|
HC UNLST PROC CASTING/STRAPPING
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
900501651
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.73 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$66.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$203.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$156.75
|
| Rate for Payer: Blue Shield of California EPN |
$124.74
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$214.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$209.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$223.41
|
| Rate for Payer: Heritage Provider Network Senior |
$223.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$157.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$198.00
|
| Rate for Payer: TriValley Medical Group Senior |
$198.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
HC UNLST PROC CASTING/STRAPPING
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
900501651
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.73 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Adventist Health Commercial |
$66.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$212.52
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$223.41
|
| Rate for Payer: Heritage Provider Network Senior |
$223.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.50
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
|
|
HC UNLST PROC TONGUE FLOOR OF MOUTH
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 41599
|
| Hospital Charge Code |
900501220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$296.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$228.00
|
| Rate for Payer: Blue Shield of California EPN |
$181.44
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$312.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.96
|
| Rate for Payer: Heritage Provider Network Senior |
$324.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$228.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$288.00
|
| Rate for Payer: TriValley Medical Group Senior |
$288.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC UNLST PROC TONGUE FLOOR OF MOUTH
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 41599
|
| Hospital Charge Code |
900501220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$309.12
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.96
|
| Rate for Payer: Heritage Provider Network Senior |
$324.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
|
|
HC UPPER GI ENDOSCOPY W OPTCL END
|
Facility
|
OP
|
$3,053.00
|
|
|
Service Code
|
CPT 43252
|
| Hospital Charge Code |
906743252
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Adventist Health Commercial |
$408.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,261.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,886.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,326.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,984.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,889.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,263.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$973.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,456.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$552.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$369.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: Multiplan Commercial |
$1,530.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC UPPER GI ENDOSCOPY W OPTCL END
|
Facility
|
IP
|
$3,053.00
|
|
|
Service Code
|
CPT 43252
|
| Hospital Charge Code |
906743252
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$552.59 |
| Max. Negotiated Rate |
$2,289.75 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,966.13
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,066.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,066.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$552.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.25
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
|
OP
|
$3,240.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$586.44 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$648.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,002.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,539.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,224.72
|
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,106.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,193.48
|
| Rate for Payer: Heritage Provider Network Senior |
$2,193.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,545.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$586.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$810.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,430.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,944.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,944.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
|
IP
|
$3,240.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$586.44 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Adventist Health Commercial |
$648.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,086.56
|
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,193.48
|
| Rate for Payer: Heritage Provider Network Senior |
$2,193.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$586.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$810.00
|
| Rate for Payer: Multiplan Commercial |
$2,430.00
|
|
|
HC UPPER GI SCOPE W/THRMAL ENERGY
|
Facility
|
IP
|
$4,134.00
|
|
|
Service Code
|
CPT 43257
|
| Hospital Charge Code |
906743257
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$748.25 |
| Max. Negotiated Rate |
$3,100.50 |
| Rate for Payer: Adventist Health Commercial |
$826.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,662.30
|
| Rate for Payer: Cash Price |
$1,860.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,798.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,798.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$748.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,033.50
|
| Rate for Payer: Multiplan Commercial |
$3,100.50
|
|
|
HC UPPER GI SCOPE W/THRMAL ENERGY
|
Facility
|
OP
|
$4,891.00
|
|
|
Service Code
|
CPT 43257
|
| Hospital Charge Code |
906743257
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$978.20
|
| Rate for Payer: Adventist Health Commercial |
$826.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,554.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,022.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| 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: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: Cash Price |
$1,860.30
|
| Rate for Payer: Cash Price |
$1,860.30
|
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: Cash Price |
$1,860.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,687.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,179.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,454.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,958.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,958.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,958.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,027.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,558.95
|
| Rate for Payer: Heritage Provider Network Senior |
$6,099.30
|
| Rate for Payer: Heritage Provider Network Senior |
$6,099.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,958.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,971.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,333.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$885.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$748.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,702.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,702.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,033.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,222.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,644.77
|
| Rate for Payer: Multiplan Commercial |
$3,668.25
|
| Rate for Payer: Multiplan Commercial |
$3,100.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,438.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,454.66
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
| Rate for Payer: Vantage Medical Group Senior |
$4,958.78
|
|
|
HC UREA NITROGEN, UR
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900910460
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$132.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.07
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Senior |
$133.09
|
| Rate for Payer: Heritage Provider Network Senior |
$16.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$102.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.45
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Senior |
$5.56
|
| Rate for Payer: TriValley Medical Group Senior |
$5.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
|
HC UREA NITROGEN, UR
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900910460
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.46
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.56
|
| Rate for Payer: Heritage Provider Network Senior |
$145.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
|
|
HC UREA NITROGEN URINE 24 HOURS
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.46
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.56
|
| Rate for Payer: Heritage Provider Network Senior |
$145.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
|
|
HC UREA NITROGEN URINE 24 HOURS
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$132.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.07
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Senior |
$133.09
|
| Rate for Payer: Heritage Provider Network Senior |
$16.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$102.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.45
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Senior |
$5.56
|
| Rate for Payer: TriValley Medical Group Senior |
$5.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
|
HC UREA NITROGEN URINE RANDOM
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.46
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.56
|
| Rate for Payer: Heritage Provider Network Senior |
$145.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
|
|
HC UREA NITROGEN URINE RANDOM
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$132.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.07
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Senior |
$133.09
|
| Rate for Payer: Heritage Provider Network Senior |
$16.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$102.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.45
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Senior |
$5.56
|
| Rate for Payer: TriValley Medical Group Senior |
$5.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
|
HC URE EMBOLIZATION OR OCCLUSION
|
Facility
|
IP
|
$6,462.00
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
909050705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,169.62 |
| Max. Negotiated Rate |
$4,846.50 |
| Rate for Payer: Adventist Health Commercial |
$1,292.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,161.53
|
| Rate for Payer: Cash Price |
$2,907.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,374.77
|
| Rate for Payer: Heritage Provider Network Senior |
$4,374.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,169.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,615.50
|
| Rate for Payer: Multiplan Commercial |
$4,846.50
|
|
|
HC URE EMBOLIZATION OR OCCLUSION
|
Facility
|
OP
|
$6,462.00
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
909050705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,292.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,993.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,492.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,554.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,846.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$2,907.90
|
| Rate for Payer: Cash Price |
$2,907.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,200.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,492.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,492.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,492.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,999.98
|
| Rate for Payer: Heritage Provider Network Senior |
$3,999.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,082.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,169.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,615.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,523.40
|
| Rate for Payer: Multiplan Commercial |
$4,846.50
|
| 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 |
$5,492.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,492.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5,492.70
|
|
|
HC URE STNT PLCMNT W NEPH CATH
|
Facility
|
OP
|
$11,722.00
|
|
|
Service Code
|
CPT 50695
|
| Hospital Charge Code |
909050695
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,121.68 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,344.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,244.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$5,274.90
|
| Rate for Payer: Cash Price |
$5,274.90
|
| Rate for Payer: Cash Price |
$5,274.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,619.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,533.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,255.92
|
| Rate for Payer: Heritage Provider Network Senior |
$5,576.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,614.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,121.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,213.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,930.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,075.17
|
| Rate for Payer: Multiplan Commercial |
$8,791.50
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,987.08
|
| Rate for Payer: TriValley Medical Group Senior |
$4,987.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
HC URE STNT PLCMNT W NEPH CATH
|
Facility
|
IP
|
$11,722.00
|
|
|
Service Code
|
CPT 50695
|
| Hospital Charge Code |
909050695
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,121.68 |
| Max. Negotiated Rate |
$8,791.50 |
| Rate for Payer: Adventist Health Commercial |
$2,344.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,548.97
|
| Rate for Payer: Cash Price |
$5,274.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,935.79
|
| Rate for Payer: Heritage Provider Network Senior |
$7,935.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,121.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,930.50
|
| Rate for Payer: Multiplan Commercial |
$8,791.50
|
|
|
HC URETERAL BIOPSY
|
Facility
|
IP
|
$11,347.00
|
|
|
Service Code
|
CPT 50955
|
| Hospital Charge Code |
909000193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,053.81 |
| Max. Negotiated Rate |
$8,510.25 |
| Rate for Payer: Adventist Health Commercial |
$2,269.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,307.47
|
| Rate for Payer: Cash Price |
$5,106.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,681.92
|
| Rate for Payer: Heritage Provider Network Senior |
$7,681.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,053.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,836.75
|
| Rate for Payer: Multiplan Commercial |
$8,510.25
|
|
|
HC URETERAL BIOPSY
|
Facility
|
OP
|
$11,347.00
|
|
|
Service Code
|
CPT 50955
|
| Hospital Charge Code |
909000193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,053.81 |
| Max. Negotiated Rate |
$13,102.72 |
| Rate for Payer: Adventist Health Commercial |
$2,269.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,012.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,896.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$5,106.15
|
| Rate for Payer: Cash Price |
$5,106.15
|
| Rate for Payer: Cash Price |
$5,106.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,375.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,585.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,896.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,896.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,023.79
|
| Rate for Payer: Heritage Provider Network Senior |
$8,482.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,896.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,102.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,053.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,930.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,836.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,240.87
|
| Rate for Payer: Multiplan Commercial |
$8,510.25
|
| Rate for Payer: Multiplan WC |
$10,291.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,585.79
|
| Rate for Payer: TriValley Medical Group Senior |
$7,585.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Vantage Medical Group Senior |
$6,896.17
|
|
|
HC URETERAL BRUSH BIOPSY
|
Facility
|
IP
|
$11,347.00
|
|
|
Service Code
|
CPT 52007
|
| Hospital Charge Code |
909000173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,053.81 |
| Max. Negotiated Rate |
$8,510.25 |
| Rate for Payer: Adventist Health Commercial |
$2,269.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,307.47
|
| Rate for Payer: Cash Price |
$5,106.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,681.92
|
| Rate for Payer: Heritage Provider Network Senior |
$7,681.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,053.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,836.75
|
| Rate for Payer: Multiplan Commercial |
$8,510.25
|
|
|
HC URETERAL BRUSH BIOPSY
|
Facility
|
OP
|
$11,347.00
|
|
|
Service Code
|
CPT 52007
|
| Hospital Charge Code |
909000173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,053.81 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,269.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,012.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$5,106.15
|
| Rate for Payer: Cash Price |
$5,106.15
|
| Rate for Payer: Cash Price |
$5,106.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,375.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,533.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,023.79
|
| Rate for Payer: Heritage Provider Network Senior |
$5,576.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,614.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,053.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,213.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,836.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,075.17
|
| Rate for Payer: Multiplan Commercial |
$8,510.25
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,987.08
|
| Rate for Payer: TriValley Medical Group Senior |
$4,987.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
HC URETERAL DILATION
|
Facility
|
IP
|
$10,278.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,860.32 |
| Max. Negotiated Rate |
$7,708.50 |
| Rate for Payer: Adventist Health Commercial |
$2,055.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,619.03
|
| Rate for Payer: Cash Price |
$4,625.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,958.21
|
| Rate for Payer: Heritage Provider Network Senior |
$6,958.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,860.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,569.50
|
| Rate for Payer: Multiplan Commercial |
$7,708.50
|
|
