|
HC BODY PLETHYSMOGRAPHY
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
900801003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$103.53 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Adventist Health Commercial |
$114.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$368.37
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$387.24
|
| Rate for Payer: Heritage Provider Network Senior |
$387.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.00
|
| Rate for Payer: Multiplan Commercial |
$429.00
|
|
|
HC BODY POS CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8981
|
| Hospital Charge Code |
900018303
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC BODY POS CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8981
|
| Hospital Charge Code |
900018403
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC BODY POS CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8981
|
| Hospital Charge Code |
900018303
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC BODY POS CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8981
|
| Hospital Charge Code |
900018403
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC BODY POS D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8983
|
| Hospital Charge Code |
900018405
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC BODY POS D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8983
|
| Hospital Charge Code |
900018405
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC BODY POS D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8983
|
| Hospital Charge Code |
900018305
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC BODY POS D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8983
|
| Hospital Charge Code |
900018305
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC BODY POS GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8982
|
| Hospital Charge Code |
900018304
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC BODY POS GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8982
|
| Hospital Charge Code |
900018304
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC BODY POS GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8982
|
| Hospital Charge Code |
900018404
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC BODY POS GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8982
|
| Hospital Charge Code |
900018404
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC BONE AGE
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
909001602
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.55 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Cigna of CA HMO/PPO |
$418.60
|
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$397.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.78
|
| Rate for Payer: Blue Shield of California Commercial |
$71.57
|
| Rate for Payer: Blue Shield of California EPN |
$57.55
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$379.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$398.64
|
| Rate for Payer: Heritage Provider Network Senior |
$398.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$307.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC BONE AGE
|
Facility
|
IP
|
$644.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
909001602
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.56 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$414.74
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$435.99
|
| Rate for Payer: Heritage Provider Network Senior |
$435.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
|
|
HC BONE BIOPSY DEEP, PERCUTAN
|
Facility
|
OP
|
$5,405.00
|
|
|
Service Code
|
CPT 20225
|
| Hospital Charge Code |
909000107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$978.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,081.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,340.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$2,432.25
|
| Rate for Payer: Cash Price |
$2,432.25
|
| Rate for Payer: Cash Price |
$2,432.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,513.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,345.70
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,036.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$978.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,351.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$4,053.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,336.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2,336.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC BONE BIOPSY DEEP, PERCUTAN
|
Facility
|
IP
|
$5,405.00
|
|
|
Service Code
|
CPT 20225
|
| Hospital Charge Code |
909000107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$978.30 |
| Max. Negotiated Rate |
$4,053.75 |
| Rate for Payer: Adventist Health Commercial |
$1,081.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,480.82
|
| Rate for Payer: Cash Price |
$2,432.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,659.18
|
| Rate for Payer: Heritage Provider Network Senior |
$3,659.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$978.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,351.25
|
| Rate for Payer: Multiplan Commercial |
$4,053.75
|
|
|
HC BONE BIOPSY SUPFCL, PERCUT
|
Facility
|
IP
|
$1,863.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
909000106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$337.20 |
| Max. Negotiated Rate |
$1,397.25 |
| Rate for Payer: Adventist Health Commercial |
$372.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,199.77
|
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,261.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1,261.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.75
|
| Rate for Payer: Multiplan Commercial |
$1,397.25
|
|
|
HC BONE BIOPSY SUPFCL, PERCUT
|
Facility
|
OP
|
$1,863.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
909000106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$337.20 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$372.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,151.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| 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 |
$838.35
|
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,210.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,153.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,036.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$1,397.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,336.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2,336.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC BONE CEMENT
|
Facility
|
OP
|
$805.00
|
|
| Hospital Charge Code |
909081735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$497.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$603.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$323.61
|
| Rate for Payer: Blue Shield of California EPN |
$323.61
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$370.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$515.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$372.71
|
| Rate for Payer: Heritage Provider Network Senior |
$372.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$402.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$402.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$402.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$563.50
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$290.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$266.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC BONE CEMENT
|
Facility
|
IP
|
$805.00
|
|
| Hospital Charge Code |
909081735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$518.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$323.61
|
| Rate for Payer: Blue Shield of California EPN |
$323.61
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$372.71
|
| Rate for Payer: Heritage Provider Network Senior |
$372.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$402.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$402.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$402.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$290.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$266.54
|
|
|
HC BONE, FINE NEEDLE ASPIRATION
|
Facility
|
OP
|
$1,618.00
|
|
|
Service Code
|
CPT 20615
|
| Hospital Charge Code |
909020019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.86 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$323.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$999.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| 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 |
$728.10
|
| Rate for Payer: Cash Price |
$728.10
|
| Rate for Payer: Cash Price |
$728.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,051.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,001.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,730.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$292.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,213.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,001.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,001.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC BONE, FINE NEEDLE ASPIRATION
|
Facility
|
IP
|
$1,618.00
|
|
|
Service Code
|
CPT 20615
|
| Hospital Charge Code |
909020019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.86 |
| Max. Negotiated Rate |
$1,213.50 |
| Rate for Payer: Adventist Health Commercial |
$323.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,041.99
|
| Rate for Payer: Cash Price |
$728.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,095.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,095.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$292.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.50
|
| Rate for Payer: Multiplan Commercial |
$1,213.50
|
|
|
HC BONE LENGTH
|
Facility
|
IP
|
$691.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
909001603
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.07 |
| Max. Negotiated Rate |
$518.25 |
| Rate for Payer: Adventist Health Commercial |
$138.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$445.00
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$467.81
|
| Rate for Payer: Heritage Provider Network Senior |
$467.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.75
|
| Rate for Payer: Multiplan Commercial |
$518.25
|
|
|
HC BONE LENGTH
|
Facility
|
OP
|
$691.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
909001603
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$518.25 |
| Rate for Payer: Adventist Health Commercial |
$138.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$427.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.59
|
| Rate for Payer: Blue Shield of California Commercial |
$118.32
|
| Rate for Payer: Blue Shield of California EPN |
$95.15
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$449.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$407.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$427.73
|
| Rate for Payer: Heritage Provider Network Senior |
$427.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$329.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$518.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
