|
HC AQUATIC THERAPY EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$108.00
|
|
| Hospital Charge Code |
900400041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$44.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.85
|
| Rate for Payer: Heritage Provider Network Senior |
$66.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$51.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| 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 |
$91.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.80
|
| Rate for Payer: Vantage Medical Group Senior |
$91.80
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
905103142
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$158.42
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$166.54
|
| Rate for Payer: Heritage Provider Network Senior |
$166.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
905103142
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$100.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$152.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$184.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$159.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.27
|
| Rate for Payer: Heritage Provider Network Senior |
$152.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$117.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| 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 |
$209.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT COMM MCARE
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900417113
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$118.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$188.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$179.51
|
| Rate for Payer: Heritage Provider Network Senior |
$179.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$138.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| 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 |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT COMM MCARE
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900417113
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$217.50 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.76
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$196.33
|
| Rate for Payer: Heritage Provider Network Senior |
$196.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.50
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
|
|
HC ARA H 1 (PEANUT), IGE
|
Facility
|
OP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913724
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.45
|
| Rate for Payer: Heritage Provider Network Senior |
$9.54
|
| Rate for Payer: Heritage Provider Network Senior |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC ARA H 1 (PEANUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913724
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.91
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.52
|
| Rate for Payer: Heritage Provider Network Senior |
$12.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
|
|
HC ARA H 2 (PEANUT), IGE
|
Facility
|
OP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913725
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.45
|
| Rate for Payer: Heritage Provider Network Senior |
$9.54
|
| Rate for Payer: Heritage Provider Network Senior |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC ARA H 2 (PEANUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913725
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.91
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.52
|
| Rate for Payer: Heritage Provider Network Senior |
$12.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
|
|
HC ARA H 3 (PEANUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913726
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.91
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.52
|
| Rate for Payer: Heritage Provider Network Senior |
$12.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
|
|
HC ARA H 3 (PEANUT), IGE
|
Facility
|
OP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913726
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.45
|
| Rate for Payer: Heritage Provider Network Senior |
$9.54
|
| Rate for Payer: Heritage Provider Network Senior |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC ARA H 6 (PEANUT), IGE
|
Facility
|
OP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913727
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.45
|
| Rate for Payer: Heritage Provider Network Senior |
$9.54
|
| Rate for Payer: Heritage Provider Network Senior |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC ARA H 6 (PEANUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913727
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.91
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.52
|
| Rate for Payer: Heritage Provider Network Senior |
$12.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
|
|
HC ARA H 8 (PEANUT), IGE
|
Facility
|
OP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913728
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.45
|
| Rate for Payer: Heritage Provider Network Senior |
$9.54
|
| Rate for Payer: Heritage Provider Network Senior |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC ARA H 8 (PEANUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913728
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.91
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.52
|
| Rate for Payer: Heritage Provider Network Senior |
$12.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
|
|
HC ARA H 9 (PEANUT), IGE
|
Facility
|
OP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913729
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.45
|
| Rate for Payer: Heritage Provider Network Senior |
$9.54
|
| Rate for Payer: Heritage Provider Network Senior |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC ARA H 9 (PEANUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913729
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.91
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.52
|
| Rate for Payer: Heritage Provider Network Senior |
$12.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
|
|
HC ARCH AORTA
|
Facility
|
OP
|
$4,862.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
909020144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$880.02 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,160.30
|
| Rate for Payer: Adventist Health Commercial |
$972.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,004.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$2,187.90
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,009.58
|
| Rate for Payer: Heritage Provider Network Senior |
$4,995.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,715.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$880.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,215.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$3,646.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,467.15
|
| Rate for Payer: TriValley Medical Group Senior |
$4,467.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC ARCH AORTA
|
Facility
|
IP
|
$4,862.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
909020144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$880.02 |
| Max. Negotiated Rate |
$3,646.50 |
| Rate for Payer: Adventist Health Commercial |
$972.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,131.13
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,291.57
|
| Rate for Payer: Heritage Provider Network Senior |
$3,291.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$880.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,215.50
|
| Rate for Payer: Multiplan Commercial |
$3,646.50
|
|
|
HC ARGON, THROMBEC CATH
|
Facility
|
IP
|
$2,827.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.50 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$565.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,820.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,136.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,136.65
|
| Rate for Payer: Cash Price |
$1,272.38
|
| Rate for Payer: Cash Price |
$1,272.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,300.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,526.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,309.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,309.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,413.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,413.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,413.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.88
|
| Rate for Payer: Multiplan Commercial |
$2,120.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,021.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$936.19
|
|
|
HC ARGON, THROMBEC CATH
|
Facility
|
OP
|
$2,827.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.50 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$565.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,747.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,403.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,555.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,136.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,136.65
|
| Rate for Payer: Cash Price |
$1,272.38
|
| Rate for Payer: Cash Price |
$1,272.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,300.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,403.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,403.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,403.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,809.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,309.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,309.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,413.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,413.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,413.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,979.25
|
| Rate for Payer: Multiplan Commercial |
$2,120.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,021.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$936.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,403.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,403.38
|
| Rate for Payer: Vantage Medical Group Senior |
$2,403.38
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
909081322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$568.50 |
| Rate for Payer: Adventist Health Commercial |
$151.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$488.15
|
| Rate for Payer: Cash Price |
$341.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$513.17
|
| Rate for Payer: Heritage Provider Network Senior |
$513.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.50
|
| Rate for Payer: Multiplan Commercial |
$568.50
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
909081322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$151.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$468.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$644.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$416.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$568.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$341.10
|
| Rate for Payer: Cash Price |
$341.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$492.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$644.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$644.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$644.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$469.20
|
| Rate for Payer: Heritage Provider Network Senior |
$469.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$361.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$530.60
|
| Rate for Payer: Multiplan Commercial |
$568.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$644.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$644.30
|
| Rate for Payer: Vantage Medical Group Senior |
$644.30
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
909081319
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$1,488.00 |
| Rate for Payer: Adventist Health Commercial |
$396.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,277.70
|
| Rate for Payer: Cash Price |
$892.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,343.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,343.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$359.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.00
|
| Rate for Payer: Multiplan Commercial |
$1,488.00
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
909081319
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$396.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,226.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,686.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,091.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,488.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$892.80
|
| Rate for Payer: Cash Price |
$892.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,289.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,686.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,686.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,686.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,228.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,228.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$946.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$359.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.80
|
| Rate for Payer: Multiplan Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,686.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,686.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,686.40
|
|
