|
HC EXPLORE LIMB VESSELS
|
Facility
|
IP
|
$5,764.00
|
|
|
Service Code
|
CPT 35860
|
| Hospital Charge Code |
900501597
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,043.28 |
| Max. Negotiated Rate |
$4,323.00 |
| Rate for Payer: Adventist Health Commercial |
$1,152.80
|
| Rate for Payer: Cash Price |
$3,170.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,902.23
|
| Rate for Payer: Heritage Provider Network Senior |
$3,902.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,043.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,441.00
|
| Rate for Payer: Multiplan Commercial |
$4,323.00
|
|
|
HC EXPLORE LIMB VESSELS
|
Facility
|
OP
|
$5,764.00
|
|
|
Service Code
|
CPT 35860
|
| Hospital Charge Code |
900501597
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,152.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,959.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$3,170.20
|
| Rate for Payer: Cash Price |
$3,170.20
|
| Rate for Payer: Cash Price |
$3,170.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,746.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,902.23
|
| Rate for Payer: Heritage Provider Network Senior |
$3,902.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,749.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,043.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,441.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$4,323.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,073.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,908.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC EXPLORE/TREAT FINGER JOINT EA
|
Facility
|
OP
|
$3,990.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
900501434
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,741.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,593.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Senior |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,122.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,903.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,740.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,194.48
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,435.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,321.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC EXPLORE/TREAT FINGER JOINT EA
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
900501434
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
|
|
HC EXPLOR W/RMVL DEEP F.B.FOREARM
|
Facility
|
OP
|
$5,215.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
900501469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,043.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,582.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,868.25
|
| Rate for Payer: Cash Price |
$2,868.25
|
| Rate for Payer: Cash Price |
$2,868.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,389.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Senior |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,033.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,530.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,530.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,487.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$943.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,338.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,303.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,562.18
|
| Rate for Payer: Multiplan Commercial |
$3,911.25
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,876.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,726.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC EXPLOR W/RMVL DEEP F.B.FOREARM
|
Facility
|
IP
|
$5,215.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
900501469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$943.91 |
| Max. Negotiated Rate |
$3,911.25 |
| Rate for Payer: Adventist Health Commercial |
$1,043.00
|
| Rate for Payer: Cash Price |
$2,868.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,530.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,530.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$943.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,303.75
|
| Rate for Payer: Multiplan Commercial |
$3,911.25
|
|
|
HC EXT CAROTID UNI
|
Facility
|
IP
|
$9,892.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
906820228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,790.45 |
| Max. Negotiated Rate |
$7,419.00 |
| Rate for Payer: Adventist Health Commercial |
$1,978.40
|
| Rate for Payer: Cash Price |
$5,440.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,696.88
|
| Rate for Payer: Heritage Provider Network Senior |
$6,696.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,790.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.00
|
| Rate for Payer: Multiplan Commercial |
$7,419.00
|
|
|
HC EXT CAROTID UNI
|
Facility
|
IP
|
$20,686.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909020160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,744.17 |
| Max. Negotiated Rate |
$15,514.50 |
| Rate for Payer: Adventist Health Commercial |
$4,137.20
|
| Rate for Payer: Cash Price |
$11,377.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,004.42
|
| Rate for Payer: Heritage Provider Network Senior |
$14,004.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,744.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,171.50
|
| Rate for Payer: Multiplan Commercial |
$15,514.50
|
|
|
HC EXT CAROTID UNI
|
Facility
|
OP
|
$9,892.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
906820228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,978.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,795.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,408.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,440.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| 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 |
$5,440.60
|
| Rate for Payer: Cash Price |
$5,440.60
|
| Rate for Payer: Cash Price |
$5,440.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,429.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,408.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,408.20
|
| Rate for Payer: Dignity Health Senior |
$8,408.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,123.15
|
| Rate for Payer: Heritage Provider Network Senior |
$6,123.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,718.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,790.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,924.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,924.40
|
| Rate for Payer: Multiplan Commercial |
$7,419.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,408.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,408.20
|
| Rate for Payer: Vantage Medical Group Senior |
$8,408.20
|
|
|
HC EXT CAROTID UNI
|
Facility
|
OP
|
$20,686.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909020160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$17,583.10 |
| Rate for Payer: Adventist Health Commercial |
$4,137.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,211.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,583.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,377.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,514.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| 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 |
$11,377.30
|
| Rate for Payer: Cash Price |
$11,377.30
|
| Rate for Payer: Cash Price |
$11,377.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,445.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,583.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,583.10
|
| Rate for Payer: Dignity Health Senior |
$17,583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,804.63
|
| Rate for Payer: Heritage Provider Network Senior |
$12,804.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,867.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,744.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,171.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,480.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,480.20
|
| Rate for Payer: Multiplan Commercial |
$15,514.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,583.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,583.10
|
| Rate for Payer: Vantage Medical Group Senior |
$17,583.10
|
|
|
HC EXT ECG > 48HR TO 21 DAY RCRD
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 0296T
|
| Hospital Charge Code |
900000296
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$361.50 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.31
|
| Rate for Payer: Heritage Provider Network Senior |
$326.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
|
|
HC EXT ECG > 48HR TO 21 DAY RCRD
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 0296T
|
| Hospital Charge Code |
900000296
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$409.70 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$257.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$331.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$361.50
|
| Rate for Payer: Blue Shield of California Commercial |
$294.02
|
| Rate for Payer: Blue Shield of California EPN |
$235.22
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.70
|
| Rate for Payer: Dignity Health Senior |
$409.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.36
|
| Rate for Payer: Heritage Provider Network Senior |
$298.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$229.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.40
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.70
|
| Rate for Payer: Vantage Medical Group Senior |
$409.70
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
900203242
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$361.50 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.31
|
| Rate for Payer: Heritage Provider Network Senior |
$326.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
900203242
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$257.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$331.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Blue Shield of California Commercial |
$294.02
|
| Rate for Payer: Blue Shield of California EPN |
$235.22
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Senior |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$49.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.36
|
| Rate for Payer: Heritage Provider Network Senior |
$298.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$229.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.84
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$54.86
|
| Rate for Payer: TriValley Medical Group Senior |
$49.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD SA
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
900203243
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$257.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$331.13
|
| 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: Blue Shield of California Commercial |
$294.02
|
| Rate for Payer: Blue Shield of California EPN |
$235.22
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.30
|
| 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 |
$313.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.36
|
| Rate for Payer: Heritage Provider Network Senior |
$298.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$310.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$229.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| 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 |
$361.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$180.16
|
| Rate for Payer: TriValley Medical Group Senior |
$163.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| 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 EXT ECG GT 48HR TO 7 DAY RCRD SA
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
900203243
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$361.50 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.31
|
| Rate for Payer: Heritage Provider Network Senior |
$326.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
|
|
HC EXT ECG GT 7 DAY TO 15 DAY RCRD
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
900203246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$361.50 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.31
|
| Rate for Payer: Heritage Provider Network Senior |
$326.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
|
|
HC EXT ECG GT 7 DAY TO 15 DAY RCRD
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
900203246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$257.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$331.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Blue Shield of California Commercial |
$294.02
|
| Rate for Payer: Blue Shield of California EPN |
$235.22
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Senior |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$49.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.36
|
| Rate for Payer: Heritage Provider Network Senior |
$298.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$229.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.84
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$54.86
|
| Rate for Payer: TriValley Medical Group Senior |
$49.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC EXT ECG GT 7 DY TO 15 DY RCRD SA
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
900203247
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$257.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$331.13
|
| 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: Blue Shield of California Commercial |
$294.02
|
| Rate for Payer: Blue Shield of California EPN |
$235.22
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.30
|
| 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 |
$313.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.36
|
| Rate for Payer: Heritage Provider Network Senior |
$298.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$326.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$229.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| 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 |
$361.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$180.16
|
| Rate for Payer: TriValley Medical Group Senior |
$163.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| 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 EXT ECG GT 7 DY TO 15 DY RCRD SA
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
900203247
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$361.50 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.31
|
| Rate for Payer: Heritage Provider Network Senior |
$326.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
|
|
HC EXTENDED LENGTH TRACH TUBE
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.57 |
| Max. Negotiated Rate |
$636.65 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$400.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$514.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$636.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$411.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$561.75
|
| Rate for Payer: Blue Shield of California Commercial |
$456.89
|
| Rate for Payer: Blue Shield of California EPN |
$365.51
|
| Rate for Payer: Cash Price |
$411.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$486.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$636.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$636.65
|
| Rate for Payer: Dignity Health Senior |
$636.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.63
|
| Rate for Payer: Heritage Provider Network Senior |
$463.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$357.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$524.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$524.30
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$374.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$374.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$636.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$636.65
|
| Rate for Payer: Vantage Medical Group Senior |
$636.65
|
|
|
HC EXTENDED LENGTH TRACH TUBE
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.57 |
| Max. Negotiated Rate |
$561.75 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Cash Price |
$411.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.07
|
| Rate for Payer: Heritage Provider Network Senior |
$507.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
|
|
HC EXTERNAL EAR, UNLISTED PROCEDU
|
Facility
|
OP
|
$883.00
|
|
|
Service Code
|
CPT 69399
|
| Hospital Charge Code |
900501298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.82 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$176.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$471.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$606.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$485.65
|
| Rate for Payer: Cash Price |
$485.65
|
| Rate for Payer: Cash Price |
$485.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$573.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Senior |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$295.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$597.79
|
| Rate for Payer: Heritage Provider Network Senior |
$597.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$421.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.78
|
| Rate for Payer: Multiplan Commercial |
$662.25
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$317.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$292.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC EXTERNAL EAR, UNLISTED PROCEDU
|
Facility
|
IP
|
$883.00
|
|
|
Service Code
|
CPT 69399
|
| Hospital Charge Code |
900501298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.82 |
| Max. Negotiated Rate |
$662.25 |
| Rate for Payer: Adventist Health Commercial |
$176.60
|
| Rate for Payer: Cash Price |
$485.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$597.79
|
| Rate for Payer: Heritage Provider Network Senior |
$597.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.75
|
| Rate for Payer: Multiplan Commercial |
$662.25
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$8,848.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,601.49 |
| Max. Negotiated Rate |
$6,636.00 |
| Rate for Payer: Adventist Health Commercial |
$1,769.60
|
| Rate for Payer: Cash Price |
$4,866.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,990.10
|
| Rate for Payer: Heritage Provider Network Senior |
$5,990.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,601.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,212.00
|
| Rate for Payer: Multiplan Commercial |
$6,636.00
|
|
