|
HC FLEX VIDEOSCOPE AMBU LARGE
|
Facility
|
IP
|
$1,561.00
|
|
| Hospital Charge Code |
900800003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.54 |
| Max. Negotiated Rate |
$1,170.75 |
| Rate for Payer: Adventist Health Commercial |
$312.20
|
| Rate for Payer: Cash Price |
$858.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,056.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1,056.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.25
|
| Rate for Payer: Multiplan Commercial |
$1,170.75
|
|
|
HC FLEX VIDEOSCOPE AMBU SLIM
|
Facility
|
OP
|
$1,357.00
|
|
| Hospital Charge Code |
900800001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$1,153.45 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$725.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$932.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$746.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,017.75
|
| Rate for Payer: Blue Shield of California Commercial |
$827.77
|
| Rate for Payer: Blue Shield of California EPN |
$662.22
|
| Rate for Payer: Cash Price |
$746.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$882.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,153.45
|
| Rate for Payer: Dignity Health Senior |
$1,153.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$882.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$839.98
|
| Rate for Payer: Heritage Provider Network Senior |
$839.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$647.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$949.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$949.90
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$678.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$678.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,153.45
|
|
|
HC FLEX VIDEOSCOPE AMBU SLIM
|
Facility
|
IP
|
$1,357.00
|
|
| Hospital Charge Code |
900800001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$1,017.75 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Cash Price |
$746.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$918.69
|
| Rate for Payer: Heritage Provider Network Senior |
$918.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.25
|
| Rate for Payer: Multiplan Commercial |
$1,017.75
|
|
|
HC FLOW VOLUME STUDY
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
900801022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$593.49 |
| Rate for Payer: Adventist Health Commercial |
$84.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$225.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$289.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Blue Shield of California Commercial |
$105.89
|
| Rate for Payer: Blue Shield of California EPN |
$85.15
|
| Rate for Payer: Cash Price |
$231.55
|
| Rate for Payer: Cash Price |
$231.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$273.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Senior |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$395.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$260.60
|
| Rate for Payer: Heritage Provider Network Senior |
$260.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$200.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$455.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$498.53
|
| Rate for Payer: Multiplan Commercial |
$315.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$435.23
|
| Rate for Payer: TriValley Medical Group Senior |
$395.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$210.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$210.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC FLOW VOLUME STUDY
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
900801022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$76.20 |
| Max. Negotiated Rate |
$315.75 |
| Rate for Payer: Adventist Health Commercial |
$84.20
|
| Rate for Payer: Cash Price |
$231.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$285.02
|
| Rate for Payer: Heritage Provider Network Senior |
$285.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.25
|
| Rate for Payer: Multiplan Commercial |
$315.75
|
|
|
HC FLUORESCENT STAIN FUNGI
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900912418
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$83.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$107.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.05
|
| Rate for Payer: Blue Shield of California Commercial |
$43.20
|
| Rate for Payer: Blue Shield of California EPN |
$34.65
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$101.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Senior |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.56
|
| Rate for Payer: Heritage Provider Network Senior |
$96.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$74.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.79
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Senior |
$5.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC FLUORESCENT STAIN FUNGI
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900912418
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.24 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.61
|
| Rate for Payer: Heritage Provider Network Senior |
$105.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
|
|
HC FLUORO GUIDANCE CNTRL VNS ACCESS DVC
|
Facility
|
IP
|
$928.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
909081673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$167.97 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Adventist Health Commercial |
$185.60
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$628.26
|
| Rate for Payer: Heritage Provider Network Senior |
$628.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
|
|
HC FLUORO GUIDANCE CNTRL VNS ACCESS DVC
|
Facility
|
OP
|
$928.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
909081673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.97 |
| Max. Negotiated Rate |
$788.80 |
| Rate for Payer: Adventist Health Commercial |
$185.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$496.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$637.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$788.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$510.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$346.77
|
| Rate for Payer: Blue Shield of California Commercial |
$513.36
|
| Rate for Payer: Blue Shield of California EPN |
$412.83
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$603.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$788.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$788.80
|
| Rate for Payer: Dignity Health Senior |
$788.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$603.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$574.43
|
| Rate for Payer: Heritage Provider Network Senior |
$574.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$442.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.60
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$464.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$464.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$788.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$788.80
|
| Rate for Payer: Vantage Medical Group Senior |
$788.80
|
|
|
HC FLUORO GUIDE NDL PLCMNT THRPY INJ
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
909001368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$385.89
|
| Rate for Payer: Heritage Provider Network Senior |
$385.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.50
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
|
|
HC FLUORO GUIDE NDL PLCMNT THRPY INJ
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
909001368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$304.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$391.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$427.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$439.46
|
| Rate for Payer: Blue Shield of California Commercial |
$214.13
|
| Rate for Payer: Blue Shield of California EPN |
$172.19
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$370.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$484.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$484.50
|
| Rate for Payer: Dignity Health Senior |
$484.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$352.83
|
| Rate for Payer: Heritage Provider Network Senior |
$352.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$107.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$271.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$399.00
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$285.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$484.50
|
| Rate for Payer: Vantage Medical Group Senior |
$484.50
|
|
|
HC FLUORO GUIDE SPINE OR PARASPINOUS
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
909001358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.77 |
| Max. Negotiated Rate |
$380.25 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$343.24
|
| Rate for Payer: Heritage Provider Network Senior |
$343.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.75
|
| Rate for Payer: Multiplan Commercial |
$380.25
|
|
|
HC FLUORO GUIDE SPINE OR PARASPINOUS
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
909001358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.77 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$270.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$348.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$278.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$380.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.71
|
| Rate for Payer: Blue Shield of California Commercial |
$131.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.61
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$329.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$430.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$430.95
|
| Rate for Payer: Dignity Health Senior |
$430.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$329.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$313.83
|
| Rate for Payer: Heritage Provider Network Senior |
$313.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$241.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$354.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$354.90
|
| Rate for Payer: Multiplan Commercial |
$380.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$253.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$253.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$430.95
|
| Rate for Payer: Vantage Medical Group Senior |
$430.95
|
|
|
HC FLUORO IN RAD > 1 HR
|
Facility
|
OP
|
$867.00
|
|
|
Service Code
|
CPT 76001
|
| Hospital Charge Code |
909001670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.93 |
| Max. Negotiated Rate |
$736.95 |
| Rate for Payer: Adventist Health Commercial |
$173.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$463.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$595.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$736.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$476.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$650.25
|
| Rate for Payer: Blue Shield of California Commercial |
$528.87
|
| Rate for Payer: Blue Shield of California EPN |
$423.10
|
| Rate for Payer: Cash Price |
$476.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$563.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$736.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.95
|
| Rate for Payer: Dignity Health Senior |
$736.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$536.67
|
| Rate for Payer: Heritage Provider Network Senior |
$536.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$413.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$606.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$606.90
|
| Rate for Payer: Multiplan Commercial |
$650.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$433.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$433.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$736.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.95
|
| Rate for Payer: Vantage Medical Group Senior |
$736.95
|
|
|
HC FLUORO IN RAD > 1 HR
|
Facility
|
IP
|
$867.00
|
|
|
Service Code
|
CPT 76001
|
| Hospital Charge Code |
909001670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.93 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Adventist Health Commercial |
$173.40
|
| Rate for Payer: Cash Price |
$476.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$586.96
|
| Rate for Payer: Heritage Provider Network Senior |
$586.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.75
|
| Rate for Payer: Multiplan Commercial |
$650.25
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
OP
|
$1,508.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906820105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.30 |
| Max. Negotiated Rate |
$1,131.00 |
| Rate for Payer: Adventist Health Commercial |
$301.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$806.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,036.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$297.17
|
| Rate for Payer: Blue Shield of California Commercial |
$274.70
|
| Rate for Payer: Blue Shield of California EPN |
$220.91
|
| Rate for Payer: Cash Price |
$829.40
|
| Rate for Payer: Cash Price |
$829.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$980.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$980.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$933.45
|
| Rate for Payer: Heritage Provider Network Senior |
$933.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$719.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$1,131.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$307.13
|
| Rate for Payer: TriValley Medical Group Senior |
$307.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$141.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$141.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906811312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$418.50 |
| Rate for Payer: Adventist Health Commercial |
$111.60
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$377.77
|
| Rate for Payer: Heritage Provider Network Senior |
$377.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.50
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
IP
|
$1,508.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906820105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.95 |
| Max. Negotiated Rate |
$1,131.00 |
| Rate for Payer: Adventist Health Commercial |
$301.60
|
| Rate for Payer: Cash Price |
$829.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,020.92
|
| Rate for Payer: Heritage Provider Network Senior |
$1,020.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.00
|
| Rate for Payer: Multiplan Commercial |
$1,131.00
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906811312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.30 |
| Max. Negotiated Rate |
$460.69 |
| Rate for Payer: Adventist Health Commercial |
$111.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$298.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$383.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$297.17
|
| Rate for Payer: Blue Shield of California Commercial |
$274.70
|
| Rate for Payer: Blue Shield of California EPN |
$220.91
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$362.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.40
|
| Rate for Payer: Heritage Provider Network Senior |
$345.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$266.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$307.13
|
| Rate for Payer: TriValley Medical Group Senior |
$307.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$141.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$141.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC FLUORO XM G/COLON TUBE
|
Facility
|
OP
|
$1,306.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$261.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$897.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$718.30
|
| Rate for Payer: Cash Price |
$718.30
|
| Rate for Payer: Cash Price |
$718.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$848.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$808.41
|
| Rate for Payer: Heritage Provider Network Senior |
$377.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$228.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$622.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$979.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| 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 |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC FLUORO XM G/COLON TUBE
|
Facility
|
IP
|
$1,306.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$236.39 |
| Max. Negotiated Rate |
$979.50 |
| Rate for Payer: Adventist Health Commercial |
$261.20
|
| Rate for Payer: Cash Price |
$718.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$884.16
|
| Rate for Payer: Heritage Provider Network Senior |
$884.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.50
|
| Rate for Payer: Multiplan Commercial |
$979.50
|
|
|
HC FMRI BRAIN BY PHYS/PSYCH
|
Facility
|
OP
|
$6,425.00
|
|
|
Service Code
|
CPT 70555
|
| Hospital Charge Code |
908801023
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$160.40 |
| Max. Negotiated Rate |
$4,818.75 |
| Rate for Payer: Adventist Health Commercial |
$1,285.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,434.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,413.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,919.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,135.40
|
| Rate for Payer: Cash Price |
$3,533.75
|
| Rate for Payer: Cash Price |
$3,533.75
|
| Rate for Payer: Cash Price |
$3,533.75
|
| Rate for Payer: Cash Price |
$3,533.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$160.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,064.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,162.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,606.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$4,818.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC FMRI BRAIN BY PHYS/PSYCH
|
Facility
|
IP
|
$6,425.00
|
|
|
Service Code
|
CPT 70555
|
| Hospital Charge Code |
908801023
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,818.75 |
| Rate for Payer: Adventist Health Commercial |
$1,285.00
|
| Rate for Payer: Cash Price |
$3,533.75
|
| Rate for Payer: Cash Price |
$3,533.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,349.73
|
| Rate for Payer: Heritage Provider Network Senior |
$4,349.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,162.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,606.25
|
| Rate for Payer: Multiplan Commercial |
$4,818.75
|
|
|
HC FMRI BRAIN BY TECH
|
Facility
|
IP
|
$5,962.00
|
|
|
Service Code
|
CPT 70554
|
| Hospital Charge Code |
908801022
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,471.50 |
| Rate for Payer: Adventist Health Commercial |
$1,192.40
|
| Rate for Payer: Cash Price |
$3,279.10
|
| Rate for Payer: Cash Price |
$3,279.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,036.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4,036.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,079.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,490.50
|
| Rate for Payer: Multiplan Commercial |
$4,471.50
|
|
|
HC FMRI BRAIN BY TECH
|
Facility
|
OP
|
$5,962.00
|
|
|
Service Code
|
CPT 70554
|
| Hospital Charge Code |
908801022
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$4,471.50 |
| Rate for Payer: Adventist Health Commercial |
$1,192.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,186.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,095.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2,722.22
|
| Rate for Payer: Blue Shield of California EPN |
$2,189.12
|
| Rate for Payer: Cash Price |
$3,279.10
|
| Rate for Payer: Cash Price |
$3,279.10
|
| Rate for Payer: Cash Price |
$3,279.10
|
| Rate for Payer: Cash Price |
$3,279.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$605.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,843.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,079.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,490.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$4,471.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
