|
HC TRIIODOTHYRONINE, FREE
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
900912135
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$228.75 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$188.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.89
|
| Rate for Payer: Blue Shield of California Commercial |
$136.34
|
| Rate for Payer: Blue Shield of California Commercial |
$136.34
|
| Rate for Payer: Blue Shield of California EPN |
$109.36
|
| Rate for Payer: Blue Shield of California EPN |
$109.36
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$112.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$198.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.79
|
| Rate for Payer: Heritage Provider Network Senior |
$107.09
|
| Rate for Payer: Heritage Provider Network Senior |
$188.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$82.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$145.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.70
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.94
|
| Rate for Payer: TriValley Medical Group Senior |
$16.94
|
| Rate for Payer: TriValley Medical Group Senior |
$16.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC TRIMMING NONDYSTROPHIC NAILS
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
900501406
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.22
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.69
|
| Rate for Payer: Heritage Provider Network Senior |
$132.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
|
|
HC TRIMMING NONDYSTROPHIC NAILS
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
900501406
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$93.10
|
| Rate for Payer: Blue Shield of California EPN |
$74.09
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.69
|
| Rate for Payer: Heritage Provider Network Senior |
$132.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$93.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Senior |
$117.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC TRIM SKIN LESION MORE THAN 4
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
900101494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.08 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$68.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.57
|
| Rate for Payer: Blue Shield of California Commercial |
$209.23
|
| Rate for Payer: Blue Shield of California EPN |
$167.38
|
| Rate for Payer: Cash Price |
$154.35
|
| Rate for Payer: Cash Price |
$154.35
|
| Rate for Payer: Cash Price |
$154.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$222.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$212.32
|
| Rate for Payer: Heritage Provider Network Senior |
$212.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$163.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$257.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$283.86
|
| Rate for Payer: TriValley Medical Group Senior |
$283.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$171.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$171.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC TRIM SKIN LESION MORE THAN 4
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
900101494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.08 |
| Max. Negotiated Rate |
$257.25 |
| Rate for Payer: Adventist Health Commercial |
$68.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$220.89
|
| Rate for Payer: Cash Price |
$154.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$232.21
|
| Rate for Payer: Heritage Provider Network Senior |
$232.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.75
|
| Rate for Payer: Multiplan Commercial |
$257.25
|
|
|
HC TRLUML BLLN ANGIO ADDL ART
|
Facility
|
OP
|
$8,984.00
|
|
|
Service Code
|
CPT 37247
|
| Hospital Charge Code |
909037247
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,796.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,552.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,636.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,941.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,738.00
|
| 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 |
$4,042.80
|
| Rate for Payer: Cash Price |
$4,042.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,839.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,636.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,636.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,636.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,561.10
|
| Rate for Payer: Heritage Provider Network Senior |
$5,561.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,285.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,626.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,246.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,288.80
|
| Rate for Payer: Multiplan Commercial |
$6,738.00
|
| 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 |
$7,636.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,636.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7,636.40
|
|
|
HC TRLUML BLLN ANGIO ADDL ART
|
Facility
|
IP
|
$8,984.00
|
|
|
Service Code
|
CPT 37247
|
| Hospital Charge Code |
909037247
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,626.10 |
| Max. Negotiated Rate |
$6,738.00 |
| Rate for Payer: Adventist Health Commercial |
$1,796.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,785.70
|
| Rate for Payer: Cash Price |
$4,042.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,082.17
|
| Rate for Payer: Heritage Provider Network Senior |
$6,082.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,626.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,246.00
|
| Rate for Payer: Multiplan Commercial |
$6,738.00
|
|
|
HC TRLUML BLLN ANGIO ADDL VEIN
|
Facility
|
OP
|
$7,823.00
|
|
|
Service Code
|
CPT 37249
|
| Hospital Charge Code |
909037249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,564.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,834.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,649.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,302.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,867.25
|
| 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 |
$3,520.35
|
| Rate for Payer: Cash Price |
$3,520.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,084.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,649.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,649.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,649.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,842.44
|
| Rate for Payer: Heritage Provider Network Senior |
$4,842.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,731.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,955.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,476.10
|
| Rate for Payer: Multiplan Commercial |
$5,867.25
|
| 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 |
$6,649.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,649.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6,649.55
|
|
|
HC TRLUML BLLN ANGIO ADDL VEIN
|
Facility
|
IP
|
$7,823.00
|
|
|
Service Code
|
CPT 37249
|
| Hospital Charge Code |
909037249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,415.96 |
| Max. Negotiated Rate |
$5,867.25 |
| Rate for Payer: Adventist Health Commercial |
$1,564.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,038.01
|
| Rate for Payer: Cash Price |
$3,520.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,296.17
|
| Rate for Payer: Heritage Provider Network Senior |
$5,296.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,955.75
|
| Rate for Payer: Multiplan Commercial |
$5,867.25
|
|
|
HC TRLUML BLLN ANGIO INIT ART
|
Facility
|
IP
|
$17,967.00
|
|
|
Service Code
|
CPT 37246
|
| Hospital Charge Code |
909037246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,252.03 |
| Max. Negotiated Rate |
$13,475.25 |
| Rate for Payer: Adventist Health Commercial |
$3,593.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,570.75
|
| Rate for Payer: Cash Price |
$8,085.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,163.66
|
| Rate for Payer: Heritage Provider Network Senior |
$12,163.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,252.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,491.75
|
| Rate for Payer: Multiplan Commercial |
$13,475.25
|
|
|
HC TRLUML BLLN ANGIO INIT ART
|
Facility
|
OP
|
$17,967.00
|
|
|
Service Code
|
CPT 37246
|
| Hospital Charge Code |
909037246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,252.03 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Cigna of CA HMO/PPO |
$11,678.55
|
| Rate for Payer: Adventist Health Commercial |
$3,593.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,103.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,320.30
|
| 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 |
$8,085.15
|
| Rate for Payer: Cash Price |
$8,085.15
|
| Rate for Payer: Cash Price |
$8,085.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,052.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,320.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,320.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,121.57
|
| Rate for Payer: Heritage Provider Network Senior |
$9,003.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,908.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,252.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,418.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,491.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,809.20
|
| Rate for Payer: Multiplan Commercial |
$13,475.25
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,052.33
|
| Rate for Payer: TriValley Medical Group Senior |
$8,052.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7,320.30
|
|
|
HC TRLUML BLLN ANGIO INIT VEIN
|
Facility
|
OP
|
$15,645.00
|
|
|
Service Code
|
CPT 37248
|
| Hospital Charge Code |
909037248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,831.74 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$3,129.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,668.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,320.30
|
| 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 |
$7,040.25
|
| Rate for Payer: Cash Price |
$7,040.25
|
| Rate for Payer: Cash Price |
$7,040.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,169.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,052.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,320.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,320.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,684.25
|
| Rate for Payer: Heritage Provider Network Senior |
$9,003.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,908.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,831.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,418.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,911.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,809.20
|
| Rate for Payer: Multiplan Commercial |
$11,733.75
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,052.33
|
| Rate for Payer: TriValley Medical Group Senior |
$8,052.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7,320.30
|
|
|
HC TRLUML BLLN ANGIO INIT VEIN
|
Facility
|
IP
|
$15,645.00
|
|
|
Service Code
|
CPT 37248
|
| Hospital Charge Code |
909037248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,831.74 |
| Max. Negotiated Rate |
$11,733.75 |
| Rate for Payer: Adventist Health Commercial |
$3,129.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,075.38
|
| Rate for Payer: Cash Price |
$7,040.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,591.67
|
| Rate for Payer: Heritage Provider Network Senior |
$10,591.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,831.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,911.25
|
| Rate for Payer: Multiplan Commercial |
$11,733.75
|
|
|
HC TRMNT SPEECH/LANG/DYSPHAGIA GRP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 92508
|
| Hospital Charge Code |
905601501
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$184.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$278.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$382.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$247.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$292.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$382.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$382.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$382.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.55
|
| Rate for Payer: Heritage Provider Network Senior |
$278.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$214.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$315.00
|
| Rate for Payer: Multiplan Commercial |
$337.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$382.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$382.50
|
| Rate for Payer: Vantage Medical Group Senior |
$382.50
|
|
|
HC TRMNT SPEECH/LANG/DYSPHAGIA GRP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 92508
|
| Hospital Charge Code |
905601501
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Adventist Health Commercial |
$90.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$289.80
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$304.65
|
| Rate for Payer: Heritage Provider Network Senior |
$304.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.50
|
| Rate for Payer: Multiplan Commercial |
$337.50
|
|
|
HC TRMNT SPEECH/LANG/DYSPHAGIA GRP MCAL
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT X4302
|
| Hospital Charge Code |
907000038
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$56.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.80
|
| Rate for Payer: Heritage Provider Network Senior |
$84.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$65.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC TRMNT SPEECH/LANG/DYSPHAGIA GRP MCAL
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT X4302
|
| Hospital Charge Code |
907000038
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.23
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.75
|
| Rate for Payer: Heritage Provider Network Senior |
$92.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.25
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
|
|
HC TRMNT SPEECH/LANG/VOICE INDIV MCAL
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000041
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$97.74 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$347.76
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$365.58
|
| Rate for Payer: Heritage Provider Network Senior |
$365.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
|
|
HC TRMNT SPEECH/LANG/VOICE INDIV MCAL
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000041
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$97.74 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$333.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$351.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$351.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.26
|
| Rate for Payer: Heritage Provider Network Senior |
$334.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$257.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$378.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
HC TROPONIN - I
|
Facility
|
IP
|
$1,014.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900910994
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$183.53 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Adventist Health Commercial |
$202.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$653.02
|
| Rate for Payer: Cash Price |
$456.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$686.48
|
| Rate for Payer: Heritage Provider Network Senior |
$686.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.50
|
| Rate for Payer: Multiplan Commercial |
$760.50
|
|
|
HC TROPONIN - I
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900910994
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$181.15 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Adventist Health Commercial |
$202.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$626.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.15
|
| Rate for Payer: Blue Shield of California Commercial |
$79.20
|
| Rate for Payer: Blue Shield of California Commercial |
$79.20
|
| Rate for Payer: Blue Shield of California EPN |
$63.52
|
| Rate for Payer: Blue Shield of California EPN |
$63.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$456.30
|
| Rate for Payer: Cash Price |
$456.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$659.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$598.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$627.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.66
|
| Rate for Payer: Heritage Provider Network Senior |
$627.67
|
| Rate for Payer: Heritage Provider Network Senior |
$34.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$483.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$760.50
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.47
|
| Rate for Payer: TriValley Medical Group Senior |
$12.47
|
| Rate for Payer: TriValley Medical Group Senior |
$12.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Vantage Medical Group Senior |
$12.47
|
| Rate for Payer: Vantage Medical Group Senior |
$12.47
|
|
|
HC TROPONIN-T
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900912119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$202.86
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.25
|
| Rate for Payer: Heritage Provider Network Senior |
$213.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
|
|
HC TROPONIN-T
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900912119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$181.15 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$194.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.15
|
| Rate for Payer: Blue Shield of California Commercial |
$79.20
|
| Rate for Payer: Blue Shield of California Commercial |
$79.20
|
| Rate for Payer: Blue Shield of California EPN |
$63.52
|
| Rate for Payer: Blue Shield of California EPN |
$63.52
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.28
|
| Rate for Payer: Heritage Provider Network Senior |
$194.99
|
| Rate for Payer: Heritage Provider Network Senior |
$48.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$150.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.47
|
| Rate for Payer: TriValley Medical Group Senior |
$12.47
|
| Rate for Payer: TriValley Medical Group Senior |
$12.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Vantage Medical Group Senior |
$12.47
|
| Rate for Payer: Vantage Medical Group Senior |
$12.47
|
|
|
HC TRSNCATH INS/REPL LEADLESS PCR
|
Facility
|
OP
|
$48,374.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
906811498
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,245.00 |
| Max. Negotiated Rate |
$47,070.12 |
| Rate for Payer: Adventist Health Commercial |
$9,674.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29,895.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,773.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$21,768.30
|
| Rate for Payer: Cash Price |
$21,768.30
|
| Rate for Payer: Cash Price |
$21,768.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31,443.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,773.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,773.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$29,943.51
|
| Rate for Payer: Heritage Provider Network Senior |
$30,471.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,773.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47,070.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,755.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,489.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,093.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,196.82
|
| Rate for Payer: Multiplan Commercial |
$36,280.50
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$27,251.12
|
| Rate for Payer: TriValley Medical Group Senior |
$27,251.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,939.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$24,773.75
|
|
|
HC TRSNCATH INS/REPL LEADLESS PCR
|
Facility
|
IP
|
$48,374.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
906811498
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,755.69 |
| Max. Negotiated Rate |
$36,280.50 |
| Rate for Payer: Adventist Health Commercial |
$9,674.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31,152.86
|
| Rate for Payer: Cash Price |
$21,768.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$32,749.20
|
| Rate for Payer: Heritage Provider Network Senior |
$32,749.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,755.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,093.50
|
| Rate for Payer: Multiplan Commercial |
$36,280.50
|
|
