|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
908600110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.00
|
| Rate for Payer: Blue Shield of California Commercial |
$119.23
|
| Rate for Payer: Blue Shield of California EPN |
$112.70
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.20
|
| Rate for Payer: Dignity Health Senior |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.85
|
| Rate for Payer: Heritage Provider Network Senior |
$118.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$92.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Senior |
$96.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.20
|
| Rate for Payer: Vantage Medical Group Senior |
$163.20
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.00
|
| Rate for Payer: Blue Shield of California Commercial |
$119.23
|
| Rate for Payer: Blue Shield of California EPN |
$112.70
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.20
|
| Rate for Payer: Dignity Health Senior |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.85
|
| Rate for Payer: Heritage Provider Network Senior |
$118.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$92.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Senior |
$96.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.20
|
| Rate for Payer: Vantage Medical Group Senior |
$163.20
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908603211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.29 |
| Max. Negotiated Rate |
$320.25 |
| Rate for Payer: Adventist Health Commercial |
$85.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$293.35
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$289.08
|
| Rate for Payer: Heritage Provider Network Senior |
$289.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.75
|
| Rate for Payer: Multiplan Commercial |
$320.25
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908710007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.13 |
| Max. Negotiated Rate |
$294.75 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.99
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$266.06
|
| Rate for Payer: Heritage Provider Network Senior |
$266.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.25
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$180.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$247.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$181.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.16
|
| Rate for Payer: Blue Shield of California Commercial |
$158.36
|
| Rate for Payer: Blue Shield of California EPN |
$149.68
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$247.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.68
|
| Rate for Payer: Dignity Health Senior |
$165.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.84
|
| Rate for Payer: Heritage Provider Network Senior |
$157.84
|
| Rate for Payer: Humana Medicare |
$165.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$313.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.10
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$181.68
|
| Rate for Payer: TriValley Medical Group Senior |
$181.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$247.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.68
|
| Rate for Payer: Vantage Medical Group Senior |
$165.16
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908710007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$334.05 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$334.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.75
|
| Rate for Payer: Blue Shield of California Commercial |
$244.05
|
| Rate for Payer: Blue Shield of California EPN |
$230.69
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$334.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$334.05
|
| Rate for Payer: Dignity Health Senior |
$334.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$243.27
|
| Rate for Payer: Heritage Provider Network Senior |
$243.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.25
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$196.50
|
| Rate for Payer: TriValley Medical Group Senior |
$196.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$334.05
|
| Rate for Payer: Vantage Medical Group Senior |
$334.05
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.18
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.64
|
| Rate for Payer: Heritage Provider Network Senior |
$172.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908603211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$362.95 |
| Rate for Payer: Adventist Health Commercial |
$85.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$293.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$320.25
|
| Rate for Payer: Blue Shield of California Commercial |
$265.17
|
| Rate for Payer: Blue Shield of California EPN |
$250.65
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.95
|
| Rate for Payer: Dignity Health Senior |
$362.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$264.31
|
| Rate for Payer: Heritage Provider Network Senior |
$264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$205.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.75
|
| Rate for Payer: Multiplan Commercial |
$320.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$213.50
|
| Rate for Payer: TriValley Medical Group Senior |
$213.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.95
|
| Rate for Payer: Vantage Medical Group Senior |
$362.95
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$303.45 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$303.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$196.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.75
|
| Rate for Payer: Blue Shield of California Commercial |
$221.70
|
| Rate for Payer: Blue Shield of California EPN |
$209.56
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$303.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$303.45
|
| Rate for Payer: Dignity Health Senior |
$303.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.98
|
| Rate for Payer: Heritage Provider Network Senior |
$220.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$172.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.25
|
| Rate for Payer: Multiplan Commercial |
$267.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$178.50
|
| Rate for Payer: TriValley Medical Group Senior |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$303.45
|
| Rate for Payer: Vantage Medical Group Senior |
$303.45
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$313.80 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$180.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$247.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$181.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.16
|
| Rate for Payer: Blue Shield of California Commercial |
$221.70
|
| Rate for Payer: Blue Shield of California EPN |
$209.56
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$247.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.68
|
| Rate for Payer: Dignity Health Senior |
$165.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.98
|
| Rate for Payer: Heritage Provider Network Senior |
$220.98
|
| Rate for Payer: Humana Medicare |
$165.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$313.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.10
|
| Rate for Payer: Multiplan Commercial |
$267.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$178.50
|
| Rate for Payer: TriValley Medical Group Senior |
$178.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$247.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.68
|
| Rate for Payer: Vantage Medical Group Senior |
$165.16
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.26
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.69
|
| Rate for Payer: Heritage Provider Network Senior |
$241.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.25
|
| Rate for Payer: Multiplan Commercial |
$267.75
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.26
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.69
|
| Rate for Payer: Heritage Provider Network Senior |
$241.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.25
|
| Rate for Payer: Multiplan Commercial |
$267.75
|
|
|
HC ESTRADIOL
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
900912127
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$233.91 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$81.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.91
|
| Rate for Payer: Blue Shield of California Commercial |
$218.23
|
| Rate for Payer: Blue Shield of California EPN |
$170.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.73
|
| Rate for Payer: Dignity Health Senior |
$27.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.47
|
| Rate for Payer: Heritage Provider Network Senior |
$54.47
|
| Rate for Payer: Humana Medicare |
$27.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$53.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.94
|
| Rate for Payer: TriValley Medical Group Senior |
$27.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$30.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Vantage Medical Group Senior |
$27.94
|
|
|
HC ESTRADIOL
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
900912127
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.08
|
| Rate for Payer: Cash Price |
$149.40
|
| 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 ETHIODOL (LIPIODOL)
|
Facility
|
IP
|
$700.00
|
|
| Hospital Charge Code |
909001008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Adventist Health Commercial |
$140.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$480.90
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$473.90
|
| Rate for Payer: Heritage Provider Network Senior |
$473.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$525.00
|
|
|
HC ETHIODOL (LIPIODOL)
|
Facility
|
OP
|
$700.00
|
|
| Hospital Charge Code |
909001008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Adventist Health Commercial |
$140.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$374.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$480.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$595.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$385.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$525.00
|
| Rate for Payer: Blue Shield of California Commercial |
$434.70
|
| Rate for Payer: Blue Shield of California EPN |
$410.90
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$455.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$595.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$595.00
|
| Rate for Payer: Dignity Health Senior |
$595.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.30
|
| Rate for Payer: Heritage Provider Network Senior |
$433.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$337.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$280.00
|
| Rate for Payer: TriValley Medical Group Senior |
$280.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$595.00
|
| Rate for Payer: Vantage Medical Group Senior |
$595.00
|
|
|
HC EVAC OF SUBUNG HEMATOMA
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
900501016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$57.38 |
| Max. Negotiated Rate |
$237.75 |
| Rate for Payer: Adventist Health Commercial |
$63.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$217.78
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$214.61
|
| Rate for Payer: Heritage Provider Network Senior |
$214.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.25
|
| Rate for Payer: Multiplan Commercial |
$237.75
|
|
|
HC EVAC OF SUBUNG HEMATOMA
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
900501016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$57.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$63.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$217.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$206.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$214.61
|
| Rate for Payer: Heritage Provider Network Senior |
$214.61
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$152.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$237.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$115.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$105.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC EVACUATE MOLE OF UTERUS
|
Facility
|
IP
|
$4,248.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
900501632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$768.89 |
| Max. Negotiated Rate |
$3,186.00 |
| Rate for Payer: Adventist Health Commercial |
$849.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,918.38
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,875.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,875.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$768.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,062.00
|
| Rate for Payer: Multiplan Commercial |
$3,186.00
|
|
|
HC EVACUATE MOLE OF UTERUS
|
Facility
|
OP
|
$4,248.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
900501632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$768.89 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$849.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,918.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,761.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: Dignity Health Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,875.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,875.90
|
| Rate for Payer: Humana Medicare |
$3,906.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,047.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$768.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,609.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,062.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,921.79
|
| Rate for Payer: Multiplan Commercial |
$3,186.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,542.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,419.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC EVAL AUD REHAB STATUS 1ST HR
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
905601903
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$31.28 |
| Max. Negotiated Rate |
$370.82 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$177.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC EVAL AUD REHAB STATUS 1ST HR
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
905601903
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC EVAL AUD REHAB STATUS ADD 15 M
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
905601904
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.40
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.54
|
| Rate for Payer: Heritage Provider Network Senior |
$57.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
|
|
HC EVAL AUD REHAB STATUS ADD 15 M
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
905601904
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.25
|
| Rate for Payer: Dignity Health Senior |
$72.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.62
|
| Rate for Payer: Heritage Provider Network Senior |
$52.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.25
|
| Rate for Payer: Vantage Medical Group Senior |
$72.25
|
|
|
HC EVAL FOR PRESCRIPT VOICE PROST
|
Facility
|
OP
|
$623.00
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
905601758
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$112.76 |
| Max. Negotiated Rate |
$529.55 |
| Rate for Payer: Adventist Health Commercial |
$124.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$412.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$428.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$529.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$342.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$467.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$280.35
|
| Rate for Payer: Cash Price |
$280.35
|
| Rate for Payer: Cash Price |
$280.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$404.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$529.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$529.55
|
| Rate for Payer: Dignity Health Senior |
$529.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$385.64
|
| Rate for Payer: Heritage Provider Network Senior |
$385.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$149.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$300.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.75
|
| Rate for Payer: Multiplan Commercial |
$467.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$529.55
|
| Rate for Payer: Vantage Medical Group Senior |
$529.55
|
|
