|
HC ACT HMS (POC)
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912038
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.42
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.23
|
| Rate for Payer: Heritage Provider Network Senior |
$37.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC ACT HMS (POC)
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912038
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.40
|
| Rate for Payer: Blue Shield of California Commercial |
$34.27
|
| Rate for Payer: Blue Shield of California Commercial |
$34.27
|
| Rate for Payer: Blue Shield of California EPN |
$27.49
|
| Rate for Payer: Blue Shield of California EPN |
$27.49
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.83
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.05
|
| Rate for Payer: Heritage Provider Network Senior |
$22.90
|
| Rate for Payer: Heritage Provider Network Senior |
$34.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.28
|
| Rate for Payer: TriValley Medical Group Senior |
$4.28
|
| Rate for Payer: TriValley Medical Group Senior |
$4.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
HC ACT LOW RANGE/PLUS (POC)
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$160.50 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.82
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.88
|
| Rate for Payer: Heritage Provider Network Senior |
$144.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.50
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
|
|
HC ACT LOW RANGE/PLUS (POC)
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$160.50 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$132.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.40
|
| Rate for Payer: Blue Shield of California Commercial |
$34.27
|
| Rate for Payer: Blue Shield of California EPN |
$27.49
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.47
|
| Rate for Payer: Heritage Provider Network Senior |
$132.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$102.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.28
|
| Rate for Payer: TriValley Medical Group Senior |
$4.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
HC ACUTE ABD SERIES
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
909001701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$185.53 |
| Max. Negotiated Rate |
$768.75 |
| Rate for Payer: Adventist Health Commercial |
$205.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$660.10
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.92
|
| Rate for Payer: Heritage Provider Network Senior |
$693.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.25
|
| Rate for Payer: Multiplan Commercial |
$768.75
|
|
|
HC ACUTE ABD SERIES
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
909001701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$768.75 |
| Rate for Payer: Adventist Health Commercial |
$205.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$633.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.42
|
| Rate for Payer: Blue Shield of California Commercial |
$156.72
|
| Rate for Payer: Blue Shield of California EPN |
$126.03
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$666.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$604.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$634.48
|
| Rate for Payer: Heritage Provider Network Senior |
$634.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$488.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$768.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC ACUTE HEPATITIS PANEL
|
Facility
|
IP
|
$867.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
900910701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$156.93 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Adventist Health Commercial |
$173.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$558.35
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$586.96
|
| Rate for Payer: Heritage Provider Network Senior |
$586.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.75
|
| Rate for Payer: Multiplan Commercial |
$650.25
|
|
|
HC ACUTE HEPATITIS PANEL
|
Facility
|
OP
|
$867.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
900910701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Adventist Health Commercial |
$173.40
|
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$535.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.98
|
| Rate for Payer: Blue Shield of California Commercial |
$383.27
|
| Rate for Payer: Blue Shield of California Commercial |
$383.27
|
| Rate for Payer: Blue Shield of California EPN |
$307.41
|
| Rate for Payer: Blue Shield of California EPN |
$307.41
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$563.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$511.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$47.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$47.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$536.67
|
| Rate for Payer: Heritage Provider Network Senior |
$103.99
|
| Rate for Payer: Heritage Provider Network Senior |
$536.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$80.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$413.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.82
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$650.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$47.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$47.63
|
| Rate for Payer: TriValley Medical Group Senior |
$47.63
|
| Rate for Payer: TriValley Medical Group Senior |
$47.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$51.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$51.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.39
|
| Rate for Payer: Vantage Medical Group Senior |
$47.63
|
| Rate for Payer: Vantage Medical Group Senior |
$47.63
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
905601756
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$155.25 |
| Rate for Payer: Adventist Health Commercial |
$41.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.31
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.14
|
| Rate for Payer: Heritage Provider Network Senior |
$140.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$155.25
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
905601756
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$84.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$175.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.25
|
| 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 |
$93.15
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$134.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$175.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.13
|
| Rate for Payer: Heritage Provider Network Senior |
$128.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$98.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$144.90
|
| Rate for Payer: Multiplan Commercial |
$155.25
|
| 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 |
$175.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.95
|
| Rate for Payer: Vantage Medical Group Senior |
$175.95
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE MCAL
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$155.25 |
| Rate for Payer: Adventist Health Commercial |
$41.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.31
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.14
|
| Rate for Payer: Heritage Provider Network Senior |
$140.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$155.25
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE MCAL
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$84.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$175.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.25
|
| 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 |
$93.15
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$134.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$175.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.13
|
| Rate for Payer: Heritage Provider Network Senior |
$128.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$98.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$144.90
|
| Rate for Payer: Multiplan Commercial |
$155.25
|
| 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 |
$175.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.95
|
| Rate for Payer: Vantage Medical Group Senior |
$175.95
|
|
|
HC ADDITIONAL FROZEN SECTIONS
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
903800036
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Adventist Health Commercial |
$76.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$244.72
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$257.26
|
| Rate for Payer: Heritage Provider Network Senior |
$257.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.00
|
| Rate for Payer: Multiplan Commercial |
$285.00
|
|
|
HC ADDITIONAL FROZEN SECTIONS
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
903800036
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.53 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Adventist Health Commercial |
$76.00
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$234.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$323.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$209.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$285.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.36
|
| Rate for Payer: Blue Shield of California Commercial |
$51.36
|
| Rate for Payer: Blue Shield of California EPN |
$41.30
|
| Rate for Payer: Blue Shield of California EPN |
$41.30
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$247.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$323.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$323.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$235.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.71
|
| Rate for Payer: Heritage Provider Network Senior |
$235.22
|
| Rate for Payer: Heritage Provider Network Senior |
$55.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$181.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$42.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$266.00
|
| Rate for Payer: Multiplan Commercial |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$323.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$323.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$323.00
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
HC ADDL PMP NW SUBC THER INF SITE
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 96371
|
| Hospital Charge Code |
907296371
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$49.77 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$55.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$178.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$92.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$170.22
|
| Rate for Payer: Heritage Provider Network Senior |
$170.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$131.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$206.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$101.86
|
| Rate for Payer: TriValley Medical Group Senior |
$92.60
|
| 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 |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC ADDL PMP NW SUBC THER INF SITE
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 96371
|
| Hospital Charge Code |
907296371
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$49.77 |
| Max. Negotiated Rate |
$206.25 |
| Rate for Payer: Adventist Health Commercial |
$55.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.10
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.18
|
| Rate for Payer: Heritage Provider Network Senior |
$186.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.75
|
| Rate for Payer: Multiplan Commercial |
$206.25
|
|
|
HC ADD VENOUS ABLATION SNGL EXTRE
|
Facility
|
IP
|
$14,481.00
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
909080042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,621.06 |
| Max. Negotiated Rate |
$10,860.75 |
| Rate for Payer: Adventist Health Commercial |
$2,896.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,325.76
|
| Rate for Payer: Cash Price |
$6,516.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,803.64
|
| Rate for Payer: Heritage Provider Network Senior |
$9,803.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,621.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,620.25
|
| Rate for Payer: Multiplan Commercial |
$10,860.75
|
|
|
HC ADD VENOUS ABLATION SNGL EXTRE
|
Facility
|
OP
|
$14,481.00
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
909080042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$12,308.85 |
| Rate for Payer: Adventist Health Commercial |
$2,896.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,949.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,308.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,964.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,860.75
|
| 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 |
$6,516.45
|
| Rate for Payer: Cash Price |
$6,516.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,412.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,308.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,308.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,308.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,963.74
|
| Rate for Payer: Heritage Provider Network Senior |
$8,963.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,907.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,621.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,620.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,136.70
|
| Rate for Payer: Multiplan Commercial |
$10,860.75
|
| 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 |
$12,308.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,308.85
|
| Rate for Payer: Vantage Medical Group Senior |
$12,308.85
|
|
|
HC ADENOVIRUS DNA DETECTION BY PCR
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913627
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$65.70 |
| Max. Negotiated Rate |
$272.25 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$233.77
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.75
|
| Rate for Payer: Heritage Provider Network Senior |
$245.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.75
|
| Rate for Payer: Multiplan Commercial |
$272.25
|
|
|
HC ADENOVIRUS DNA DETECTION BY PCR
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913627
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$224.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.42
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$235.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.17
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.70
|
| Rate for Payer: Heritage Provider Network Senior |
$224.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$173.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$272.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC ADENOVIRUS DNA QUANT
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913624
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.81
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC ADENOVIRUS DNA QUANT
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913624
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$344.74 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Adventist Health Commercial |
$54.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.65
|
| Rate for Payer: Blue Shield of California Commercial |
$344.74
|
| Rate for Payer: Blue Shield of California Commercial |
$344.74
|
| Rate for Payer: Blue Shield of California EPN |
$276.51
|
| Rate for Payer: Blue Shield of California EPN |
$276.51
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$178.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$169.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$169.61
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$130.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$158.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$205.50
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC ADJACNT TISS TRNSF LT 10 SQ CM
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
900501289
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,798.23 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Cash Price |
$4,470.75
|
| Rate for Payer: Adventist Health Commercial |
$1,987.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,139.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,719.12
|
| Rate for Payer: Blue Shield of California EPN |
$3,755.43
|
| Rate for Payer: Cash Price |
$4,470.75
|
| Rate for Payer: Cash Price |
$4,470.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,457.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,653.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,725.99
|
| Rate for Payer: Heritage Provider Network Senior |
$6,725.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,738.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,798.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,051.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,483.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$7,451.25
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,961.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5,961.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC ADJACNT TISS TRNSF LT 10 SQ CM
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
900501289
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,798.23 |
| Max. Negotiated Rate |
$7,451.25 |
| Rate for Payer: Adventist Health Commercial |
$1,987.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,398.14
|
| Rate for Payer: Cash Price |
$4,470.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,725.99
|
| Rate for Payer: Heritage Provider Network Senior |
$6,725.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,798.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,483.75
|
| Rate for Payer: Multiplan Commercial |
$7,451.25
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
IP
|
$1,649.00
|
|
|
Service Code
|
CPT S2083
|
| Hospital Charge Code |
909020143
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$298.47 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: Adventist Health Commercial |
$329.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,061.96
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,116.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$298.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.25
|
| Rate for Payer: Multiplan Commercial |
$1,236.75
|
|
