|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
IP
|
$1,252.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$226.61 |
| Max. Negotiated Rate |
$939.00 |
| Rate for Payer: Adventist Health Commercial |
$250.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$806.29
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$847.60
|
| Rate for Payer: Heritage Provider Network Senior |
$847.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$226.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.00
|
| Rate for Payer: Multiplan Commercial |
$939.00
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
IP
|
$1,252.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$226.61 |
| Max. Negotiated Rate |
$939.00 |
| Rate for Payer: Adventist Health Commercial |
$250.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$806.29
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$847.60
|
| Rate for Payer: Heritage Provider Network Senior |
$847.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$226.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.00
|
| Rate for Payer: Multiplan Commercial |
$939.00
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
IP
|
$2,112.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$382.27 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Adventist Health Commercial |
$422.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,360.13
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,429.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,429.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$382.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.00
|
| Rate for Payer: Multiplan Commercial |
$1,584.00
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
OP
|
$2,112.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$382.27 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Adventist Health Commercial |
$422.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,305.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,372.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,372.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$424.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,307.33
|
| Rate for Payer: Heritage Provider Network Senior |
$1,307.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$424.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,007.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$382.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$488.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$1,584.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$467.31
|
| Rate for Payer: TriValley Medical Group Senior |
$424.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$764.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$641.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC CHEMO ADMIN INTRA-ART PUSH
|
Facility
|
IP
|
$1,084.00
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
911800810
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$813.00 |
| Rate for Payer: Adventist Health Commercial |
$216.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$698.10
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$733.87
|
| Rate for Payer: Heritage Provider Network Senior |
$733.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.00
|
| Rate for Payer: Multiplan Commercial |
$813.00
|
|
|
HC CHEMO ADMIN INTRA-ART PUSH
|
Facility
|
OP
|
$1,084.00
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
911800810
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$813.00 |
| Rate for Payer: Adventist Health Commercial |
$216.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$669.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.00
|
| Rate for Payer: Blue Shield of California Commercial |
$661.24
|
| Rate for Payer: Blue Shield of California EPN |
$528.99
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$704.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$424.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$671.00
|
| Rate for Payer: Heritage Provider Network Senior |
$671.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$424.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$517.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$488.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$813.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$467.31
|
| Rate for Payer: TriValley Medical Group Senior |
$424.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$764.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$641.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC CHEMODENRVTN 1 EXT 1 TO 4 MUSC
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
912964642
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$343.54 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$379.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,172.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,233.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,138.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,174.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,724.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$343.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$474.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$1,423.50
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$998.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC CHEMODENRVTN 1 EXT 1 TO 4 MUSC
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
912964642
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$343.54 |
| Max. Negotiated Rate |
$1,423.50 |
| Rate for Payer: Adventist Health Commercial |
$379.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,222.31
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,284.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1,284.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$343.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$474.50
|
| Rate for Payer: Multiplan Commercial |
$1,423.50
|
|
|
HC CHEMODENRVTN TRNK 1 TO 5 MUSC
|
Facility
|
OP
|
$3,085.00
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
909004646
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$558.38 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$617.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,906.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,388.25
|
| Rate for Payer: Cash Price |
$1,388.25
|
| Rate for Payer: Cash Price |
$1,388.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,005.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,851.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,909.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,724.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$558.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$771.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$2,313.75
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$998.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC CHEMODENRVTN TRNK 1 TO 5 MUSC
|
Facility
|
IP
|
$3,085.00
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
909004646
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$558.38 |
| Max. Negotiated Rate |
$2,313.75 |
| Rate for Payer: Adventist Health Commercial |
$617.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,986.74
|
| Rate for Payer: Cash Price |
$1,388.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,088.55
|
| Rate for Payer: Heritage Provider Network Senior |
$2,088.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$558.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$771.25
|
| Rate for Payer: Multiplan Commercial |
$2,313.75
|
|
|
HC CHEMODENRVTN TRNK 6 OR MORE MUSC
|
Facility
|
IP
|
$2,886.00
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
909004647
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$522.37 |
| Max. Negotiated Rate |
$2,164.50 |
| Rate for Payer: Adventist Health Commercial |
$577.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,858.58
|
| Rate for Payer: Cash Price |
$1,298.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,953.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$522.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.50
|
| Rate for Payer: Multiplan Commercial |
$2,164.50
|
|
|
HC CHEMODENRVTN TRNK 6 OR MORE MUSC
|
Facility
|
OP
|
$2,886.00
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
909004647
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$522.37 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$577.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,783.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,298.70
|
| Rate for Payer: Cash Price |
$1,298.70
|
| Rate for Payer: Cash Price |
$1,298.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,875.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,731.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,786.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,724.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$522.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$2,164.50
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$998.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC CHEST 2 VIEWS
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
909001407
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$150.77 |
| Max. Negotiated Rate |
$624.75 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$536.45
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$563.94
|
| Rate for Payer: Heritage Provider Network Senior |
$563.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.25
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
|
|
HC CHEST 2 VIEWS
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
909001407
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$624.75 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$514.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$221.49
|
| Rate for Payer: Blue Shield of California Commercial |
$110.54
|
| Rate for Payer: Blue Shield of California EPN |
$88.90
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$541.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$515.63
|
| Rate for Payer: Heritage Provider Network Senior |
$515.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$397.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$99.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC CHEST COMP 4 VIEWS
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909001402
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$181.36 |
| Max. Negotiated Rate |
$751.50 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$645.29
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$678.35
|
| Rate for Payer: Heritage Provider Network Senior |
$678.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$181.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.50
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
|
|
HC CHEST COMP 4 VIEWS
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909001402
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$116.49 |
| Max. Negotiated Rate |
$751.50 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$619.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$290.46
|
| Rate for Payer: Blue Shield of California Commercial |
$144.86
|
| Rate for Payer: Blue Shield of California EPN |
$116.49
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$651.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$591.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.24
|
| Rate for Payer: Heritage Provider Network Senior |
$620.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$477.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$181.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC CHEST FLUORO/PACEMKR
|
Facility
|
OP
|
$872.00
|
|
| Hospital Charge Code |
909001469
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$157.83 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$538.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$741.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$479.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$654.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$436.17
|
| 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 |
$392.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$566.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$741.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$741.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$539.77
|
| Rate for Payer: Heritage Provider Network Senior |
$539.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$415.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$610.40
|
| Rate for Payer: Multiplan Commercial |
$654.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$436.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$436.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$741.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.20
|
| Rate for Payer: Vantage Medical Group Senior |
$741.20
|
|
|
HC CHEST FLUORO/PACEMKR
|
Facility
|
IP
|
$872.00
|
|
| Hospital Charge Code |
909001469
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$157.83 |
| Max. Negotiated Rate |
$654.00 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$561.57
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$590.34
|
| Rate for Payer: Heritage Provider Network Senior |
$590.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.00
|
| Rate for Payer: Multiplan Commercial |
$654.00
|
|
|
HC CHEST FOUR OR MORE VIEWS
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909071048
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$116.49 |
| Max. Negotiated Rate |
$751.50 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$619.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$290.46
|
| Rate for Payer: Blue Shield of California Commercial |
$144.86
|
| Rate for Payer: Blue Shield of California EPN |
$116.49
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$651.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$591.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.24
|
| Rate for Payer: Heritage Provider Network Senior |
$620.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$477.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$181.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC CHEST FOUR OR MORE VIEWS
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909071048
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$181.36 |
| Max. Negotiated Rate |
$751.50 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$645.29
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$678.35
|
| Rate for Payer: Heritage Provider Network Senior |
$678.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$181.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.50
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
|
|
HC CHEST PORT
|
Facility
|
IP
|
$2,139.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.16 |
| Max. Negotiated Rate |
$1,604.25 |
| Rate for Payer: Adventist Health Commercial |
$427.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,377.52
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,448.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,448.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$387.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.75
|
| Rate for Payer: Multiplan Commercial |
$1,604.25
|
|
|
HC CHEST PORT
|
Facility
|
OP
|
$2,139.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.16 |
| Max. Negotiated Rate |
$1,818.15 |
| Rate for Payer: Adventist Health Commercial |
$427.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,321.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,818.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,176.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,604.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,069.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,304.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,043.83
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,390.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,818.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,818.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,818.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,262.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,324.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,324.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,020.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$387.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,497.30
|
| Rate for Payer: Multiplan Commercial |
$1,604.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,069.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,069.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,818.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,818.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,818.15
|
|
|
HC CHEST SINGLE VIEW
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
909001408
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$48.25 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Adventist Health Commercial |
$152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$469.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.79
|
| Rate for Payer: Blue Shield of California Commercial |
$60.00
|
| Rate for Payer: Blue Shield of California EPN |
$48.25
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$494.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$470.44
|
| Rate for Payer: Heritage Provider Network Senior |
$470.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$362.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$99.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC CHEST SINGLE VIEW
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
909001408
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$137.56 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Adventist Health Commercial |
$152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$489.44
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$514.52
|
| Rate for Payer: Heritage Provider Network Senior |
$514.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.00
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
|
|
HC CHEST THREE VIEWS
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
909071047
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$691.50 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$593.77
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$624.19
|
| Rate for Payer: Heritage Provider Network Senior |
$624.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.50
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
|
