|
HC EXPLORATION OF NECK WOUND
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
900501384
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.02 |
| Max. Negotiated Rate |
$1,143.75 |
| Rate for Payer: Adventist Health Commercial |
$305.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,047.68
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,032.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,032.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.25
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
|
|
HC EXPLORATION OF NECK WOUND
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
900501384
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$305.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,204.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,047.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$991.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: Dignity Health Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,032.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,032.42
|
| Rate for Payer: Humana Medicare |
$687.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$735.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$811.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$866.17
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$553.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$509.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC EXPLORE KNEE I & D W/F.B. RMVL
|
Facility
|
OP
|
$6,736.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
900501671
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,347.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,627.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,378.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,560.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4,560.27
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,246.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$5,052.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,445.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,250.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC EXPLORE KNEE I & D W/F.B. RMVL
|
Facility
|
IP
|
$6,736.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
900501671
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,219.22 |
| Max. Negotiated Rate |
$5,052.00 |
| Rate for Payer: Adventist Health Commercial |
$1,347.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,627.63
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,560.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4,560.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.00
|
| Rate for Payer: Multiplan Commercial |
$5,052.00
|
|
|
HC EXPLORE LIMB VESSELS
|
Facility
|
IP
|
$8,648.00
|
|
|
Service Code
|
CPT 35860
|
| Hospital Charge Code |
900501597
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,565.29 |
| Max. Negotiated Rate |
$6,486.00 |
| Rate for Payer: Adventist Health Commercial |
$1,729.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,941.18
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,854.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,854.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,565.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,162.00
|
| Rate for Payer: Multiplan Commercial |
$6,486.00
|
|
|
HC EXPLORE LIMB VESSELS
|
Facility
|
OP
|
$8,648.00
|
|
|
Service Code
|
CPT 35860
|
| Hospital Charge Code |
900501597
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,729.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,941.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,621.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,854.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,854.70
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,168.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,565.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,162.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$6,486.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,140.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,889.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC EXPLORE/TREAT FINGER JOINT EA
|
Facility
|
OP
|
$3,653.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
900501434
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$730.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,509.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,374.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,473.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,473.08
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,760.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$2,739.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,326.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,220.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC EXPLORE/TREAT FINGER JOINT EA
|
Facility
|
IP
|
$3,653.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
900501434
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.19 |
| Max. Negotiated Rate |
$2,739.75 |
| Rate for Payer: Adventist Health Commercial |
$730.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,509.61
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,473.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,473.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| Rate for Payer: Multiplan Commercial |
$2,739.75
|
|
|
HC EXPLOR W/RMVL DEEP F.B.FOREARM
|
Facility
|
IP
|
$4,774.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
900501469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$864.09 |
| Max. Negotiated Rate |
$3,580.50 |
| Rate for Payer: Adventist Health Commercial |
$954.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,279.74
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,232.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,232.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$864.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,193.50
|
| Rate for Payer: Multiplan Commercial |
$3,580.50
|
|
|
HC EXPLOR W/RMVL DEEP F.B.FOREARM
|
Facility
|
OP
|
$4,774.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
900501469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$864.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$954.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,279.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,103.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,232.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,232.00
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,301.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$864.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,193.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: Multiplan Commercial |
$3,580.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,733.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,594.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC EXT CAROTID UNI
|
Facility
|
OP
|
$21,162.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
906820228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.23 |
| Max. Negotiated Rate |
$17,987.70 |
| Rate for Payer: Adventist Health Commercial |
$4,232.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,538.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,987.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,639.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,871.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,755.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,987.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,987.70
|
| Rate for Payer: Dignity Health Senior |
$17,987.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,099.28
|
| Rate for Payer: Heritage Provider Network Senior |
$13,099.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$138.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,200.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,830.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,290.50
|
| Rate for Payer: Multiplan Commercial |
$15,871.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,987.70
|
| Rate for Payer: Vantage Medical Group Senior |
$17,987.70
|
|
|
HC EXT CAROTID UNI
|
Facility
|
OP
|
$21,162.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909020160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.23 |
| Max. Negotiated Rate |
$17,987.70 |
| Rate for Payer: Adventist Health Commercial |
$4,232.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,538.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,987.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,639.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,871.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,755.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,987.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,987.70
|
| Rate for Payer: Dignity Health Senior |
$17,987.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,099.28
|
| Rate for Payer: Heritage Provider Network Senior |
$13,099.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$138.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,200.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,830.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,290.50
|
| Rate for Payer: Multiplan Commercial |
$15,871.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,987.70
|
| Rate for Payer: Vantage Medical Group Senior |
$17,987.70
|
|
|
HC EXT CAROTID UNI
|
Facility
|
IP
|
$21,162.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909020160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,830.32 |
| Max. Negotiated Rate |
$15,871.50 |
| Rate for Payer: Adventist Health Commercial |
$4,232.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,538.29
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,326.67
|
| Rate for Payer: Heritage Provider Network Senior |
$14,326.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,830.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,290.50
|
| Rate for Payer: Multiplan Commercial |
$15,871.50
|
|
|
HC EXT CAROTID UNI
|
Facility
|
IP
|
$21,162.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
906820228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,830.32 |
| Max. Negotiated Rate |
$15,871.50 |
| Rate for Payer: Adventist Health Commercial |
$4,232.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,538.29
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,326.67
|
| Rate for Payer: Heritage Provider Network Senior |
$14,326.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,830.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,290.50
|
| Rate for Payer: Multiplan Commercial |
$15,871.50
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
900203242
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.76
|
| Rate for Payer: Heritage Provider Network Senior |
$333.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
900203242
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Blue Shield of California Commercial |
$306.15
|
| Rate for Payer: Blue Shield of California EPN |
$289.39
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$320.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: Dignity Health Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$50.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.17
|
| Rate for Payer: Heritage Provider Network Senior |
$305.17
|
| Rate for Payer: Humana Medicare |
$50.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.14
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$55.12
|
| Rate for Payer: TriValley Medical Group Senior |
$50.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD SA
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
900203243
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.76
|
| Rate for Payer: Heritage Provider Network Senior |
$333.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD SA
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
900203243
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$92.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| 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: Blue Shield of California Commercial |
$306.15
|
| Rate for Payer: Blue Shield of California EPN |
$289.39
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$320.45
|
| 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 |
$320.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.17
|
| Rate for Payer: Heritage Provider Network Senior |
$305.17
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| 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 |
$369.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.56
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| 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 EXT ECG GT 7 DAY TO 15 DAY RCRD
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
900203246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Blue Shield of California Commercial |
$306.15
|
| Rate for Payer: Blue Shield of California EPN |
$289.39
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$320.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: Dignity Health Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$50.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.17
|
| Rate for Payer: Heritage Provider Network Senior |
$305.17
|
| Rate for Payer: Humana Medicare |
$50.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.14
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$55.12
|
| Rate for Payer: TriValley Medical Group Senior |
$50.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC EXT ECG GT 7 DAY TO 15 DAY RCRD
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
900203246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.76
|
| Rate for Payer: Heritage Provider Network Senior |
$333.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
|
|
HC EXT ECG GT 7 DY TO 15 DY RCRD SA
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
900203247
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$92.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| 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: Blue Shield of California Commercial |
$306.15
|
| Rate for Payer: Blue Shield of California EPN |
$289.39
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$320.45
|
| 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 |
$320.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.17
|
| Rate for Payer: Heritage Provider Network Senior |
$305.17
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| 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 |
$369.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.56
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| 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 EXT ECG GT 7 DY TO 15 DY RCRD SA
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
900203247
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.76
|
| Rate for Payer: Heritage Provider Network Senior |
$333.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
|
|
HC EXTENDED LENGTH TRACH TUBE
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.57 |
| Max. Negotiated Rate |
$561.75 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$514.56
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.07
|
| Rate for Payer: Heritage Provider Network Senior |
$507.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
|
|
HC EXTENDED LENGTH TRACH TUBE
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$636.65 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$514.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$636.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$411.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$561.75
|
| Rate for Payer: Blue Shield of California Commercial |
$465.13
|
| Rate for Payer: Blue Shield of California EPN |
$439.66
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$486.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$636.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$636.65
|
| Rate for Payer: Dignity Health Senior |
$636.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.63
|
| Rate for Payer: Heritage Provider Network Senior |
$463.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$361.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$636.65
|
| Rate for Payer: Vantage Medical Group Senior |
$636.65
|
|
|
HC EXTERNAL EAR, UNLISTED PROCEDU
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT 69399
|
| Hospital Charge Code |
900501298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.96 |
| Max. Negotiated Rate |
$617.25 |
| Rate for Payer: Adventist Health Commercial |
$164.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$565.40
|
| Rate for Payer: Cash Price |
$370.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.17
|
| Rate for Payer: Heritage Provider Network Senior |
$557.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.75
|
| Rate for Payer: Multiplan Commercial |
$617.25
|
|
