|
HC BILIRUBIN TRANSCUTANEOUS
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
900912154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.49
|
| Rate for Payer: Heritage Provider Network Senior |
$97.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
|
|
HC BIL STNT PLCMNT NEW ACC W CATH
|
Facility
|
IP
|
$27,853.00
|
|
|
Service Code
|
CPT 47540
|
| Hospital Charge Code |
909047540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,041.39 |
| Max. Negotiated Rate |
$20,889.75 |
| Rate for Payer: Adventist Health Commercial |
$5,570.60
|
| Rate for Payer: Cash Price |
$15,319.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,856.48
|
| Rate for Payer: Heritage Provider Network Senior |
$18,856.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,041.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,963.25
|
| Rate for Payer: Multiplan Commercial |
$20,889.75
|
|
|
HC BIL STNT PLCMNT NEW ACC W CATH
|
Facility
|
OP
|
$27,853.00
|
|
|
Service Code
|
CPT 47540
|
| Hospital Charge Code |
909047540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$20,889.75 |
| Rate for Payer: Adventist Health Commercial |
$5,570.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,135.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,413.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$15,319.15
|
| Rate for Payer: Cash Price |
$15,319.15
|
| Rate for Payer: Cash Price |
$15,319.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,104.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,154.45
|
| Rate for Payer: Dignity Health Senior |
$7,413.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,413.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,241.01
|
| Rate for Payer: Heritage Provider Network Senior |
$9,118.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,689.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,413.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14,084.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,041.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,525.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,963.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,340.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,340.56
|
| Rate for Payer: Multiplan Commercial |
$20,889.75
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,154.45
|
| Rate for Payer: TriValley Medical Group Senior |
$8,154.45
|
| 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 |
$11,119.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,413.14
|
|
|
HC BIL STNT PLCMT NEW ACC WO CATH
|
Facility
|
OP
|
$27,853.00
|
|
|
Service Code
|
CPT 47539
|
| Hospital Charge Code |
909047539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$20,889.75 |
| Rate for Payer: Adventist Health Commercial |
$5,570.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,135.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,413.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$15,319.15
|
| Rate for Payer: Cash Price |
$15,319.15
|
| Rate for Payer: Cash Price |
$15,319.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,104.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,154.45
|
| Rate for Payer: Dignity Health Senior |
$7,413.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,413.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,241.01
|
| Rate for Payer: Heritage Provider Network Senior |
$9,118.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,404.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,413.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14,084.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,041.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,525.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,963.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,340.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,340.56
|
| Rate for Payer: Multiplan Commercial |
$20,889.75
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,154.45
|
| Rate for Payer: TriValley Medical Group Senior |
$8,154.45
|
| 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 |
$11,119.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,413.14
|
|
|
HC BIL STNT PLCMT NEW ACC WO CATH
|
Facility
|
IP
|
$27,853.00
|
|
|
Service Code
|
CPT 47539
|
| Hospital Charge Code |
909047539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,041.39 |
| Max. Negotiated Rate |
$20,889.75 |
| Rate for Payer: Adventist Health Commercial |
$5,570.60
|
| Rate for Payer: Cash Price |
$15,319.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,856.48
|
| Rate for Payer: Heritage Provider Network Senior |
$18,856.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,041.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,963.25
|
| Rate for Payer: Multiplan Commercial |
$20,889.75
|
|
|
HC BIOFEEDBACK PERI/URO/RECTAL
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 90911
|
| Hospital Charge Code |
906790911
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$471.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$128.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.00
|
| Rate for Payer: Blue Shield of California Commercial |
$146.40
|
| Rate for Payer: Blue Shield of California EPN |
$117.12
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$156.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$204.00
|
| Rate for Payer: Dignity Health Senior |
$204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.56
|
| Rate for Payer: Heritage Provider Network Senior |
$148.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$114.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$471.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$394.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$204.00
|
|
|
HC BIOFEEDBACK PERI/URO/RECTAL
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 90911
|
| Hospital Charge Code |
906790911
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.48
|
| Rate for Payer: Heritage Provider Network Senior |
$162.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
|
|
HC BIOFEEDBACK PERI/URO/RECTAL
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 90911
|
| Hospital Charge Code |
906790911
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$98.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$128.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$156.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$204.00
|
| Rate for Payer: Dignity Health Senior |
$204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.56
|
| Rate for Payer: Heritage Provider Network Senior |
$148.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$114.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| 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 |
$204.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$204.00
|
|
|
HC BIOFEEDBACK PERI/URO/RECTAL
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 90911
|
| Hospital Charge Code |
906790911
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.48
|
| Rate for Payer: Heritage Provider Network Senior |
$162.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
|
|
HC BIOFEEDBACK TRNG 1ST 15 MIN
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
906790912
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$162.75 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$146.91
|
| Rate for Payer: Heritage Provider Network Senior |
$146.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.25
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
|
|
HC BIOFEEDBACK TRNG 1ST 15 MIN
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
906790912
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$471.00 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$115.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Blue Shield of California Commercial |
$132.37
|
| Rate for Payer: Blue Shield of California EPN |
$105.90
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Senior |
$184.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.32
|
| Rate for Payer: Heritage Provider Network Senior |
$134.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$103.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$471.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$394.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC BIOFEEDBACK TRNG EA ADD 15 MIN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 90913
|
| Hospital Charge Code |
906790913
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$471.00 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.25
|
| Rate for Payer: Blue Shield of California Commercial |
$53.07
|
| Rate for Payer: Blue Shield of California EPN |
$42.46
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.95
|
| Rate for Payer: Dignity Health Senior |
$73.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.85
|
| Rate for Payer: Heritage Provider Network Senior |
$53.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.90
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$471.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$394.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.95
|
| Rate for Payer: Vantage Medical Group Senior |
$73.95
|
|
|
HC BIOFEEDBACK TRNG EA ADD 15 MIN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 90913
|
| Hospital Charge Code |
906790913
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.90
|
| Rate for Payer: Heritage Provider Network Senior |
$58.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
|
|
HC BIOPHYSICAL PROFILE W NST ADDL FETUS
|
Facility
|
IP
|
$1,584.00
|
|
|
Service Code
|
CPT 76818 59
|
| Hospital Charge Code |
910400112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$286.70 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Adventist Health Commercial |
$316.80
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,072.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,072.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.00
|
| Rate for Payer: Multiplan Commercial |
$1,188.00
|
|
|
HC BIOPHYSICAL PROFILE W NST ADDL FETUS
|
Facility
|
OP
|
$1,584.00
|
|
|
Service Code
|
CPT 76818 59
|
| Hospital Charge Code |
910400112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$154.10 |
| Max. Negotiated Rate |
$1,346.40 |
| Rate for Payer: Adventist Health Commercial |
$316.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$846.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,088.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,346.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$871.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,188.00
|
| Rate for Payer: Blue Shield of California Commercial |
$341.66
|
| Rate for Payer: Blue Shield of California EPN |
$274.75
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,029.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,346.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,346.40
|
| Rate for Payer: Dignity Health Senior |
$1,346.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,029.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$980.50
|
| Rate for Payer: Heritage Provider Network Senior |
$980.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$755.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,108.80
|
| Rate for Payer: Multiplan Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,346.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,346.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,346.40
|
|
|
HC BIOPHYSICAL PROFILE W NST SINGLE FETUS
|
Facility
|
OP
|
$1,584.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
910400111
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Adventist Health Commercial |
$316.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$846.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,088.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$341.66
|
| Rate for Payer: Blue Shield of California EPN |
$274.75
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,029.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,029.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$980.50
|
| Rate for Payer: Heritage Provider Network Senior |
$980.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$755.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,188.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC BIOPHYSICAL PROFILE W NST SINGLE FETUS
|
Facility
|
IP
|
$1,584.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
910400111
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$286.70 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Adventist Health Commercial |
$316.80
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,072.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,072.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.00
|
| Rate for Payer: Multiplan Commercial |
$1,188.00
|
|
|
HC BIOPHYSICAL PROFILE WO NST ADDL FETUS
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
CPT 76819 59
|
| Hospital Charge Code |
910400114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$124.58 |
| Max. Negotiated Rate |
$634.10 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$398.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$512.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$410.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$559.50
|
| Rate for Payer: Blue Shield of California Commercial |
$341.66
|
| Rate for Payer: Blue Shield of California EPN |
$274.75
|
| Rate for Payer: Cash Price |
$410.30
|
| Rate for Payer: Cash Price |
$410.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$484.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$634.10
|
| Rate for Payer: Dignity Health Senior |
$634.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.77
|
| Rate for Payer: Heritage Provider Network Senior |
$461.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$124.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$355.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$522.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$522.20
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$634.10
|
| Rate for Payer: Vantage Medical Group Senior |
$634.10
|
|
|
HC BIOPHYSICAL PROFILE WO NST ADDL FETUS
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT 76819 59
|
| Hospital Charge Code |
910400114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.03 |
| Max. Negotiated Rate |
$559.50 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Cash Price |
$410.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$505.04
|
| Rate for Payer: Heritage Provider Network Senior |
$505.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
|
|
HC BIOPHYSICAL PROFILE WO NST SINGLE FETUS
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
910400113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$127.75 |
| Max. Negotiated Rate |
$559.50 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$398.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$512.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$341.66
|
| Rate for Payer: Blue Shield of California EPN |
$274.75
|
| Rate for Payer: Cash Price |
$410.30
|
| Rate for Payer: Cash Price |
$410.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$484.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.77
|
| Rate for Payer: Heritage Provider Network Senior |
$461.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$355.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC BIOPHYSICAL PROFILE WO NST SINGLE FETUS
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
910400113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.03 |
| Max. Negotiated Rate |
$559.50 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Cash Price |
$410.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$505.04
|
| Rate for Payer: Heritage Provider Network Senior |
$505.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
|
|
HC BIOPSY ANORECTAL WALL
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
CPT 45100
|
| Hospital Charge Code |
906745100
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$986.09 |
| Max. Negotiated Rate |
$4,086.00 |
| Rate for Payer: Adventist Health Commercial |
$1,089.60
|
| Rate for Payer: Cash Price |
$2,996.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,688.30
|
| Rate for Payer: Heritage Provider Network Senior |
$3,688.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$986.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,362.00
|
| Rate for Payer: Multiplan Commercial |
$4,086.00
|
|
|
HC BIOPSY ANORECTAL WALL
|
Facility
|
OP
|
$5,448.00
|
|
|
Service Code
|
CPT 45100
|
| Hospital Charge Code |
906745100
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,089.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,742.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,484.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$2,996.40
|
| Rate for Payer: Cash Price |
$2,996.40
|
| Rate for Payer: Cash Price |
$2,996.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,541.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,832.93
|
| Rate for Payer: Dignity Health Senior |
$3,484.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,484.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,372.31
|
| Rate for Payer: Heritage Provider Network Senior |
$4,285.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$273.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,484.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,598.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$986.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,007.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,362.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,390.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,390.44
|
| Rate for Payer: Multiplan Commercial |
$4,086.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$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 Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Vantage Medical Group Senior |
$3,484.48
|
|
|
HC BIOPSY EXTERNAL EAR
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
900501504
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.17 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$659.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$801.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Senior |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$801.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$295.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$834.74
|
| Rate for Payer: Heritage Provider Network Senior |
$834.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$588.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.78
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$443.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$408.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC BIOPSY EXTERNAL EAR
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
900501504
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.17 |
| Max. Negotiated Rate |
$924.75 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$834.74
|
| Rate for Payer: Heritage Provider Network Senior |
$834.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.25
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
|
