|
HC BODY POS D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8983
|
| Hospital Charge Code |
900018305
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC BODY POS D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8983
|
| Hospital Charge Code |
900018405
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC BODY POS D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8983
|
| Hospital Charge Code |
900018305
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC BODY POS GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8982
|
| Hospital Charge Code |
900018404
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC BODY POS GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8982
|
| Hospital Charge Code |
900018304
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC BODY POS GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8982
|
| Hospital Charge Code |
900018304
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC BODY POS GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8982
|
| Hospital Charge Code |
900018404
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC BONE AGE
|
Facility
|
IP
|
$644.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
909001602
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.56 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Cash Price |
$354.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$435.99
|
| Rate for Payer: Heritage Provider Network Senior |
$435.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
|
|
HC BONE AGE
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
909001602
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.87 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$344.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$442.43
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$136.32
|
| Rate for Payer: Blue Shield of California Commercial |
$71.57
|
| Rate for Payer: Blue Shield of California EPN |
$57.55
|
| Rate for Payer: Cash Price |
$354.20
|
| Rate for Payer: Cash Price |
$354.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$418.60
|
| 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 |
$418.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$398.64
|
| Rate for Payer: Heritage Provider Network Senior |
$398.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$307.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| 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 |
$483.00
|
| 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 |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| 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 BONE BIOPSY DEEP, PERCUTAN
|
Facility
|
IP
|
$5,405.00
|
|
|
Service Code
|
CPT 20225
|
| Hospital Charge Code |
909000107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$978.30 |
| Max. Negotiated Rate |
$4,053.75 |
| Rate for Payer: Adventist Health Commercial |
$1,081.00
|
| Rate for Payer: Cash Price |
$2,972.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,659.18
|
| Rate for Payer: Heritage Provider Network Senior |
$3,659.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$978.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,351.25
|
| Rate for Payer: Multiplan Commercial |
$4,053.75
|
|
|
HC BONE BIOPSY DEEP, PERCUTAN
|
Facility
|
OP
|
$5,405.00
|
|
|
Service Code
|
CPT 20225
|
| Hospital Charge Code |
909000107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,081.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,713.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$2,972.75
|
| Rate for Payer: Cash Price |
$2,972.75
|
| Rate for Payer: Cash Price |
$2,972.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,513.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,345.70
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$978.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,351.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$4,053.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| 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 |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC BONE BIOPSY SUPFCL, PERCUT
|
Facility
|
IP
|
$1,863.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
909000106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$337.20 |
| Max. Negotiated Rate |
$1,397.25 |
| Rate for Payer: Adventist Health Commercial |
$372.60
|
| Rate for Payer: Cash Price |
$1,024.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,261.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1,261.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.75
|
| Rate for Payer: Multiplan Commercial |
$1,397.25
|
|
|
HC BONE BIOPSY SUPFCL, PERCUT
|
Facility
|
OP
|
$1,863.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
909000106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$372.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,279.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| 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 |
$1,024.65
|
| Rate for Payer: Cash Price |
$1,024.65
|
| Rate for Payer: Cash Price |
$1,024.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,210.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,153.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$138.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$1,397.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC BONE CEMENT
|
Facility
|
IP
|
$805.00
|
|
| Hospital Charge Code |
909081735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$386.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$323.61
|
| Rate for Payer: Blue Shield of California EPN |
$323.61
|
| Rate for Payer: Cash Price |
$442.75
|
| Rate for Payer: Cash Price |
$442.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$372.71
|
| Rate for Payer: Heritage Provider Network Senior |
$372.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$290.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$266.54
|
|
|
HC BONE CEMENT
|
Facility
|
OP
|
$805.00
|
|
| Hospital Charge Code |
909081735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$386.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$603.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$323.61
|
| Rate for Payer: Blue Shield of California EPN |
$323.61
|
| Rate for Payer: Cash Price |
$442.75
|
| Rate for Payer: Cash Price |
$442.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$370.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: Dignity Health Senior |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$515.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$372.71
|
| Rate for Payer: Heritage Provider Network Senior |
$372.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$563.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$563.50
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$290.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$266.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC BONE, FINE NEEDLE ASPIRATION
|
Facility
|
IP
|
$1,618.00
|
|
|
Service Code
|
CPT 20615
|
| Hospital Charge Code |
909020019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.86 |
| Max. Negotiated Rate |
$1,213.50 |
| Rate for Payer: Adventist Health Commercial |
$323.60
|
| Rate for Payer: Cash Price |
$889.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,095.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,095.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.50
|
| Rate for Payer: Multiplan Commercial |
$1,213.50
|
|
|
HC BONE, FINE NEEDLE ASPIRATION
|
Facility
|
OP
|
$1,618.00
|
|
|
Service Code
|
CPT 20615
|
| Hospital Charge Code |
909020019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$323.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,111.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| 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 |
$889.90
|
| Rate for Payer: Cash Price |
$889.90
|
| Rate for Payer: Cash Price |
$889.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,051.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,001.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,099.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$273.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,698.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$1,213.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$983.38
|
| Rate for Payer: TriValley Medical Group Senior |
$983.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC BONE LENGTH
|
Facility
|
OP
|
$691.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
909001603
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$51.92 |
| Max. Negotiated Rate |
$518.25 |
| Rate for Payer: Adventist Health Commercial |
$138.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$369.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$474.72
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$206.33
|
| Rate for Payer: Blue Shield of California Commercial |
$118.32
|
| Rate for Payer: Blue Shield of California EPN |
$95.15
|
| Rate for Payer: Cash Price |
$380.05
|
| Rate for Payer: Cash Price |
$380.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$449.15
|
| 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 |
$449.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$427.73
|
| Rate for Payer: Heritage Provider Network Senior |
$427.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$329.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.75
|
| 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 |
$518.25
|
| 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 |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| 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 BONE LENGTH
|
Facility
|
IP
|
$691.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
909001603
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.07 |
| Max. Negotiated Rate |
$518.25 |
| Rate for Payer: Adventist Health Commercial |
$138.20
|
| Rate for Payer: Cash Price |
$380.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$467.81
|
| Rate for Payer: Heritage Provider Network Senior |
$467.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.75
|
| Rate for Payer: Multiplan Commercial |
$518.25
|
|
|
HC BONE MARROW ASP/AT TIME OF BX
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
911800314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$259.92 |
| Max. Negotiated Rate |
$1,077.00 |
| Rate for Payer: Adventist Health Commercial |
$287.20
|
| Rate for Payer: Cash Price |
$789.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$972.17
|
| Rate for Payer: Heritage Provider Network Senior |
$972.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.00
|
| Rate for Payer: Multiplan Commercial |
$1,077.00
|
|
|
HC BONE MARROW ASP/AT TIME OF BX
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
911800314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$287.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$986.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| 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 |
$789.80
|
| Rate for Payer: Cash Price |
$789.80
|
| Rate for Payer: Cash Price |
$789.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$933.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Senior |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,636.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$888.88
|
| Rate for Payer: Heritage Provider Network Senior |
$4,472.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$249.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,909.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,182.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,582.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,582.02
|
| Rate for Payer: Multiplan Commercial |
$1,077.00
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,000.17
|
| Rate for Payer: TriValley Medical Group Senior |
$4,000.17
|
| 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 |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC BONE MARROW ASP ONLY
|
Facility
|
OP
|
$1,404.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
911800312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$964.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| 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 |
$772.20
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$912.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$869.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$297.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC BONE MARROW ASP ONLY
|
Facility
|
IP
|
$1,404.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
911800312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$254.12 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$950.51
|
| Rate for Payer: Heritage Provider Network Senior |
$950.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
|
|
HC BONE MARROW BX ONLY
|
Facility
|
OP
|
$1,429.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
909020057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$285.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$981.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| 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 |
$785.95
|
| Rate for Payer: Cash Price |
$785.95
|
| Rate for Payer: Cash Price |
$785.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$928.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$884.55
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$317.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$1,071.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC BONE MARROW BX ONLY
|
Facility
|
IP
|
$1,429.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
909020057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.65 |
| Max. Negotiated Rate |
$1,071.75 |
| Rate for Payer: Adventist Health Commercial |
$285.80
|
| Rate for Payer: Cash Price |
$785.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$967.43
|
| Rate for Payer: Heritage Provider Network Senior |
$967.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.25
|
| Rate for Payer: Multiplan Commercial |
$1,071.75
|
|
