|
HC CL TRT FX GREAT TOE,W/MANIPUL
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
900501249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.55 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$411.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$316.35
|
| Rate for Payer: Blue Shield of California EPN |
$251.75
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.88
|
| Rate for Payer: Heritage Provider Network Senior |
$450.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$317.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$399.60
|
| Rate for Payer: TriValley Medical Group Senior |
$399.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TRT MET FX W MANIPULATION EA
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
900501248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.99 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$969.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$745.27
|
| Rate for Payer: Blue Shield of California EPN |
$593.08
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,019.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,062.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,062.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$748.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,176.75
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$941.40
|
| Rate for Payer: TriValley Medical Group Senior |
$941.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TRT MET FX W MANIPULATION EA
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
900501248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.99 |
| Max. Negotiated Rate |
$1,176.75 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,010.44
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,062.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,062.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.25
|
| Rate for Payer: Multiplan Commercial |
$1,176.75
|
|
|
HC CL TRT OF KNEE DISC W/O ANESTH
|
Facility
|
IP
|
$1,291.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
900501246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.67 |
| Max. Negotiated Rate |
$968.25 |
| Rate for Payer: Adventist Health Commercial |
$258.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$831.40
|
| Rate for Payer: Cash Price |
$580.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.01
|
| Rate for Payer: Heritage Provider Network Senior |
$874.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.75
|
| Rate for Payer: Multiplan Commercial |
$968.25
|
|
|
HC CL TRT OF KNEE DISC W/O ANESTH
|
Facility
|
OP
|
$1,291.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
900501246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$258.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$797.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$613.23
|
| Rate for Payer: Blue Shield of California EPN |
$488.00
|
| Rate for Payer: Cash Price |
$580.95
|
| Rate for Payer: Cash Price |
$580.95
|
| Rate for Payer: Cash Price |
$580.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$839.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.01
|
| Rate for Payer: Heritage Provider Network Senior |
$874.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$615.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$968.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$774.60
|
| Rate for Payer: TriValley Medical Group Senior |
$774.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CMRI MORPH/FUNCT W/O CONTRAST
|
Facility
|
IP
|
$12,208.00
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
908801260
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$9,156.00 |
| Rate for Payer: Adventist Health Commercial |
$2,441.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,861.95
|
| Rate for Payer: Cash Price |
$5,493.60
|
| Rate for Payer: Cash Price |
$5,493.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,264.82
|
| Rate for Payer: Heritage Provider Network Senior |
$8,264.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,209.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,052.00
|
| Rate for Payer: Multiplan Commercial |
$9,156.00
|
|
|
HC CMRI MORPH/FUNCT W/O CONTRAST
|
Facility
|
OP
|
$12,208.00
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
908801260
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$9,156.00 |
| Rate for Payer: Adventist Health Commercial |
$2,441.60
|
| Rate for Payer: Adventist Health Commercial |
$957.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,958.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,544.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,394.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,106.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2,212.32
|
| Rate for Payer: Blue Shield of California Commercial |
$2,212.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,779.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,779.07
|
| Rate for Payer: Cash Price |
$2,154.15
|
| Rate for Payer: Cash Price |
$5,493.60
|
| Rate for Payer: Cash Price |
$5,493.60
|
| Rate for Payer: Cash Price |
$5,493.60
|
| Rate for Payer: Cash Price |
$5,493.60
|
| Rate for Payer: Cash Price |
$2,154.15
|
| Rate for Payer: Cash Price |
$2,154.15
|
| Rate for Payer: Cash Price |
$2,154.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,283.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,823.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$866.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,209.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,052.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,196.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$9,156.00
|
| Rate for Payer: Multiplan Commercial |
$3,590.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC CMRI MORPH/FUNCT W+W/O CONT
|
Facility
|
IP
|
$5,743.00
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
908801270
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,307.25 |
| Rate for Payer: Adventist Health Commercial |
$1,148.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,698.49
|
| Rate for Payer: Cash Price |
$2,584.35
|
| Rate for Payer: Cash Price |
$2,584.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,888.01
|
| Rate for Payer: Heritage Provider Network Senior |
$3,888.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,039.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,435.75
|
| Rate for Payer: Multiplan Commercial |
$4,307.25
|
|
|
HC CMRI MORPH/FUNCT W+W/O CONT
|
Facility
|
OP
|
$5,679.00
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
908801270
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,259.25 |
| Rate for Payer: Adventist Health Commercial |
$1,135.80
|
| Rate for Payer: Adventist Health Commercial |
$1,148.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,549.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,509.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,872.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,840.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3,156.53
|
| Rate for Payer: Blue Shield of California Commercial |
$3,156.53
|
| Rate for Payer: Blue Shield of California EPN |
$2,538.37
|
| Rate for Payer: Blue Shield of California EPN |
$2,538.37
|
| Rate for Payer: Cash Price |
$2,584.35
|
| Rate for Payer: Cash Price |
$2,555.55
|
| Rate for Payer: Cash Price |
$2,555.55
|
| Rate for Payer: Cash Price |
$2,555.55
|
| Rate for Payer: Cash Price |
$2,555.55
|
| Rate for Payer: Cash Price |
$2,584.35
|
| Rate for Payer: Cash Price |
$2,584.35
|
| Rate for Payer: Cash Price |
$2,584.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,739.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,708.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,039.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,027.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,435.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$4,259.25
|
| Rate for Payer: Multiplan Commercial |
$4,307.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$854.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$854.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$854.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$854.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC CMRI W FLOW/VEL QUANT W/O CONT
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
908801261
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$202.72 |
| Max. Negotiated Rate |
$929.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$721.28
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$758.24
|
| Rate for Payer: Heritage Provider Network Senior |
$758.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
|
|
HC CMRI W FLOW/VEL QUANT W/O CONT
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
908801261
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$202.72 |
| Max. Negotiated Rate |
$1,075.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$692.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$616.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$840.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$560.22
|
| Rate for Payer: Blue Shield of California Commercial |
$683.20
|
| Rate for Payer: Blue Shield of California EPN |
$546.56
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$952.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$952.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$952.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$534.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$784.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$560.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$560.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$952.00
|
| Rate for Payer: Vantage Medical Group Senior |
$952.00
|
|
|
HC CMRI W FLOW/VEL QUANT W+W/O CO
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
908801271
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$202.72 |
| Max. Negotiated Rate |
$929.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$721.28
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$758.24
|
| Rate for Payer: Heritage Provider Network Senior |
$758.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
|
|
HC CMRI W FLOW/VEL QUANT W+W/O CO
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
908801271
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$202.72 |
| Max. Negotiated Rate |
$1,075.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$692.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$616.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$840.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$560.22
|
| Rate for Payer: Blue Shield of California Commercial |
$683.20
|
| Rate for Payer: Blue Shield of California EPN |
$546.56
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$952.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$952.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$952.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$534.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$784.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$560.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$560.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$952.00
|
| Rate for Payer: Vantage Medical Group Senior |
$952.00
|
|
|
HC CMRI W FLOW/VEL+STRESS W/O CON
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
908801263
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$202.72 |
| Max. Negotiated Rate |
$1,075.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$692.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$616.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$840.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$560.22
|
| Rate for Payer: Blue Shield of California Commercial |
$683.20
|
| Rate for Payer: Blue Shield of California EPN |
$546.56
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$952.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$952.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$952.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$534.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$784.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$560.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$560.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$952.00
|
| Rate for Payer: Vantage Medical Group Senior |
$952.00
|
|
|
HC CMRI W FLOW/VEL+STRESS W/O CON
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
908801263
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$202.72 |
| Max. Negotiated Rate |
$929.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$721.28
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$758.24
|
| Rate for Payer: Heritage Provider Network Senior |
$758.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
|
|
HC CMRI W FLOW/VEL+STRESS W+W/O C
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
908801273
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$202.72 |
| Max. Negotiated Rate |
$929.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$721.28
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$758.24
|
| Rate for Payer: Heritage Provider Network Senior |
$758.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
|
|
HC CMRI W FLOW/VEL+STRESS W+W/O C
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
908801273
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$202.72 |
| Max. Negotiated Rate |
$1,075.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$692.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$616.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$840.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$560.22
|
| Rate for Payer: Blue Shield of California Commercial |
$683.20
|
| Rate for Payer: Blue Shield of California EPN |
$546.56
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$952.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$952.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$952.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$534.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$784.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$560.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$560.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$952.00
|
| Rate for Payer: Vantage Medical Group Senior |
$952.00
|
|
|
HC CMRI W STRESS W/O CONT
|
Facility
|
OP
|
$10,853.00
|
|
|
Service Code
|
CPT 75559
|
| Hospital Charge Code |
908801262
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$8,139.75 |
| Rate for Payer: Adventist Health Commercial |
$2,170.60
|
| Rate for Payer: Adventist Health Commercial |
$1,048.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,239.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,707.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,622.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,428.67
|
| Rate for Payer: Blue Shield of California Commercial |
$3,355.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3,355.58
|
| Rate for Payer: Blue Shield of California EPN |
$2,698.45
|
| Rate for Payer: Blue Shield of California EPN |
$2,698.45
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cash Price |
$4,883.85
|
| Rate for Payer: Cash Price |
$4,883.85
|
| Rate for Payer: Cash Price |
$4,883.85
|
| Rate for Payer: Cash Price |
$4,883.85
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$702.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$702.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,500.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,176.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$948.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,964.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$808.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$808.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,713.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,310.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$8,139.75
|
| Rate for Payer: Multiplan Commercial |
$3,931.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
HC CMRI W STRESS W/O CONT
|
Facility
|
IP
|
$10,853.00
|
|
|
Service Code
|
CPT 75559
|
| Hospital Charge Code |
908801262
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$8,139.75 |
| Rate for Payer: Adventist Health Commercial |
$2,170.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,989.33
|
| Rate for Payer: Cash Price |
$4,883.85
|
| Rate for Payer: Cash Price |
$4,883.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,347.48
|
| Rate for Payer: Heritage Provider Network Senior |
$7,347.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,964.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,713.25
|
| Rate for Payer: Multiplan Commercial |
$8,139.75
|
|
|
HC CMRI W STRESS W+W/O CONT
|
Facility
|
IP
|
$15,930.00
|
|
|
Service Code
|
CPT 75563
|
| Hospital Charge Code |
908801272
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$11,947.50 |
| Rate for Payer: Adventist Health Commercial |
$3,186.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,258.92
|
| Rate for Payer: Cash Price |
$7,168.50
|
| Rate for Payer: Cash Price |
$7,168.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,784.61
|
| Rate for Payer: Heritage Provider Network Senior |
$10,784.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,883.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,982.50
|
| Rate for Payer: Multiplan Commercial |
$11,947.50
|
|
|
HC CMRI W STRESS W+W/O CONT
|
Facility
|
OP
|
$15,930.00
|
|
|
Service Code
|
CPT 75563
|
| Hospital Charge Code |
908801272
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$11,947.50 |
| Rate for Payer: Adventist Health Commercial |
$3,186.00
|
| Rate for Payer: Adventist Health Commercial |
$1,231.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,805.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,844.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,079.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,968.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3,945.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3,945.74
|
| Rate for Payer: Blue Shield of California EPN |
$3,173.04
|
| Rate for Payer: Blue Shield of California EPN |
$3,173.04
|
| Rate for Payer: Cash Price |
$2,770.65
|
| Rate for Payer: Cash Price |
$7,168.50
|
| Rate for Payer: Cash Price |
$7,168.50
|
| Rate for Payer: Cash Price |
$7,168.50
|
| Rate for Payer: Cash Price |
$7,168.50
|
| Rate for Payer: Cash Price |
$2,770.65
|
| Rate for Payer: Cash Price |
$2,770.65
|
| Rate for Payer: Cash Price |
$2,770.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,109.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,008.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,008.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,008.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,008.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,936.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,598.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,883.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,159.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,159.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,982.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,539.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.06
|
| Rate for Payer: Multiplan Commercial |
$11,947.50
|
| Rate for Payer: Multiplan Commercial |
$4,617.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$854.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$854.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$854.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$854.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,512.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,109.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.25
|
|
|
HC CMVABG
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
900913699
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$136.22 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.22
|
| Rate for Payer: Blue Shield of California Commercial |
$115.83
|
| Rate for Payer: Blue Shield of California Commercial |
$115.83
|
| Rate for Payer: Blue Shield of California EPN |
$92.91
|
| Rate for Payer: Blue Shield of California EPN |
$92.91
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC CMVABG
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
900913699
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.59
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
|
|
HC CMV AB IGG
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
900910987
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.81
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$184.82
|
| Rate for Payer: Heritage Provider Network Senior |
$184.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.25
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
|
|
HC CMV AB IGG
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
900910987
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$136.22 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$168.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.22
|
| Rate for Payer: Blue Shield of California Commercial |
$115.83
|
| Rate for Payer: Blue Shield of California Commercial |
$115.83
|
| Rate for Payer: Blue Shield of California EPN |
$92.91
|
| Rate for Payer: Blue Shield of California EPN |
$92.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$177.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$168.99
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$130.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
