|
HC DUPLEX SCAN AORTA/VENA CAVA
|
Facility
|
IP
|
$1,931.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
906601159
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$349.51 |
| Max. Negotiated Rate |
$1,448.25 |
| Rate for Payer: Adventist Health Commercial |
$386.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,326.60
|
| Rate for Payer: Cash Price |
$868.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,307.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,307.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.75
|
| Rate for Payer: Multiplan Commercial |
$1,448.25
|
|
|
HC DUPLEX SCAN AORTA/VENA CAVA
|
Facility
|
OP
|
$1,931.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
906601159
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$256.07 |
| Max. Negotiated Rate |
$1,448.25 |
| Rate for Payer: Adventist Health Commercial |
$386.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$369.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,326.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$710.84
|
| Rate for Payer: Blue Shield of California EPN |
$404.23
|
| Rate for Payer: Cash Price |
$868.95
|
| Rate for Payer: Cash Price |
$868.95
|
| Rate for Payer: Cash Price |
$868.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,255.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,255.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,195.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,195.29
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$256.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,448.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$336.78
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUPLX EXT VEIN BILAT
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
908100110
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$262.45 |
| Max. Negotiated Rate |
$1,192.50 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$369.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,092.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$789.54
|
| Rate for Payer: Blue Shield of California EPN |
$448.99
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,033.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,033.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$984.21
|
| Rate for Payer: Heritage Provider Network Senior |
$984.21
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$262.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$336.78
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUPLX EXT VEIN BILAT
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
908100110
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$287.79 |
| Max. Negotiated Rate |
$1,192.50 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,092.33
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,076.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,076.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.50
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
|
|
HC DUPLX EXT VEIN UNILAT
|
Facility
|
OP
|
$1,713.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
908100124
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$131.91 |
| Max. Negotiated Rate |
$1,284.75 |
| Rate for Payer: Adventist Health Commercial |
$342.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$232.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,176.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$569.31
|
| Rate for Payer: Blue Shield of California EPN |
$323.75
|
| Rate for Payer: Cash Price |
$770.85
|
| Rate for Payer: Cash Price |
$770.85
|
| Rate for Payer: Cash Price |
$770.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,113.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,113.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,060.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,060.35
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$310.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,284.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$151.10
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DUPLX EXT VEIN UNILAT
|
Facility
|
IP
|
$1,713.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
908100124
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$310.05 |
| Max. Negotiated Rate |
$1,284.75 |
| Rate for Payer: Adventist Health Commercial |
$342.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,176.83
|
| Rate for Payer: Cash Price |
$770.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,159.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,159.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$310.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.25
|
| Rate for Payer: Multiplan Commercial |
$1,284.75
|
|
|
HC DUPLX LO EXT ARTERY BILAT
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
908100106
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$470.60 |
| Max. Negotiated Rate |
$1,950.00 |
| Rate for Payer: Adventist Health Commercial |
$520.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,786.20
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,760.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,760.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.00
|
| Rate for Payer: Multiplan Commercial |
$1,950.00
|
|
|
HC DUPLX LO EXT ARTERY BILAT
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
908100106
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$151.12 |
| Max. Negotiated Rate |
$1,950.00 |
| Rate for Payer: Adventist Health Commercial |
$520.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$368.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,786.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$964.90
|
| Rate for Payer: Blue Shield of California EPN |
$548.71
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,690.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,690.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,609.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,609.40
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$151.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,950.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$336.78
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUPLX UP EXT ARTERY UNI
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
908100120
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$220.82 |
| Max. Negotiated Rate |
$915.00 |
| Rate for Payer: Adventist Health Commercial |
$244.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$838.14
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$825.94
|
| Rate for Payer: Heritage Provider Network Senior |
$825.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.00
|
| Rate for Payer: Multiplan Commercial |
$915.00
|
|
|
HC DUPLX UP EXT ARTERY UNI
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
908100120
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$129.26 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Adventist Health Commercial |
$244.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$232.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$838.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$565.12
|
| Rate for Payer: Blue Shield of California EPN |
$321.37
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$793.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$793.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$755.18
|
| Rate for Payer: Heritage Provider Network Senior |
$755.18
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$915.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$151.10
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DUP SCAN EXTRACRANIAL ART COMPLEX
|
Facility
|
OP
|
$1,413.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
908100102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$244.36 |
| Max. Negotiated Rate |
$1,059.75 |
| Rate for Payer: Adventist Health Commercial |
$282.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$369.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$970.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$827.62
|
| Rate for Payer: Blue Shield of California EPN |
$470.64
|
| Rate for Payer: Cash Price |
$635.85
|
| Rate for Payer: Cash Price |
$635.85
|
| Rate for Payer: Cash Price |
$635.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$918.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$918.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.65
|
| Rate for Payer: Heritage Provider Network Senior |
$874.65
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$244.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,059.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$336.78
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUP SCAN EXTRACRANIAL ART COMPLEX
|
Facility
|
IP
|
$1,413.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
908100102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$255.75 |
| Max. Negotiated Rate |
$1,059.75 |
| Rate for Payer: Adventist Health Commercial |
$282.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$970.73
|
| Rate for Payer: Cash Price |
$635.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$956.60
|
| Rate for Payer: Heritage Provider Network Senior |
$956.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.25
|
| Rate for Payer: Multiplan Commercial |
$1,059.75
|
|
|
HC DUP SCAN EXTRACRANIAL ART LIMITED
|
Facility
|
OP
|
$961.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
908100116
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$118.93 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Adventist Health Commercial |
$192.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$368.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$660.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$593.68
|
| Rate for Payer: Blue Shield of California EPN |
$337.61
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$624.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$594.86
|
| Rate for Payer: Heritage Provider Network Senior |
$594.86
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$151.10
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DUP SCAN EXTRACRANIAL ART LIMITED
|
Facility
|
IP
|
$961.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
908100116
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$173.94 |
| Max. Negotiated Rate |
$720.75 |
| Rate for Payer: Adventist Health Commercial |
$192.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$660.21
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$650.60
|
| Rate for Payer: Heritage Provider Network Senior |
$650.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.25
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
|
|
HC DVLP TEST PHYS/QHP PT 1ST HR
|
Facility
|
IP
|
$1,138.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
900400020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$205.98 |
| Max. Negotiated Rate |
$853.50 |
| Rate for Payer: Adventist Health Commercial |
$227.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$781.81
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$770.43
|
| Rate for Payer: Heritage Provider Network Senior |
$770.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.50
|
| Rate for Payer: Multiplan Commercial |
$853.50
|
|
|
HC DVLP TEST PHYS/QHP PT 1ST HR
|
Facility
|
OP
|
$1,138.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
900400020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$853.50 |
| Rate for Payer: Adventist Health Commercial |
$227.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$298.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$781.81
|
| 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 |
$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 |
$512.10
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$739.70
|
| 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 |
$739.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$704.42
|
| Rate for Payer: Heritage Provider Network Senior |
$704.42
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$181.85
|
| 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 |
$205.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.50
|
| 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 |
$853.50
|
| 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 Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC DVLP TEST PHYS/QHP ST 1ST HR
|
Facility
|
OP
|
$1,138.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
905601811
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$853.50 |
| Rate for Payer: Adventist Health Commercial |
$227.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$298.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$781.81
|
| 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 |
$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 |
$512.10
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$739.70
|
| 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 |
$739.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$704.42
|
| Rate for Payer: Heritage Provider Network Senior |
$704.42
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$181.85
|
| 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 |
$205.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.50
|
| 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 |
$853.50
|
| 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 Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC DVLP TEST PHYS/QHP ST 1ST HR
|
Facility
|
IP
|
$1,138.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
905601811
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$205.98 |
| Max. Negotiated Rate |
$853.50 |
| Rate for Payer: Adventist Health Commercial |
$227.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$781.81
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$770.43
|
| Rate for Payer: Heritage Provider Network Senior |
$770.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.50
|
| Rate for Payer: Multiplan Commercial |
$853.50
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
|
OP
|
$1,283.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$232.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$256.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$881.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,090.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$705.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$962.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$796.74
|
| Rate for Payer: Blue Shield of California EPN |
$753.12
|
| Rate for Payer: Cash Price |
$577.35
|
| Rate for Payer: Cash Price |
$577.35
|
| Rate for Payer: Cash Price |
$577.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$833.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,090.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,090.55
|
| Rate for Payer: Dignity Health Senior |
$1,090.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$794.18
|
| Rate for Payer: Heritage Provider Network Senior |
$794.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$236.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$618.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.75
|
| Rate for Payer: Multiplan Commercial |
$962.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,090.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,090.55
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
|
IP
|
$1,283.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$232.22 |
| Max. Negotiated Rate |
$962.25 |
| Rate for Payer: Adventist Health Commercial |
$256.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$881.42
|
| Rate for Payer: Cash Price |
$577.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$868.59
|
| Rate for Payer: Heritage Provider Network Senior |
$868.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.75
|
| Rate for Payer: Multiplan Commercial |
$962.25
|
|
|
HC EA ADDL LESION STEREO
|
Facility
|
OP
|
$2,121.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$290.39 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$424.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,457.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,802.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,166.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,590.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,378.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,802.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,802.85
|
| Rate for Payer: Dignity Health Senior |
$1,802.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,312.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,312.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$290.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,022.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$530.25
|
| Rate for Payer: Multiplan Commercial |
$1,590.75
|
| 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 Medi-Cal |
$1,802.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,802.85
|
|
|
HC EA ADDL LESION STEREO
|
Facility
|
IP
|
$2,121.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$383.90 |
| Max. Negotiated Rate |
$1,590.75 |
| Rate for Payer: Adventist Health Commercial |
$424.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,457.13
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,435.92
|
| Rate for Payer: Heritage Provider Network Senior |
$1,435.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$530.25
|
| Rate for Payer: Multiplan Commercial |
$1,590.75
|
|
|
HC EA ADDL MAGNETIC RESONANCE
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
908819288
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$139.72
|
| Rate for Payer: Blue Shield of California EPN |
$132.08
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: Dignity Health Senior |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$108.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC EA ADDL MAGNETIC RESONANCE
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
908819288
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$929.00 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.32
|
| Rate for Payer: Heritage Provider Network Senior |
$152.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
|
|
HC EA ADDL ULTRASOUND
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
906619286
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.26 |
| Max. Negotiated Rate |
$179.25 |
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.19
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$161.80
|
| Rate for Payer: Heritage Provider Network Senior |
$161.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.75
|
| Rate for Payer: Multiplan Commercial |
$179.25
|
|
