
|
$1,357.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400022
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$838.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$827.77
|
| Rate for Payer: Blue Shield of California EPN |
$662.22
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$882.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$567.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$839.98
|
| Rate for Payer: Heritage Provider Network Senior |
$839.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$647.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$652.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$624.16
|
| Rate for Payer: TriValley Medical Group Senior |
$567.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC TRANSFUS INTRAUTERINE ADDL FETUS
|
Facility
|
IP
|
$1,357.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400022
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$1,017.75 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$873.91
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$918.69
|
| Rate for Payer: Heritage Provider Network Senior |
$918.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$245.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.25
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
|
|
HC TRANSFUS INTRAUTERINE FETUS
|
Facility
|
IP
|
$1,231.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400021
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$222.81 |
| Max. Negotiated Rate |
$923.25 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$792.76
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$833.39
|
| Rate for Payer: Heritage Provider Network Senior |
$833.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$222.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.75
|
| Rate for Payer: Multiplan Commercial |
$923.25
|
|
|
HC TRANSFUS INTRAUTERINE FETUS
|
Facility
|
OP
|
$1,231.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400021
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$222.81 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$760.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$750.91
|
| Rate for Payer: Blue Shield of California EPN |
$600.73
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$800.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$567.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$761.99
|
| Rate for Payer: Heritage Provider Network Senior |
$761.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$587.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$222.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$652.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$760.34
|
| Rate for Payer: Multiplan Commercial |
$923.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$624.16
|
| Rate for Payer: TriValley Medical Group Senior |
$567.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.16
|
| Rate for Payer: Vantage Medical Group Senior |
$567.42
|
|
|
HC TRANSGLUTAMINASE IGA AB
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913555
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.23
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.81
|
| Rate for Payer: Heritage Provider Network Senior |
$52.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
|
|
HC TRANSGLUTAMINASE IGA AB
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913555
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.20
|
| 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 |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.70
|
| 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 |
$46.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.86
|
| 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 |
$33.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.28
|
| Rate for Payer: Heritage Provider Network Senior |
$33.43
|
| Rate for Payer: Heritage Provider Network Senior |
$48.28
|
| 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 |
$25.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| 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 |
$19.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| 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 |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| 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 TRANSTHYRETIN
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
900910925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.43 |
| Max. Negotiated Rate |
$275.25 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$236.35
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$248.46
|
| Rate for Payer: Heritage Provider Network Senior |
$248.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.75
|
| Rate for Payer: Multiplan Commercial |
$275.25
|
|
|
HC TRANSTHYRETIN
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
900910925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$275.25 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$226.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.90
|
| Rate for Payer: Blue Shield of California Commercial |
$117.39
|
| Rate for Payer: Blue Shield of California Commercial |
$117.39
|
| Rate for Payer: Blue Shield of California EPN |
$94.16
|
| Rate for Payer: Blue Shield of California EPN |
$94.16
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$238.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$227.17
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$227.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$52.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$175.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.55
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Multiplan Commercial |
$275.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.59
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.59
|
| Rate for Payer: TriValley Medical Group Senior |
$14.59
|
| Rate for Payer: TriValley Medical Group Senior |
$14.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Vantage Medical Group Senior |
$14.59
|
| Rate for Payer: Vantage Medical Group Senior |
$14.59
|
|
|
HC TRAY SUTURE REMOVAL
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
900101278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.04
|
| Rate for Payer: Blue Shield of California Commercial |
$122.00
|
| Rate for Payer: Blue Shield of California EPN |
$97.60
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC TRAY SUTURE REMOVAL
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
900101278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.80
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC TREAT CLAVICLE FRACTURE
|
Facility
|
IP
|
$18,844.00
|
|
|
Service Code
|
CPT 23515
|
| Hospital Charge Code |
900501799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,410.76 |
| Max. Negotiated Rate |
$14,133.00 |
| Rate for Payer: Adventist Health Commercial |
$3,768.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,135.54
|
| Rate for Payer: Cash Price |
$8,479.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,757.39
|
| Rate for Payer: Heritage Provider Network Senior |
$12,757.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,410.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,711.00
|
| Rate for Payer: Multiplan Commercial |
$14,133.00
|
|
|
HC TREAT CLAVICLE FRACTURE
|
Facility
|
OP
|
$18,844.00
|
|
|
Service Code
|
CPT 23515
|
| Hospital Charge Code |
900501799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,410.76 |
| Max. Negotiated Rate |
$14,462.30 |
| Rate for Payer: Adventist Health Commercial |
$3,768.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,645.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,950.90
|
| Rate for Payer: Blue Shield of California EPN |
$7,123.03
|
| Rate for Payer: Cash Price |
$8,479.80
|
| Rate for Payer: Cash Price |
$8,479.80
|
| Rate for Payer: Cash Price |
$8,479.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,248.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,757.39
|
| Rate for Payer: Heritage Provider Network Senior |
$12,757.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,988.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,410.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,711.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$14,133.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,306.40
|
| Rate for Payer: TriValley Medical Group Senior |
$11,306.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC TREAT FOOT DISLOCATION W/ANEST
|
Facility
|
OP
|
$1,888.00
|
|
|
Service Code
|
CPT 28605
|
| Hospital Charge Code |
902890262
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$377.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,166.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$896.80
|
| Rate for Payer: Blue Shield of California EPN |
$713.66
|
| Rate for Payer: Cash Price |
$849.60
|
| Rate for Payer: Cash Price |
$849.60
|
| Rate for Payer: Cash Price |
$849.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,227.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,278.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,278.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$900.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$341.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,416.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,132.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,132.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC TREAT FOOT DISLOCATION W/ANEST
|
Facility
|
IP
|
$1,888.00
|
|
|
Service Code
|
CPT 28605
|
| Hospital Charge Code |
902890262
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$341.73 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Adventist Health Commercial |
$377.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,215.87
|
| Rate for Payer: Cash Price |
$849.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,278.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,278.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$341.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.00
|
| Rate for Payer: Multiplan Commercial |
$1,416.00
|
|
|
HC TREAT FX RADIUS & ULNA
|
Facility
|
IP
|
$36,281.00
|
|
|
Service Code
|
CPT 25575
|
| Hospital Charge Code |
900501765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,566.86 |
| Max. Negotiated Rate |
$27,210.75 |
| Rate for Payer: Adventist Health Commercial |
$7,256.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,364.96
|
| Rate for Payer: Cash Price |
$16,326.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,562.24
|
| Rate for Payer: Heritage Provider Network Senior |
$24,562.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,566.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,070.25
|
| Rate for Payer: Multiplan Commercial |
$27,210.75
|
|
|
HC TREAT FX RADIUS & ULNA
|
Facility
|
OP
|
$36,281.00
|
|
|
Service Code
|
CPT 25575
|
| Hospital Charge Code |
900501765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,245.00 |
| Max. Negotiated Rate |
$27,210.75 |
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Adventist Health Commercial |
$7,256.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,421.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$17,233.47
|
| Rate for Payer: Blue Shield of California EPN |
$13,714.22
|
| Rate for Payer: Cash Price |
$16,326.45
|
| Rate for Payer: Cash Price |
$16,326.45
|
| Rate for Payer: Cash Price |
$16,326.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23,582.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,562.24
|
| Rate for Payer: Heritage Provider Network Senior |
$24,562.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,306.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,566.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,070.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$27,210.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$21,768.60
|
| Rate for Payer: TriValley Medical Group Senior |
$21,768.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC TREAT HIP DISLOC W/O ANESTH/MA
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
CPT 27256
|
| Hospital Charge Code |
900501604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.62 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$702.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$539.60
|
| Rate for Payer: Blue Shield of California EPN |
$429.41
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$738.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$769.07
|
| Rate for Payer: Heritage Provider Network Senior |
$769.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$541.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$681.60
|
| Rate for Payer: TriValley Medical Group Senior |
$681.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC TREAT HIP DISLOC W/O ANESTH/MA
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
CPT 27256
|
| Hospital Charge Code |
900501604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.62 |
| Max. Negotiated Rate |
$852.00 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$731.58
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$769.07
|
| Rate for Payer: Heritage Provider Network Senior |
$769.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
|
|
HC TREAT HIP SOCKET FX
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 27220
|
| Hospital Charge Code |
900501683
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$528.08
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
|
|
HC TREAT HIP SOCKET FX
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 27220
|
| Hospital Charge Code |
900501683
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$389.50
|
| Rate for Payer: Blue Shield of California EPN |
$309.96
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$533.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$391.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$492.00
|
| Rate for Payer: TriValley Medical Group Senior |
$492.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC TREAT INCOMPLETE ABORTION SURG
|
Facility
|
OP
|
$4,641.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
900501515
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$840.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,868.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,204.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,754.30
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,016.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,163.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,141.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,141.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,213.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,788.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,784.60
|
| Rate for Payer: TriValley Medical Group Senior |
$2,784.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC TREAT INCOMPLETE ABORTION SURG
|
Facility
|
IP
|
$4,641.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
900501515
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$840.02 |
| Max. Negotiated Rate |
$3,480.75 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,988.80
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,141.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,141.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
|
