|
HC CASE CONF EA ADDL 15 MIN
|
Facility
|
IP
|
$74.00
|
|
| Hospital Charge Code |
900409041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$55.50 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.10
|
| Rate for Payer: Heritage Provider Network Senior |
$50.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.50
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
907001902
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$134.84 |
| Max. Negotiated Rate |
$558.75 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$504.37
|
| Rate for Payer: Heritage Provider Network Senior |
$504.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
907001902
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$811.58 |
| Rate for Payer: Adventist Health Commercial |
$305.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$398.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$511.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$811.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$541.05
|
| 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 |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$484.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$811.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$595.15
|
| Rate for Payer: Dignity Health Senior |
$541.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$541.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.15
|
| Rate for Payer: Heritage Provider Network Senior |
$461.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$541.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$355.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$622.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$681.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$681.72
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$811.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Vantage Medical Group Senior |
$541.05
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
900409056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$811.58 |
| Rate for Payer: Adventist Health Commercial |
$305.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$398.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$511.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$811.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$541.05
|
| 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 |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$484.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$811.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$595.15
|
| Rate for Payer: Dignity Health Senior |
$541.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$541.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.15
|
| Rate for Payer: Heritage Provider Network Senior |
$461.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$541.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$355.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$622.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$681.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$681.72
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| 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 |
$811.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Vantage Medical Group Senior |
$541.05
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
901309993
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$134.84 |
| Max. Negotiated Rate |
$558.75 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$504.37
|
| Rate for Payer: Heritage Provider Network Senior |
$504.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
901309993
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$811.58 |
| Rate for Payer: Adventist Health Commercial |
$305.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$398.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$511.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$811.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$541.05
|
| 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 |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$484.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$811.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$595.15
|
| Rate for Payer: Dignity Health Senior |
$541.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$541.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.15
|
| Rate for Payer: Heritage Provider Network Senior |
$461.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$541.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$355.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$622.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$681.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$681.72
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| 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 |
$811.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Vantage Medical Group Senior |
$541.05
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
900409056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$134.84 |
| Max. Negotiated Rate |
$558.75 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$504.37
|
| Rate for Payer: Heritage Provider Network Senior |
$504.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT MCAL
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
907000005
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$811.58 |
| Rate for Payer: Adventist Health Commercial |
$305.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$398.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$511.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$811.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$541.05
|
| 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 |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$484.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$811.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$595.15
|
| Rate for Payer: Dignity Health Senior |
$541.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$541.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.15
|
| Rate for Payer: Heritage Provider Network Senior |
$461.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$541.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$355.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$622.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$681.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$681.72
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$811.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Vantage Medical Group Senior |
$541.05
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT MCAL
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
907000005
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$134.84 |
| Max. Negotiated Rate |
$558.75 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$504.37
|
| Rate for Payer: Heritage Provider Network Senior |
$504.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
|
|
HC CASE CONF INITIAL 30 MIN
|
Facility
|
IP
|
$157.00
|
|
| Hospital Charge Code |
900409040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$117.75 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.29
|
| Rate for Payer: Heritage Provider Network Senior |
$106.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
|
|
HC CASE CONF INITIAL 30 MIN
|
Facility
|
OP
|
$163.00
|
|
| Hospital Charge Code |
901309040
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$66.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$87.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.25
|
| 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 |
$73.35
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.55
|
| Rate for Payer: Dignity Health Senior |
$138.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.90
|
| Rate for Payer: Heritage Provider Network Senior |
$100.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$114.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$114.10
|
| Rate for Payer: Multiplan Commercial |
$122.25
|
| 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 |
$138.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.55
|
| Rate for Payer: Vantage Medical Group Senior |
$138.55
|
|
|
HC CASE CONF INITIAL 30 MIN
|
Facility
|
OP
|
$157.00
|
|
| Hospital Charge Code |
900409040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$83.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$107.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| 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 |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Senior |
$133.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.18
|
| Rate for Payer: Heritage Provider Network Senior |
$97.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$74.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| 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 |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC CASE CONF INITIAL 30 MIN
|
Facility
|
IP
|
$163.00
|
|
| Hospital Charge Code |
901309040
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$122.25 |
| Rate for Payer: Adventist Health Commercial |
$32.60
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.35
|
| Rate for Payer: Heritage Provider Network Senior |
$110.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.75
|
| Rate for Payer: Multiplan Commercial |
$122.25
|
|
|
HC CASE CONSULT
|
Facility
|
OP
|
$155.00
|
|
| Hospital Charge Code |
905104308
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$63.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$82.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.25
|
| 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 |
$69.75
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.75
|
| Rate for Payer: Dignity Health Senior |
$131.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.94
|
| Rate for Payer: Heritage Provider Network Senior |
$95.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$73.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$108.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$108.50
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| 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 |
$131.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.75
|
| Rate for Payer: Vantage Medical Group Senior |
$131.75
|
|
|
HC CASE CONSULT
|
Facility
|
IP
|
$155.00
|
|
| Hospital Charge Code |
905104308
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Adventist Health Commercial |
$31.00
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.94
|
| Rate for Payer: Heritage Provider Network Senior |
$104.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.75
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
|
|
HC CASH MAIN PROGRAM PER MONTH
|
Facility
|
IP
|
$109.00
|
|
| Hospital Charge Code |
900419070
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$81.75 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.79
|
| Rate for Payer: Heritage Provider Network Senior |
$73.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.25
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
|
|
HC CASH MAIN PROGRAM PER MONTH
|
Facility
|
OP
|
$109.00
|
|
| Hospital Charge Code |
900419070
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$44.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$58.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.75
|
| 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 |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.65
|
| Rate for Payer: Dignity Health Senior |
$92.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.47
|
| Rate for Payer: Heritage Provider Network Senior |
$67.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.30
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| 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 |
$92.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.65
|
| Rate for Payer: Vantage Medical Group Senior |
$92.65
|
|
|
HC CATECHOLAMINES UR FRACTIONATED
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900910455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$230.55 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.55
|
| Rate for Payer: Blue Shield of California Commercial |
$203.21
|
| Rate for Payer: Blue Shield of California EPN |
$162.99
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.77
|
| Rate for Payer: Dignity Health Senior |
$25.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.62
|
| Rate for Payer: Heritage Provider Network Senior |
$52.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.82
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.25
|
| Rate for Payer: TriValley Medical Group Senior |
$25.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Vantage Medical Group Senior |
$25.25
|
|
|
HC CATECHOLAMINES UR FRACTIONATED
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900910455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.64
|
| Rate for Payer: Heritage Provider Network Senior |
$63.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
|
|
HC CATECHOLAMINES URINE FRACTIONATED
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900912199
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$230.55 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.55
|
| Rate for Payer: Blue Shield of California Commercial |
$203.21
|
| Rate for Payer: Blue Shield of California EPN |
$162.99
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.77
|
| Rate for Payer: Dignity Health Senior |
$25.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.62
|
| Rate for Payer: Heritage Provider Network Senior |
$52.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.82
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.25
|
| Rate for Payer: TriValley Medical Group Senior |
$25.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Vantage Medical Group Senior |
$25.25
|
|
|
HC CATECHOLAMINES URINE FRACTIONATED
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900912199
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.64
|
| Rate for Payer: Heritage Provider Network Senior |
$63.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
|
|
HC CATH, ARROW-TRETOTOLA THROMBOL
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$691.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$578.88
|
| Rate for Payer: Blue Shield of California EPN |
$578.88
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$777.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$666.72
|
| Rate for Payer: Heritage Provider Network Senior |
$666.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$720.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$520.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$476.78
|
|
|
HC CATH, ARROW-TRETOTOLA THROMBOL
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$691.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$989.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$792.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,080.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$578.88
|
| Rate for Payer: Blue Shield of California EPN |
$578.88
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$662.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,224.00
|
| Rate for Payer: Dignity Health Senior |
$1,224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$921.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$666.72
|
| Rate for Payer: Heritage Provider Network Senior |
$666.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$720.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,008.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,008.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$520.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$476.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,224.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,224.00
|
|
|
HC CATH ATHERECTOMY CROSSER
|
Facility
|
OP
|
$4,737.50
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909020040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$857.49 |
| Max. Negotiated Rate |
$4,026.88 |
| Rate for Payer: Adventist Health Commercial |
$947.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,532.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,254.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,026.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,605.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,553.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,889.88
|
| Rate for Payer: Blue Shield of California EPN |
$2,311.90
|
| Rate for Payer: Cash Price |
$2,131.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,079.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,026.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,026.88
|
| Rate for Payer: Dignity Health Senior |
$4,026.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,079.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,932.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2,932.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,259.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$857.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,184.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,316.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,316.25
|
| Rate for Payer: Multiplan Commercial |
$3,553.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,368.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,368.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,026.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,026.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,026.88
|
|
|
HC CATH ATHERECTOMY CROSSER
|
Facility
|
IP
|
$4,737.50
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909020040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$857.49 |
| Max. Negotiated Rate |
$3,553.12 |
| Rate for Payer: Adventist Health Commercial |
$947.50
|
| Rate for Payer: Cash Price |
$2,131.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,207.29
|
| Rate for Payer: Heritage Provider Network Senior |
$3,207.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$857.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,184.38
|
| Rate for Payer: Multiplan Commercial |
$3,553.12
|
|
