|
HC COMPUTER/DYNAMIC POSTUROGRAPHY COMM MCARE
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
CPT 92548
|
| Hospital Charge Code |
900411039
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$263.25 |
| Rate for Payer: Adventist Health Commercial |
$70.20
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$237.63
|
| Rate for Payer: Heritage Provider Network Senior |
$237.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.75
|
| Rate for Payer: Multiplan Commercial |
$263.25
|
|
|
HC COMPUTER/DYNAMIC POSTUROGRAPHY COMM MCARE
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
CPT 92548
|
| Hospital Charge Code |
900411039
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$610.61 |
| Rate for Payer: Adventist Health Commercial |
$70.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$241.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Blue Shield of California Commercial |
$610.61
|
| Rate for Payer: Blue Shield of California EPN |
$491.03
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$228.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Senior |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$217.27
|
| Rate for Payer: Heritage Provider Network Senior |
$217.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$167.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.36
|
| Rate for Payer: Multiplan Commercial |
$263.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$180.16
|
| Rate for Payer: TriValley Medical Group Senior |
$163.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$522.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$437.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC CONG LT HEART CATH NML OR ABNL
|
Facility
|
IP
|
$6,682.00
|
|
|
Service Code
|
CPT 93595
|
| Hospital Charge Code |
906820097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,209.44 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,209.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.50
|
| Rate for Payer: Multiplan Commercial |
$5,011.50
|
|
|
HC CONG LT HEART CATH NML OR ABNL
|
Facility
|
OP
|
$6,682.00
|
|
|
Service Code
|
CPT 93595
|
| Hospital Charge Code |
906820097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$12,150.00 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,590.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| 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 |
$3,675.10
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Senior |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,343.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,086.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,136.16
|
| Rate for Payer: Heritage Provider Network Senior |
$5,026.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,764.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,209.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,149.33
|
| Rate for Payer: Multiplan Commercial |
$5,011.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,495.45
|
| Rate for Payer: TriValley Medical Group Senior |
$4,086.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CONG R & L HEART W SEPTAL
|
Facility
|
OP
|
$6,869.00
|
|
|
Service Code
|
CPT 93533
|
| Hospital Charge Code |
906811253
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,243.29 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$1,373.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,719.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,838.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,777.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,151.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| 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 |
$3,777.95
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,838.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,838.65
|
| Rate for Payer: Dignity Health Senior |
$5,838.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,464.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,251.91
|
| Rate for Payer: Heritage Provider Network Senior |
$4,251.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,276.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,243.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,808.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,808.30
|
| Rate for Payer: Multiplan Commercial |
$5,151.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,434.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,434.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,838.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,838.65
|
| Rate for Payer: Vantage Medical Group Senior |
$5,838.65
|
|
|
HC CONG R & L HEART W SEPTAL
|
Facility
|
IP
|
$6,869.00
|
|
|
Service Code
|
CPT 93533
|
| Hospital Charge Code |
906811253
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,243.29 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,373.80
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,243.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.25
|
| Rate for Payer: Multiplan Commercial |
$5,151.75
|
|
|
HC CONG R & L HEART W TRANSEPTAL
|
Facility
|
IP
|
$6,869.00
|
|
|
Service Code
|
CPT 93532
|
| Hospital Charge Code |
906811252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,243.29 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,373.80
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,243.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.25
|
| Rate for Payer: Multiplan Commercial |
$5,151.75
|
|
|
HC CONG R & L HEART W TRANSEPTAL
|
Facility
|
OP
|
$6,869.00
|
|
|
Service Code
|
CPT 93532
|
| Hospital Charge Code |
906811252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,243.29 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$1,373.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,719.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,838.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,777.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,151.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| 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 |
$3,777.95
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,838.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,838.65
|
| Rate for Payer: Dignity Health Senior |
$5,838.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,464.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,251.91
|
| Rate for Payer: Heritage Provider Network Senior |
$4,251.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,276.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,243.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,808.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,808.30
|
| Rate for Payer: Multiplan Commercial |
$5,151.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,434.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,434.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,838.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,838.65
|
| Rate for Payer: Vantage Medical Group Senior |
$5,838.65
|
|
|
HC CONG RT AND LT HEAR CATH ABNL NAT
|
Facility
|
OP
|
$6,682.00
|
|
|
Service Code
|
CPT 93597
|
| Hospital Charge Code |
906820094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$12,150.00 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,590.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| 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 |
$3,675.10
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Senior |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,343.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,086.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,136.16
|
| Rate for Payer: Heritage Provider Network Senior |
$5,026.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,764.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,209.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,149.33
|
| Rate for Payer: Multiplan Commercial |
$5,011.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,495.45
|
| Rate for Payer: TriValley Medical Group Senior |
$4,086.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CONG RT AND LT HEAR CATH ABNL NAT
|
Facility
|
IP
|
$6,682.00
|
|
|
Service Code
|
CPT 93597
|
| Hospital Charge Code |
906820094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,209.44 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,209.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.50
|
| Rate for Payer: Multiplan Commercial |
$5,011.50
|
|
|
HC CONG RT AND LT HEAR CATH ABNL NAT
|
Facility
|
OP
|
$6,682.00
|
|
|
Service Code
|
CPT 93597
|
| Hospital Charge Code |
906820096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$12,150.00 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,590.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| 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 |
$3,675.10
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Senior |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,343.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,086.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,136.16
|
| Rate for Payer: Heritage Provider Network Senior |
$5,026.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,764.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,209.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,149.33
|
| Rate for Payer: Multiplan Commercial |
$5,011.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,495.45
|
| Rate for Payer: TriValley Medical Group Senior |
$4,086.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CONG RT AND LT HEAR CATH ABNL NAT
|
Facility
|
IP
|
$6,682.00
|
|
|
Service Code
|
CPT 93597
|
| Hospital Charge Code |
906820096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,209.44 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,209.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.50
|
| Rate for Payer: Multiplan Commercial |
$5,011.50
|
|
|
HC CONG RT AND LT HEART CATH NML NAT
|
Facility
|
IP
|
$6,682.00
|
|
|
Service Code
|
CPT 93596
|
| Hospital Charge Code |
906820093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,209.44 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,209.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.50
|
| Rate for Payer: Multiplan Commercial |
$5,011.50
|
|
|
HC CONG RT AND LT HEART CATH NML NAT
|
Facility
|
OP
|
$6,682.00
|
|
|
Service Code
|
CPT 93596
|
| Hospital Charge Code |
906820093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$12,150.00 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,590.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| 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 |
$3,675.10
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Senior |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,343.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,086.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,136.16
|
| Rate for Payer: Heritage Provider Network Senior |
$5,026.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,764.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,209.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,149.33
|
| Rate for Payer: Multiplan Commercial |
$5,011.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,495.45
|
| Rate for Payer: TriValley Medical Group Senior |
$4,086.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CONG RT HEART CONG NML NAT
|
Facility
|
IP
|
$6,682.00
|
|
|
Service Code
|
CPT 93593
|
| Hospital Charge Code |
906820095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,209.44 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,209.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.50
|
| Rate for Payer: Multiplan Commercial |
$5,011.50
|
|
|
HC CONG RT HEART CONG NML NAT
|
Facility
|
OP
|
$6,682.00
|
|
|
Service Code
|
CPT 93593
|
| Hospital Charge Code |
906820095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$12,150.00 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,590.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| 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 |
$3,675.10
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Cash Price |
$3,675.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Senior |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,343.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,086.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,136.16
|
| Rate for Payer: Heritage Provider Network Senior |
$5,026.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,764.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,209.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,149.33
|
| Rate for Payer: Multiplan Commercial |
$5,011.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,495.45
|
| Rate for Payer: TriValley Medical Group Senior |
$4,086.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CONT INHAL TRT W/AERO 1ST HR
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
900800012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$27.54 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$177.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Senior |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.36
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC CONT INHAL TRT W/AERO 1ST HR
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
900800012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC CONT INHAL TRT W/AERO ADD HR
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
900800013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Adventist Health Commercial |
$49.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$132.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$160.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.95
|
| Rate for Payer: Dignity Health Senior |
$209.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.89
|
| Rate for Payer: Heritage Provider Network Senior |
$152.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$117.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.90
|
| Rate for Payer: Multiplan Commercial |
$185.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.95
|
| Rate for Payer: Vantage Medical Group Senior |
$209.95
|
|
|
HC CONT INHAL TRT W/AERO ADD HR
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
900800013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$44.71 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Adventist Health Commercial |
$49.40
|
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.22
|
| Rate for Payer: Heritage Provider Network Senior |
$167.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.75
|
| Rate for Payer: Multiplan Commercial |
$185.25
|
|
|
HC CONT OROPHARYN HEMOR, SIMPLE
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
900501252
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$445.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Senior |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$647.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$326.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$744.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$815.28
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$246.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$226.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC CONT OROPHARYN HEMOR, SIMPLE
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
900501252
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$513.75 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
|
|
HC CONTRAST BATH 15MIN OT
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
905104124
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.43
|
| Rate for Payer: Heritage Provider Network Senior |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
|
|
HC CONTRAST BATH 15MIN OT
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
905104124
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$17.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.70
|
| Rate for Payer: Dignity Health Senior |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.70
|
| Rate for Payer: Vantage Medical Group Senior |
$35.70
|
|
|
HC CONTRAST BATHS 15 MIN MCAL
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900400028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.43
|
| Rate for Payer: Heritage Provider Network Senior |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
|
