|
HC BONE MARROW ASP/AT TIME OF BX
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
911800314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$259.92 |
| Max. Negotiated Rate |
$1,077.00 |
| Rate for Payer: Adventist Health Commercial |
$287.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$924.78
|
| Rate for Payer: Cash Price |
$646.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$972.17
|
| Rate for Payer: Heritage Provider Network Senior |
$972.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$259.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.00
|
| Rate for Payer: Multiplan Commercial |
$1,077.00
|
|
|
HC BONE MARROW ASP/AT TIME OF BX
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
911800314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$259.92 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$287.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$887.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.95
|
| 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 |
$646.20
|
| Rate for Payer: Cash Price |
$646.20
|
| Rate for Payer: Cash Price |
$646.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$933.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,603.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,109.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,735.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,735.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$888.88
|
| Rate for Payer: Heritage Provider Network Senior |
$4,595.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,735.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,098.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$259.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,296.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,006.17
|
| Rate for Payer: Multiplan Commercial |
$1,077.00
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,109.55
|
| Rate for Payer: TriValley Medical Group Senior |
$4,109.55
|
| 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 |
$5,603.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,109.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,735.95
|
|
|
HC BONE MARROW ASP ONLY
|
Facility
|
IP
|
$1,404.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
911800312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$254.12 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$904.18
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$950.51
|
| Rate for Payer: Heritage Provider Network Senior |
$950.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$254.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
|
|
HC BONE MARROW ASP ONLY
|
Facility
|
OP
|
$1,404.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
911800312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$254.12 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$867.67
|
| 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 |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$912.60
|
| 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 |
$869.08
|
| 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 |
$254.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
| 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 MARROW BX ONLY
|
Facility
|
OP
|
$1,429.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
909020057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.65 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$285.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$883.12
|
| 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 |
$643.05
|
| Rate for Payer: Cash Price |
$643.05
|
| Rate for Payer: Cash Price |
$643.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$928.85
|
| 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 |
$884.55
|
| 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 |
$258.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$1,071.75
|
| 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 |
$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 MARROW BX ONLY
|
Facility
|
IP
|
$1,429.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
909020057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.65 |
| Max. Negotiated Rate |
$1,071.75 |
| Rate for Payer: Adventist Health Commercial |
$285.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$920.28
|
| Rate for Payer: Cash Price |
$643.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$967.43
|
| Rate for Payer: Heritage Provider Network Senior |
$967.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$258.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.25
|
| Rate for Payer: Multiplan Commercial |
$1,071.75
|
|
|
HC BONE MARROW IMAGING, LTD
|
Facility
|
OP
|
$1,297.00
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
909301330
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$234.76 |
| Max. Negotiated Rate |
$972.75 |
| Rate for Payer: EPIC Health Plan Commercial |
$843.05
|
| Rate for Payer: Adventist Health Commercial |
$259.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$801.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$648.76
|
| Rate for Payer: Blue Shield of California Commercial |
$429.41
|
| Rate for Payer: Blue Shield of California EPN |
$345.32
|
| Rate for Payer: Cash Price |
$583.65
|
| Rate for Payer: Cash Price |
$583.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$843.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$802.84
|
| Rate for Payer: Heritage Provider Network Senior |
$802.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$618.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$234.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$972.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$648.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$648.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC BONE MARROW IMAGING, LTD
|
Facility
|
IP
|
$1,297.00
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
909301330
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$234.76 |
| Max. Negotiated Rate |
$972.75 |
| Rate for Payer: Adventist Health Commercial |
$259.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$835.27
|
| Rate for Payer: Cash Price |
$583.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$878.07
|
| Rate for Payer: Heritage Provider Network Senior |
$878.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$234.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.25
|
| Rate for Payer: Multiplan Commercial |
$972.75
|
|
|
HC BONE SCAN LIMITED
|
Facility
|
IP
|
$1,647.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
909301370
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$298.11 |
| Max. Negotiated Rate |
$1,235.25 |
| Rate for Payer: Adventist Health Commercial |
$329.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,060.67
|
| Rate for Payer: Cash Price |
$741.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,115.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,115.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$298.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.75
|
| Rate for Payer: Multiplan Commercial |
$1,235.25
|
|
|
HC BONE SCAN LIMITED
|
Facility
|
OP
|
$1,647.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
909301370
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$298.11 |
| Max. Negotiated Rate |
$1,235.25 |
| Rate for Payer: Adventist Health Commercial |
$329.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,017.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$823.83
|
| Rate for Payer: Blue Shield of California Commercial |
$525.22
|
| Rate for Payer: Blue Shield of California EPN |
$422.36
|
| Rate for Payer: Cash Price |
$741.15
|
| Rate for Payer: Cash Price |
$741.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,070.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,070.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,019.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,019.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$785.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$298.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,235.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$823.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$823.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC BONE SCAN WHOLE BODY
|
Facility
|
OP
|
$2,563.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
909301371
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$463.90 |
| Max. Negotiated Rate |
$1,922.25 |
| Rate for Payer: Adventist Health Commercial |
$512.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,583.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,282.01
|
| Rate for Payer: Blue Shield of California Commercial |
$898.37
|
| Rate for Payer: Blue Shield of California EPN |
$722.44
|
| Rate for Payer: Cash Price |
$1,153.35
|
| Rate for Payer: Cash Price |
$1,153.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,665.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,665.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,586.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1,586.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,222.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$463.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,922.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,281.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,281.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC BONE SCAN WHOLE BODY
|
Facility
|
IP
|
$2,563.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
909301371
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$463.90 |
| Max. Negotiated Rate |
$1,922.25 |
| Rate for Payer: Adventist Health Commercial |
$512.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,650.57
|
| Rate for Payer: Cash Price |
$1,153.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,735.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1,735.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$463.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$640.75
|
| Rate for Payer: Multiplan Commercial |
$1,922.25
|
|
|
HC BONE SPECT
|
Facility
|
OP
|
$2,901.00
|
|
|
Service Code
|
CPT 78320
|
| Hospital Charge Code |
909301369
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$525.08 |
| Max. Negotiated Rate |
$2,465.85 |
| Rate for Payer: Adventist Health Commercial |
$580.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,792.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,465.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,595.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,175.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,451.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1,769.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,415.69
|
| Rate for Payer: Cash Price |
$1,305.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,885.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,465.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,465.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,465.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,885.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,795.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,795.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,383.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$525.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$725.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,030.70
|
| Rate for Payer: Multiplan Commercial |
$2,175.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,450.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,450.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,465.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,465.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,465.85
|
|
|
HC BONE SPECT
|
Facility
|
IP
|
$2,901.00
|
|
|
Service Code
|
CPT 78320
|
| Hospital Charge Code |
909301369
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$525.08 |
| Max. Negotiated Rate |
$2,175.75 |
| Rate for Payer: Adventist Health Commercial |
$580.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,868.24
|
| Rate for Payer: Cash Price |
$1,305.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,963.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,963.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$525.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$725.25
|
| Rate for Payer: Multiplan Commercial |
$2,175.75
|
|
|
HC BONE SURVEY COMPLETE
|
Facility
|
IP
|
$2,158.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$390.60 |
| Max. Negotiated Rate |
$1,618.50 |
| Rate for Payer: Adventist Health Commercial |
$431.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,389.75
|
| Rate for Payer: Cash Price |
$971.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,460.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,460.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$390.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.50
|
| Rate for Payer: Multiplan Commercial |
$1,618.50
|
|
|
HC BONE SURVEY COMPLETE
|
Facility
|
OP
|
$2,158.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$1,618.50 |
| Rate for Payer: Adventist Health Commercial |
$431.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,333.64
|
| 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 |
$391.97
|
| Rate for Payer: Blue Shield of California Commercial |
$411.50
|
| Rate for Payer: Blue Shield of California EPN |
$330.92
|
| Rate for Payer: Cash Price |
$971.10
|
| Rate for Payer: Cash Price |
$971.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,402.70
|
| 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 |
$1,273.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,335.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1,335.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,029.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$390.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,618.50
|
| 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 |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| 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 SURVEY INFANT
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
900077076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.81 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$291.09
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$306.00
|
| Rate for Payer: Heritage Provider Network Senior |
$306.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
|
|
HC BONE SURVEY INFANT
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
900077076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.81 |
| Max. Negotiated Rate |
$356.69 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$279.34
|
| 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 |
$201.42
|
| Rate for Payer: Blue Shield of California Commercial |
$356.69
|
| Rate for Payer: Blue Shield of California EPN |
$286.84
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$293.80
|
| 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 |
$266.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$279.79
|
| Rate for Payer: Heritage Provider Network Senior |
$279.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$215.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| 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 |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| 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 BOTOX INJECTION
|
Facility
|
OP
|
$4,487.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906764999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,852.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,772.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,948.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,916.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,777.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,430.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,140.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$812.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$542.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$749.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,365.25
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| 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: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC BOTOX INJECTION
|
Facility
|
IP
|
$4,487.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906764999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$812.15 |
| Max. Negotiated Rate |
$3,365.25 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,889.63
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,037.70
|
| Rate for Payer: Heritage Provider Network Senior |
$3,037.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$812.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.75
|
| Rate for Payer: Multiplan Commercial |
$3,365.25
|
|
|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
|
IP
|
$3,217.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$582.28 |
| Max. Negotiated Rate |
$2,412.75 |
| Rate for Payer: Adventist Health Commercial |
$643.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,071.75
|
| Rate for Payer: Cash Price |
$1,447.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,177.91
|
| Rate for Payer: Heritage Provider Network Senior |
$2,177.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$582.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.25
|
| Rate for Payer: Multiplan Commercial |
$2,412.75
|
|
|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
|
OP
|
$3,217.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$394.79 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$643.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,988.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| 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 |
$1,447.65
|
| Rate for Payer: Cash Price |
$1,447.65
|
| Rate for Payer: Cash Price |
$1,447.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,091.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,930.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,991.32
|
| Rate for Payer: Heritage Provider Network Senior |
$485.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$750.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$582.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$2,412.75
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$434.27
|
| Rate for Payer: TriValley Medical Group Senior |
$434.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC BRAF
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800312
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$93.94 |
| Max. Negotiated Rate |
$389.25 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$334.24
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$351.36
|
| Rate for Payer: Heritage Provider Network Senior |
$351.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.75
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
|
|
HC BRAF
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800312
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$93.94 |
| Max. Negotiated Rate |
$460.94 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$286.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$320.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$460.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$460.94
|
| Rate for Payer: Blue Shield of California Commercial |
$283.04
|
| Rate for Payer: Blue Shield of California Commercial |
$316.59
|
| Rate for Payer: Blue Shield of California EPN |
$253.27
|
| Rate for Payer: Blue Shield of California EPN |
$226.43
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$301.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$337.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$301.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$175.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$175.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$287.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$321.26
|
| Rate for Payer: Heritage Provider Network Senior |
$287.22
|
| Rate for Payer: Heritage Provider Network Senior |
$321.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$175.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$175.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$221.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$247.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$201.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$201.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$235.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$235.04
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.40
|
| Rate for Payer: TriValley Medical Group Senior |
$175.40
|
| Rate for Payer: TriValley Medical Group Senior |
$175.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Vantage Medical Group Senior |
$175.40
|
| Rate for Payer: Vantage Medical Group Senior |
$175.40
|
|
|
HC BRAF PACKAGE
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800313
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$93.94 |
| Max. Negotiated Rate |
$460.94 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$286.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$320.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$460.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$460.94
|
| Rate for Payer: Blue Shield of California Commercial |
$283.04
|
| Rate for Payer: Blue Shield of California Commercial |
$316.59
|
| Rate for Payer: Blue Shield of California EPN |
$253.27
|
| Rate for Payer: Blue Shield of California EPN |
$226.43
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$301.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$337.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$301.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$175.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$175.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$287.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$321.26
|
| Rate for Payer: Heritage Provider Network Senior |
$287.22
|
| Rate for Payer: Heritage Provider Network Senior |
$321.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$175.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$175.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$221.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$247.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$201.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$201.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$235.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$235.04
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.40
|
| Rate for Payer: TriValley Medical Group Senior |
$175.40
|
| Rate for Payer: TriValley Medical Group Senior |
$175.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Vantage Medical Group Senior |
$175.40
|
| Rate for Payer: Vantage Medical Group Senior |
$175.40
|
|
