|
HC DEST OF LESIONS LT 10 SQ CM
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
900501553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.13 |
| Max. Negotiated Rate |
$460.50 |
| Rate for Payer: Adventist Health Commercial |
$122.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$421.82
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$415.68
|
| Rate for Payer: Heritage Provider Network Senior |
$415.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.50
|
| Rate for Payer: Multiplan Commercial |
$460.50
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$223.50 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.73
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.75
|
| Rate for Payer: Heritage Provider Network Senior |
$201.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$223.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.30
|
| Rate for Payer: Dignity Health Senior |
$253.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.75
|
| Rate for Payer: Heritage Provider Network Senior |
$201.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$143.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$108.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
|
|
HC DEVELOP TESTING W/INTERP & RPT OT
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905104361
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$318.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$206.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$243.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$318.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$318.75
|
| Rate for Payer: Dignity Health Senior |
$318.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$232.12
|
| Rate for Payer: Heritage Provider Network Senior |
$232.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$180.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.75
|
| Rate for Payer: Vantage Medical Group Senior |
$318.75
|
|
|
HC DEVELOP TESTING W/INTERP & RPT OT
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905104361
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.62
|
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.88
|
| Rate for Payer: Heritage Provider Network Senior |
$253.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT PT
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905103400
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$925.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$802.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.90
|
| Rate for Payer: Dignity Health Senior |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$802.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$763.85
|
| Rate for Payer: Heritage Provider Network Senior |
$763.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$594.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.50
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC DEVELOP TESTING W/INTERP & RPT PT
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905103400
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$223.35 |
| Max. Negotiated Rate |
$925.50 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.76
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$835.42
|
| Rate for Payer: Heritage Provider Network Senior |
$835.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.50
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$925.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$802.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.90
|
| Rate for Payer: Dignity Health Senior |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$802.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$763.85
|
| Rate for Payer: Heritage Provider Network Senior |
$763.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$594.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.50
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$223.35 |
| Max. Negotiated Rate |
$925.50 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.76
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$835.42
|
| Rate for Payer: Heritage Provider Network Senior |
$835.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.50
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$925.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$802.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.90
|
| Rate for Payer: Dignity Health Senior |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$802.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$763.85
|
| Rate for Payer: Heritage Provider Network Senior |
$763.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$594.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.50
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$223.35 |
| Max. Negotiated Rate |
$925.50 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.76
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$835.42
|
| Rate for Payer: Heritage Provider Network Senior |
$835.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.50
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$223.35 |
| Max. Negotiated Rate |
$925.50 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.76
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$835.42
|
| Rate for Payer: Heritage Provider Network Senior |
$835.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.50
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$925.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$802.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.90
|
| Rate for Payer: Dignity Health Senior |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$802.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$763.85
|
| Rate for Payer: Heritage Provider Network Senior |
$763.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$594.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.50
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC DHEA-S
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$186.07 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.07
|
| Rate for Payer: Blue Shield of California Commercial |
$173.68
|
| Rate for Payer: Blue Shield of California EPN |
$135.78
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.45
|
| Rate for Payer: Dignity Health Senior |
$22.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.47
|
| Rate for Payer: Heritage Provider Network Senior |
$41.47
|
| Rate for Payer: Humana Medicare |
$22.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.01
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.23
|
| Rate for Payer: TriValley Medical Group Senior |
$22.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Vantage Medical Group Senior |
$22.23
|
|
|
HC DHEA-S
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.49 |
| Max. Negotiated Rate |
$304.50 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$278.92
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$274.86
|
| Rate for Payer: Heritage Provider Network Senior |
$274.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.50
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
|
|
HC DIAG GASTRO INTUB W ASP SPECS
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 43755
|
| Hospital Charge Code |
906743755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$77.17 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$346.64
|
| Rate for Payer: Heritage Provider Network Senior |
$240.06
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC DIAG GASTRO INTUB W ASP SPECS
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 43755
|
| Hospital Charge Code |
906743755
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$101.36 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.72
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$379.12
|
| Rate for Payer: Heritage Provider Network Senior |
$379.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
IP
|
$2,634.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$476.75 |
| Max. Negotiated Rate |
$1,975.50 |
| Rate for Payer: Adventist Health Commercial |
$526.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,809.56
|
| Rate for Payer: Cash Price |
$1,185.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,783.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,783.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.50
|
| Rate for Payer: Multiplan Commercial |
$1,975.50
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
OP
|
$2,634.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$257.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$526.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,809.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,185.30
|
| Rate for Payer: Cash Price |
$1,185.30
|
| Rate for Payer: Cash Price |
$1,185.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,712.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: Dignity Health Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,120.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,630.45
|
| Rate for Payer: Heritage Provider Network Senior |
$2,608.36
|
| Rate for Payer: Humana Medicare |
$2,120.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$257.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,029.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,671.98
|
| Rate for Payer: Multiplan Commercial |
$1,975.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,332.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,332.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
IP
|
$2,634.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$476.75 |
| Max. Negotiated Rate |
$1,975.50 |
| Rate for Payer: Adventist Health Commercial |
$526.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,809.56
|
| Rate for Payer: Cash Price |
$1,185.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,783.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,783.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.50
|
| Rate for Payer: Multiplan Commercial |
$1,975.50
|
|
|
HC DIAGNOSTIC BRONCH
|
Facility
|
OP
|
$2,634.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
900501418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$476.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$526.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,809.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,185.30
|
| Rate for Payer: Cash Price |
$1,185.30
|
| Rate for Payer: Cash Price |
$1,185.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,712.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: Dignity Health Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,120.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,783.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,783.22
|
| Rate for Payer: Humana Medicare |
$2,120.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,269.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,671.98
|
| Rate for Payer: Multiplan Commercial |
$1,975.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$956.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$880.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC DIAGNOSTIC BRONCH W BIOPSY
|
Facility
|
IP
|
$3,048.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
900803503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$551.69 |
| Max. Negotiated Rate |
$2,286.00 |
| Rate for Payer: Adventist Health Commercial |
$609.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,093.98
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,063.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2,063.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$762.00
|
| Rate for Payer: Multiplan Commercial |
$2,286.00
|
|
|
HC DIAGNOSTIC BRONCH W BIOPSY
|
Facility
|
OP
|
$3,048.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
900803503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.20 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$609.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,093.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,892.81
|
| Rate for Payer: Blue Shield of California EPN |
$1,789.18
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,981.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: Dignity Health Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,120.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,886.71
|
| Rate for Payer: Heritage Provider Network Senior |
$1,886.71
|
| Rate for Payer: Humana Medicare |
$2,120.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$314.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,029.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$762.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,671.98
|
| Rate for Payer: Multiplan Commercial |
$2,286.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,332.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC DIAGNOSTIC BRONCH W/BRUSHING
|
Facility
|
IP
|
$2,746.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
900803501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$497.03 |
| Max. Negotiated Rate |
$2,059.50 |
| Rate for Payer: Adventist Health Commercial |
$549.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,886.50
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,859.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,859.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.50
|
| Rate for Payer: Multiplan Commercial |
$2,059.50
|
|
|
HC DIAGNOSTIC BRONCH W/BRUSHING
|
Facility
|
OP
|
$2,746.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
900803501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$329.89 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$549.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,886.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,784.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: Dignity Health Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,120.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,699.77
|
| Rate for Payer: Heritage Provider Network Senior |
$2,608.36
|
| Rate for Payer: Humana Medicare |
$2,120.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$329.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,029.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,671.98
|
| Rate for Payer: Multiplan Commercial |
$2,059.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,332.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,332.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
