|
HC COMM/WORK REINTEGRATION 15 MIN MCAL
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
901300068
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.84
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN MCAL
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
901300068
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$52.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN OT
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
905104153
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$52.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN OT
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
905104153
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.84
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN PT
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
905103153
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.84
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN PT
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
905103153
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$52.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN PT COMM MCARE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
900417537
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$52.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN PT COMM MCARE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
900417537
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.84
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC COMPLEMENT C-3
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910841
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$113.97 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.97
|
| Rate for Payer: Blue Shield of California Commercial |
$96.65
|
| Rate for Payer: Blue Shield of California Commercial |
$96.65
|
| Rate for Payer: Blue Shield of California EPN |
$77.52
|
| Rate for Payer: Blue Shield of California EPN |
$77.52
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.95
|
| Rate for Payer: Heritage Provider Network Senior |
$134.94
|
| Rate for Payer: Heritage Provider Network Senior |
$56.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$103.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$43.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Senior |
$12.00
|
| Rate for Payer: TriValley Medical Group Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC COMPLEMENT C-3
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910841
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.39
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.59
|
| Rate for Payer: Heritage Provider Network Senior |
$147.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
|
|
HC COMPLEMENT C-4
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910979
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.39
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.59
|
| Rate for Payer: Heritage Provider Network Senior |
$147.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
|
|
HC COMPLEMENT C-4
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910979
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$113.97 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.97
|
| Rate for Payer: Blue Shield of California Commercial |
$96.65
|
| Rate for Payer: Blue Shield of California Commercial |
$96.65
|
| Rate for Payer: Blue Shield of California EPN |
$77.52
|
| Rate for Payer: Blue Shield of California EPN |
$77.52
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.95
|
| Rate for Payer: Heritage Provider Network Senior |
$134.94
|
| Rate for Payer: Heritage Provider Network Senior |
$56.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$103.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$43.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Senior |
$12.00
|
| Rate for Payer: TriValley Medical Group Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC COMPLEMENT TOTAL
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900910842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.85
|
| Rate for Payer: Blue Shield of California Commercial |
$163.53
|
| Rate for Payer: Blue Shield of California Commercial |
$163.53
|
| Rate for Payer: Blue Shield of California EPN |
$131.16
|
| Rate for Payer: Blue Shield of California EPN |
$131.16
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.52
|
| Rate for Payer: Heritage Provider Network Senior |
$67.47
|
| Rate for Payer: Heritage Provider Network Senior |
$49.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$51.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$38.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.23
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.32
|
| Rate for Payer: TriValley Medical Group Senior |
$20.32
|
| Rate for Payer: TriValley Medical Group Senior |
$20.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Vantage Medical Group Senior |
$20.32
|
| Rate for Payer: Vantage Medical Group Senior |
$20.32
|
|
|
HC COMPLEMENT TOTAL
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900910842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$81.75 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.20
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.79
|
| Rate for Payer: Heritage Provider Network Senior |
$73.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.25
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
|
|
HC COMPLEX PUSHABLE COIL
|
Facility
|
OP
|
$370.00
|
|
| Hospital Charge Code |
909081803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$314.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$148.74
|
| Rate for Payer: Blue Shield of California EPN |
$148.74
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$170.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$314.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.31
|
| Rate for Payer: Heritage Provider Network Senior |
$171.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$185.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$185.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$259.00
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$122.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$314.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.50
|
| Rate for Payer: Vantage Medical Group Senior |
$314.50
|
|
|
HC COMPLEX PUSHABLE COIL
|
Facility
|
IP
|
$370.00
|
|
| Hospital Charge Code |
909081803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$238.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$148.74
|
| Rate for Payer: Blue Shield of California EPN |
$148.74
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$170.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.31
|
| Rate for Payer: Heritage Provider Network Senior |
$171.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$185.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$185.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$122.51
|
|
|
HC COMPREHENSIVE METABOLIC PANEL
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
900910423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$596.25 |
| Rate for Payer: Adventist Health Commercial |
$159.00
|
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$491.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.49
|
| Rate for Payer: Blue Shield of California Commercial |
$85.08
|
| Rate for Payer: Blue Shield of California Commercial |
$85.08
|
| Rate for Payer: Blue Shield of California EPN |
$68.24
|
| Rate for Payer: Blue Shield of California EPN |
$68.24
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$492.11
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$492.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$33.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$379.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.15
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.56
|
| Rate for Payer: TriValley Medical Group Senior |
$10.56
|
| Rate for Payer: TriValley Medical Group Senior |
$10.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.62
|
| Rate for Payer: Vantage Medical Group Senior |
$10.56
|
| Rate for Payer: Vantage Medical Group Senior |
$10.56
|
|
|
HC COMPREHENSIVE METABOLIC PANEL
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
900910423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$143.90 |
| Max. Negotiated Rate |
$596.25 |
| Rate for Payer: Adventist Health Commercial |
$159.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$511.98
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$538.22
|
| Rate for Payer: Heritage Provider Network Senior |
$538.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.75
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
|
|
HC COMPUTER/DYNAMIC POSTUROGRAPHY
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
CPT 92548
|
| Hospital Charge Code |
905101073
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$263.25 |
| Rate for Payer: Adventist Health Commercial |
$70.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$226.04
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$237.63
|
| Rate for Payer: Heritage Provider Network Senior |
$237.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.75
|
| Rate for Payer: Multiplan Commercial |
$263.25
|
|
|
HC COMPUTER/DYNAMIC POSTUROGRAPHY
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
CPT 92548
|
| Hospital Charge Code |
905101073
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$610.61 |
| Rate for Payer: Adventist Health Commercial |
$70.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.57
|
| Rate for Payer: Blue Shield of California Commercial |
$610.61
|
| Rate for Payer: Blue Shield of California EPN |
$491.03
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$228.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$217.27
|
| Rate for Payer: Heritage Provider Network Senior |
$217.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$167.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$263.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.23
|
| Rate for Payer: TriValley Medical Group Senior |
$171.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$522.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$437.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC COMPUTER/DYNAMIC POSTUROGRAPHY COMM MCARE
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
CPT 92548
|
| Hospital Charge Code |
900411039
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$610.61 |
| Rate for Payer: Adventist Health Commercial |
$70.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.57
|
| Rate for Payer: Blue Shield of California Commercial |
$610.61
|
| Rate for Payer: Blue Shield of California EPN |
$491.03
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$228.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$217.27
|
| Rate for Payer: Heritage Provider Network Senior |
$217.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$167.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$263.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.23
|
| Rate for Payer: TriValley Medical Group Senior |
$171.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$522.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$437.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC COMPUTER/DYNAMIC POSTUROGRAPHY COMM MCARE
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
CPT 92548
|
| Hospital Charge Code |
900411039
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$263.25 |
| Rate for Payer: Adventist Health Commercial |
$70.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$226.04
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$237.63
|
| Rate for Payer: Heritage Provider Network Senior |
$237.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.75
|
| Rate for Payer: Multiplan Commercial |
$263.25
|
|
|
HC CONG R & L HEART W SEPTAL
|
Facility
|
OP
|
$6,869.00
|
|
|
Service Code
|
CPT 93533
|
| Hospital Charge Code |
906811253
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,243.29 |
| Max. Negotiated Rate |
$15,309.00 |
| Rate for Payer: Adventist Health Commercial |
$1,373.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,245.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,838.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,777.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,151.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,091.05
|
| Rate for Payer: Cash Price |
$3,091.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,838.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,838.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,838.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,052.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,251.91
|
| Rate for Payer: Heritage Provider Network Senior |
$4,251.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,276.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,243.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,808.30
|
| Rate for Payer: Multiplan Commercial |
$5,151.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,434.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,434.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,838.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,838.65
|
| Rate for Payer: Vantage Medical Group Senior |
$5,838.65
|
|
|
HC CONG R & L HEART W SEPTAL
|
Facility
|
IP
|
$6,869.00
|
|
|
Service Code
|
CPT 93533
|
| Hospital Charge Code |
906811253
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,243.29 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,373.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,423.64
|
| Rate for Payer: Cash Price |
$3,091.05
|
| Rate for Payer: Cash Price |
$3,091.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,243.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.25
|
| Rate for Payer: Multiplan Commercial |
$5,151.75
|
|
|
HC CONG R & L HEART W TRANSEPTAL
|
Facility
|
IP
|
$6,869.00
|
|
|
Service Code
|
CPT 93532
|
| Hospital Charge Code |
906811252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,243.29 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,373.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,423.64
|
| Rate for Payer: Cash Price |
$3,091.05
|
| Rate for Payer: Cash Price |
$3,091.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,243.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.25
|
| Rate for Payer: Multiplan Commercial |
$5,151.75
|
|
