|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.63
|
| Rate for Payer: Heritage Provider Network Senior |
$172.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$136.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Blue Shield of California Commercial |
$155.55
|
| Rate for Payer: Blue Shield of California EPN |
$124.44
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Senior |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.84
|
| Rate for Payer: Heritage Provider Network Senior |
$157.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$121.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.31
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$180.11
|
| Rate for Payer: TriValley Medical Group Senior |
$180.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$127.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$127.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.13 |
| Max. Negotiated Rate |
$294.75 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Cash Price |
$216.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$266.06
|
| Rate for Payer: Heritage Provider Network Senior |
$266.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.25
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908603211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.91 |
| Max. Negotiated Rate |
$335.25 |
| Rate for Payer: Adventist Health Commercial |
$89.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$238.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$307.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Blue Shield of California Commercial |
$272.67
|
| Rate for Payer: Blue Shield of California EPN |
$218.14
|
| Rate for Payer: Cash Price |
$245.85
|
| Rate for Payer: Cash Price |
$245.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Senior |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$276.69
|
| Rate for Payer: Heritage Provider Network Senior |
$276.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$213.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.31
|
| Rate for Payer: Multiplan Commercial |
$335.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$223.50
|
| Rate for Payer: TriValley Medical Group Senior |
$223.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$223.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$223.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.13 |
| Max. Negotiated Rate |
$294.75 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$210.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Blue Shield of California Commercial |
$239.73
|
| Rate for Payer: Blue Shield of California EPN |
$191.78
|
| Rate for Payer: Cash Price |
$216.15
|
| Rate for Payer: Cash Price |
$216.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Senior |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$243.27
|
| Rate for Payer: Heritage Provider Network Senior |
$243.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$187.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.31
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$196.50
|
| Rate for Payer: TriValley Medical Group Senior |
$196.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$196.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$196.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908603211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.91 |
| Max. Negotiated Rate |
$335.25 |
| Rate for Payer: Adventist Health Commercial |
$89.40
|
| Rate for Payer: Cash Price |
$245.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$302.62
|
| Rate for Payer: Heritage Provider Network Senior |
$302.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.75
|
| Rate for Payer: Multiplan Commercial |
$335.25
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Cash Price |
$196.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.69
|
| Rate for Payer: Heritage Provider Network Senior |
$241.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.25
|
| Rate for Payer: Multiplan Commercial |
$267.75
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$190.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Blue Shield of California Commercial |
$217.77
|
| Rate for Payer: Blue Shield of California EPN |
$174.22
|
| Rate for Payer: Cash Price |
$196.35
|
| Rate for Payer: Cash Price |
$196.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Senior |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.98
|
| Rate for Payer: Heritage Provider Network Senior |
$220.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$170.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.31
|
| Rate for Payer: Multiplan Commercial |
$267.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$178.50
|
| Rate for Payer: TriValley Medical Group Senior |
$178.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$178.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$178.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC ESTRADIOL
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
900912127
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.61 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$170.60
|
| Rate for Payer: Heritage Provider Network Senior |
$170.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
|
|
HC ESTRADIOL
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
900912127
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$255.13 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.13
|
| Rate for Payer: Blue Shield of California Commercial |
$224.87
|
| Rate for Payer: Blue Shield of California EPN |
$180.36
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$163.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.73
|
| Rate for Payer: Dignity Health Senior |
$27.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.99
|
| Rate for Payer: Heritage Provider Network Senior |
$155.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$120.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.94
|
| Rate for Payer: TriValley Medical Group Senior |
$27.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$30.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Vantage Medical Group Senior |
$27.94
|
|
|
HC ETHIODOL (LIPIODOL)
|
Facility
|
IP
|
$700.00
|
|
| Hospital Charge Code |
909001008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Adventist Health Commercial |
$140.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$473.90
|
| Rate for Payer: Heritage Provider Network Senior |
$473.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$525.00
|
|
|
HC ETHIODOL (LIPIODOL)
|
Facility
|
OP
|
$700.00
|
|
| Hospital Charge Code |
909001008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Adventist Health Commercial |
$140.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$374.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$480.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$595.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$385.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$525.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$341.60
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$455.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$595.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$595.00
|
| Rate for Payer: Dignity Health Senior |
$595.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.30
|
| Rate for Payer: Heritage Provider Network Senior |
$433.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$333.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$490.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$490.00
|
| Rate for Payer: Multiplan Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$280.00
|
| Rate for Payer: TriValley Medical Group Senior |
$280.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$350.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$350.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$595.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$595.00
|
| Rate for Payer: Vantage Medical Group Senior |
$595.00
|
|
|
HC EVAC OF SUBUNG HEMATOMA
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
900501016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$69.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$237.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$190.30
|
| Rate for Payer: Cash Price |
$190.30
|
| Rate for Payer: Cash Price |
$190.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$224.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Senior |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$234.24
|
| Rate for Payer: Heritage Provider Network Senior |
$234.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$165.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.36
|
| Rate for Payer: Multiplan Commercial |
$259.50
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$124.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$114.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC EVAC OF SUBUNG HEMATOMA
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
900501016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.63 |
| Max. Negotiated Rate |
$259.50 |
| Rate for Payer: Adventist Health Commercial |
$69.20
|
| Rate for Payer: Cash Price |
$190.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$234.24
|
| Rate for Payer: Heritage Provider Network Senior |
$234.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.50
|
| Rate for Payer: Multiplan Commercial |
$259.50
|
|
|
HC EVACUATE MOLE OF UTERUS
|
Facility
|
OP
|
$4,641.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
900501632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,188.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$2,552.55
|
| Rate for Payer: Cash Price |
$2,552.55
|
| Rate for Payer: Cash Price |
$2,552.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,016.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Senior |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,039.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,141.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,141.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,213.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$840.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,645.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,090.29
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,669.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,536.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC EVACUATE MOLE OF UTERUS
|
Facility
|
IP
|
$4,641.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
900501632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$840.02 |
| Max. Negotiated Rate |
$3,480.75 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Cash Price |
$2,552.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,141.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,141.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$840.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
|
|
HC EVAL AUD REHAB STATUS 1ST HR
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
905601903
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.25
|
| Rate for Payer: Heritage Provider Network Senior |
$213.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
|
|
HC EVAL AUD REHAB STATUS 1ST HR
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
905601903
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$32.48 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$129.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.99
|
| Rate for Payer: Heritage Provider Network Senior |
$194.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC EVAL AUD REHAB STATUS ADD 15 M
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
905601904
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.45
|
| Rate for Payer: Heritage Provider Network Senior |
$51.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
|
|
HC EVAL AUD REHAB STATUS ADD 15 M
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
905601904
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$31.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Senior |
$64.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.04
|
| Rate for Payer: Heritage Provider Network Senior |
$47.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC EVAL FOR PRESCRIPT VOICE PROST
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
905601758
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$91.04 |
| Max. Negotiated Rate |
$377.25 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$340.53
|
| Rate for Payer: Heritage Provider Network Senior |
$340.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.75
|
| Rate for Payer: Multiplan Commercial |
$377.25
|
|
|
HC EVAL FOR PRESCRIPT VOICE PROST
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
905601758
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$91.04 |
| Max. Negotiated Rate |
$427.55 |
| Rate for Payer: Adventist Health Commercial |
$206.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$268.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$345.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$377.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$276.65
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$326.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.55
|
| Rate for Payer: Dignity Health Senior |
$427.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$311.36
|
| Rate for Payer: Heritage Provider Network Senior |
$311.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$155.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$239.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$377.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.55
|
| Rate for Payer: Vantage Medical Group Senior |
$427.55
|
|
|
HC EVAL OF SWALLOW W/RADIOLOGY
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
905601754
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$64.72 |
| Max. Negotiated Rate |
$622.20 |
| Rate for Payer: Adventist Health Commercial |
$300.12
|
| Rate for Payer: Aetna of CA Gatekeeper |
$391.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$502.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$622.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$402.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$549.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$402.60
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$475.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$622.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$622.20
|
| Rate for Payer: Dignity Health Senior |
$622.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$453.11
|
| Rate for Payer: Heritage Provider Network Senior |
$453.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$64.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$349.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$512.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$512.40
|
| Rate for Payer: Multiplan Commercial |
$549.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$622.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$622.20
|
| Rate for Payer: Vantage Medical Group Senior |
$622.20
|
|
|
HC EVAL OF SWALLOW W/RADIOLOGY
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
905601754
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$132.49 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Adventist Health Commercial |
$146.40
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$495.56
|
| Rate for Payer: Heritage Provider Network Senior |
$495.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.00
|
| Rate for Payer: Multiplan Commercial |
$549.00
|
|
|
HC EVAL REVAL FOR PRESCRIPT SPCH DEVICE
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 92605
|
| Hospital Charge Code |
905601755
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$56.31 |
| Max. Negotiated Rate |
$440.30 |
| Rate for Payer: Adventist Health Commercial |
$212.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$276.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$355.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$440.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$388.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$284.90
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$336.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$440.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.30
|
| Rate for Payer: Dignity Health Senior |
$440.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.64
|
| Rate for Payer: Heritage Provider Network Senior |
$320.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$247.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$362.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$362.60
|
| Rate for Payer: Multiplan Commercial |
$388.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$440.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.30
|
| Rate for Payer: Vantage Medical Group Senior |
$440.30
|
|
