|
HC DUPLX EXT VEIN UNILAT
|
Facility
|
OP
|
$2,001.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
908100124
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,500.75 |
| Rate for Payer: Adventist Health Commercial |
$400.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,236.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,000.90
|
| Rate for Payer: Blue Shield of California Commercial |
$586.42
|
| Rate for Payer: Blue Shield of California EPN |
$471.58
|
| Rate for Payer: Cash Price |
$900.45
|
| Rate for Payer: Cash Price |
$900.45
|
| Rate for Payer: Cash Price |
$900.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,300.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,180.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,238.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,238.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$954.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$362.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,500.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.91
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC DUPLX EXT VEIN UNILAT
|
Facility
|
IP
|
$2,001.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
908100124
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$362.18 |
| Max. Negotiated Rate |
$1,500.75 |
| Rate for Payer: Adventist Health Commercial |
$400.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,288.64
|
| Rate for Payer: Cash Price |
$900.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,354.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,354.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$362.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.75
|
|
|
HC DUPLX LO EXT ARTERY BILAT
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
908100106
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$527.80 |
| Max. Negotiated Rate |
$2,187.00 |
| Rate for Payer: Adventist Health Commercial |
$583.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,877.90
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,974.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,974.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$527.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.00
|
| Rate for Payer: Multiplan Commercial |
$2,187.00
|
|
|
HC DUPLX LO EXT ARTERY BILAT
|
Facility
|
OP
|
$2,916.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
908100106
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$2,187.00 |
| Rate for Payer: Adventist Health Commercial |
$583.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,802.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,458.58
|
| Rate for Payer: Blue Shield of California Commercial |
$993.89
|
| Rate for Payer: Blue Shield of California EPN |
$799.25
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,895.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,720.44
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,390.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$527.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$2,187.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$337.57
|
| Rate for Payer: TriValley Medical Group Senior |
$306.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC DUPLX UP EXT ARTERY UNI
|
Facility
|
IP
|
$1,426.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
908100120
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$258.11 |
| Max. Negotiated Rate |
$1,069.50 |
| Rate for Payer: Adventist Health Commercial |
$285.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$918.34
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$965.40
|
| Rate for Payer: Heritage Provider Network Senior |
$965.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$258.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.50
|
| Rate for Payer: Multiplan Commercial |
$1,069.50
|
|
|
HC DUPLX UP EXT ARTERY UNI
|
Facility
|
OP
|
$1,426.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
908100120
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,077.00 |
| Rate for Payer: Adventist Health Commercial |
$285.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$881.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$713.29
|
| Rate for Payer: Blue Shield of California Commercial |
$582.10
|
| Rate for Payer: Blue Shield of California EPN |
$468.10
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$926.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$841.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$882.69
|
| Rate for Payer: Heritage Provider Network Senior |
$882.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$680.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$258.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,069.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.91
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC DUP SCAN EXTRACRANIAL ART COMPLEX
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
908100102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$206.52 |
| Max. Negotiated Rate |
$1,077.00 |
| Rate for Payer: Adventist Health Commercial |
$228.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$705.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$570.73
|
| Rate for Payer: Blue Shield of California Commercial |
$852.48
|
| Rate for Payer: Blue Shield of California EPN |
$685.54
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$741.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$706.28
|
| Rate for Payer: Heritage Provider Network Senior |
$706.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$544.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$855.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$337.57
|
| Rate for Payer: TriValley Medical Group Senior |
$306.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC DUP SCAN EXTRACRANIAL ART COMPLEX
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
908100102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$206.52 |
| Max. Negotiated Rate |
$855.75 |
| Rate for Payer: Adventist Health Commercial |
$228.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$734.80
|
| Rate for Payer: Cash Price |
$513.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$772.46
|
| Rate for Payer: Heritage Provider Network Senior |
$772.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.25
|
| Rate for Payer: Multiplan Commercial |
$855.75
|
|
|
HC DUP SCAN EXTRACRANIAL ART LIMITED
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
908100116
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$140.46 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Adventist Health Commercial |
$155.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$499.74
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$525.35
|
| Rate for Payer: Heritage Provider Network Senior |
$525.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
|
|
HC DUP SCAN EXTRACRANIAL ART LIMITED
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
908100116
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,077.00 |
| Rate for Payer: Adventist Health Commercial |
$155.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$479.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$388.16
|
| Rate for Payer: Blue Shield of California Commercial |
$611.52
|
| Rate for Payer: Blue Shield of California EPN |
$491.76
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$504.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$457.84
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$480.34
|
| Rate for Payer: Heritage Provider Network Senior |
$480.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$370.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.91
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC DVLP COG SKILL 15 MIN OT MCARE
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT G0515
|
| Hospital Charge Code |
905104369
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.86
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
|
|
HC DVLP COG SKILL 15 MIN OT MCARE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT G0515
|
| Hospital Charge Code |
905104369
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$50.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.00
|
| 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 |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$105.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$105.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.76
|
| Rate for Payer: Heritage Provider Network Senior |
$76.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$59.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$86.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| 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 |
$105.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$105.40
|
| Rate for Payer: Vantage Medical Group Senior |
$105.40
|
|
|
HC DVLP COG SKILL 15 MIN PT MCARE
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT G0515
|
| Hospital Charge Code |
905103369
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.86
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
|
|
HC DVLP COG SKILL 15 MIN PT MCARE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT G0515
|
| Hospital Charge Code |
905103369
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$50.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.00
|
| 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 |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$105.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$105.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.76
|
| Rate for Payer: Heritage Provider Network Senior |
$76.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$59.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$86.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| 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 |
$105.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$105.40
|
| Rate for Payer: Vantage Medical Group Senior |
$105.40
|
|
|
HC DVLP COG SKILL 15 MIN ST MCARE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT G0515
|
| Hospital Charge Code |
905601809
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.30
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.77
|
| Rate for Payer: Heritage Provider Network Senior |
$50.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
|
|
HC DVLP COG SKILL 15 MIN ST MCARE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT G0515
|
| Hospital Charge Code |
905601809
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$30.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.25
|
| 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 |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.42
|
| Rate for Payer: Heritage Provider Network Senior |
$46.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| 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 |
$63.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.75
|
| Rate for Payer: Vantage Medical Group Senior |
$63.75
|
|
|
HC DVLP TEST PHYS/QHP PT 1ST HR
|
Facility
|
OP
|
$1,191.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
900400020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$893.25 |
| Rate for Payer: Adventist Health Commercial |
$488.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$736.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| 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 |
$535.95
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$774.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$774.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.23
|
| Rate for Payer: Heritage Provider Network Senior |
$737.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$568.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
| 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 |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC DVLP TEST PHYS/QHP PT 1ST HR
|
Facility
|
IP
|
$1,191.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
900400020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$215.57 |
| Max. Negotiated Rate |
$893.25 |
| Rate for Payer: Adventist Health Commercial |
$238.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$767.00
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$806.31
|
| Rate for Payer: Heritage Provider Network Senior |
$806.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.75
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
|
|
HC DVLP TEST PHYS/QHP ST 1ST HR
|
Facility
|
IP
|
$1,191.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
905601811
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$215.57 |
| Max. Negotiated Rate |
$893.25 |
| Rate for Payer: Adventist Health Commercial |
$238.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$767.00
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$806.31
|
| Rate for Payer: Heritage Provider Network Senior |
$806.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.75
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
|
|
HC DVLP TEST PHYS/QHP ST 1ST HR
|
Facility
|
OP
|
$1,191.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
905601811
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$893.25 |
| Rate for Payer: Adventist Health Commercial |
$488.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$736.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| 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 |
$535.95
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$774.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$774.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.23
|
| Rate for Payer: Heritage Provider Network Senior |
$737.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$568.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
| 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 |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$189.69 |
| Max. Negotiated Rate |
$786.00 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$674.91
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$709.50
|
| Rate for Payer: Heritage Provider Network Senior |
$709.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$189.69 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$647.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$576.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$786.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$639.28
|
| Rate for Payer: Blue Shield of California EPN |
$511.42
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$681.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$890.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$890.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$890.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.71
|
| Rate for Payer: Heritage Provider Network Senior |
$648.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$499.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$733.60
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$524.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$524.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$890.80
|
| Rate for Payer: Vantage Medical Group Senior |
$890.80
|
|
|
HC EA ADDL LESION STEREO
|
Facility
|
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$507.70 |
| Max. Negotiated Rate |
$2,103.75 |
| Rate for Payer: Adventist Health Commercial |
$561.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,806.42
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,898.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,898.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$507.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.25
|
| Rate for Payer: Multiplan Commercial |
$2,103.75
|
|
|
HC EA ADDL LESION STEREO
|
Facility
|
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$507.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$561.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,733.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,384.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,542.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,103.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,823.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,384.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,384.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,384.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,736.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,736.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,337.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$507.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,963.50
|
| Rate for Payer: Multiplan Commercial |
$2,103.75
|
| 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 |
$2,384.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,384.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,384.25
|
|
|
HC EA ADDL MAGNETIC RESONANCE
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
908819288
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$929.00 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$191.91
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.75
|
| Rate for Payer: Heritage Provider Network Senior |
$201.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
|
