|
HC HAND MUSCLE TESTING MANUAL PT
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
905103403
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$67.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$87.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$139.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$90.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$106.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.40
|
| Rate for Payer: Dignity Health Senior |
$139.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.52
|
| Rate for Payer: Heritage Provider Network Senior |
$101.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$78.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$114.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$114.80
|
| Rate for Payer: Multiplan Commercial |
$123.00
|
| 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 |
$139.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.40
|
| Rate for Payer: Vantage Medical Group Senior |
$139.40
|
|
|
HC HAND MUSCLE TESTING MANUAL PT
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
905103403
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$123.00 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.03
|
| Rate for Payer: Heritage Provider Network Senior |
$111.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Multiplan Commercial |
$123.00
|
|
|
HC HAND MUSCLE TESTING MANUAL PT
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
900419058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$61.20
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$207.16
|
| Rate for Payer: Heritage Provider Network Senior |
$207.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.50
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
|
|
HC HAND MUSCLE TESTING MANUAL PT
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
900419058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$125.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$163.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$210.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$198.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.10
|
| Rate for Payer: Dignity Health Senior |
$260.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.41
|
| Rate for Payer: Heritage Provider Network Senior |
$189.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$214.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$214.20
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.10
|
| Rate for Payer: Vantage Medical Group Senior |
$260.10
|
|
|
HC HAND WRIST BOTH 1 VIEW
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
909073120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$385.05 |
| Rate for Payer: Adventist Health Commercial |
$90.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$242.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$311.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$249.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$339.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.83
|
| Rate for Payer: Blue Shield of California Commercial |
$101.86
|
| Rate for Payer: Blue Shield of California EPN |
$81.91
|
| Rate for Payer: Cash Price |
$203.85
|
| Rate for Payer: Cash Price |
$203.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$294.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$385.05
|
| Rate for Payer: Dignity Health Senior |
$385.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$280.41
|
| Rate for Payer: Heritage Provider Network Senior |
$280.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$216.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$317.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$317.10
|
| Rate for Payer: Multiplan Commercial |
$339.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$385.05
|
| Rate for Payer: Vantage Medical Group Senior |
$385.05
|
|
|
HC HAND WRIST BOTH 1 VIEW
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
909073120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.99 |
| Max. Negotiated Rate |
$339.75 |
| Rate for Payer: Adventist Health Commercial |
$90.60
|
| Rate for Payer: Cash Price |
$203.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$306.68
|
| Rate for Payer: Heritage Provider Network Senior |
$306.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.25
|
| Rate for Payer: Multiplan Commercial |
$339.75
|
|
|
HC HAPTOGLOBIN
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
900910844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC HAPTOGLOBIN
|
Facility
|
OP
|
$105.26
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
900910844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$114.81 |
| Rate for Payer: Adventist Health Commercial |
$21.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.81
|
| Rate for Payer: Blue Shield of California Commercial |
$101.26
|
| Rate for Payer: Blue Shield of California EPN |
$81.22
|
| Rate for Payer: Cash Price |
$47.37
|
| Rate for Payer: Cash Price |
$47.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.84
|
| Rate for Payer: Dignity Health Senior |
$12.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.16
|
| Rate for Payer: Heritage Provider Network Senior |
$65.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.85
|
| Rate for Payer: Multiplan Commercial |
$78.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.58
|
| Rate for Payer: TriValley Medical Group Senior |
$12.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Vantage Medical Group Senior |
$12.58
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
900904699
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$120.55 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.88
|
| Rate for Payer: Heritage Provider Network Senior |
$450.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
900904699
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$120.55 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$355.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$457.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$406.26
|
| Rate for Payer: Blue Shield of California EPN |
$325.01
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Senior |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$555.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$412.25
|
| Rate for Payer: Heritage Provider Network Senior |
$412.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$317.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$638.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$699.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$699.90
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$555.48
|
| Rate for Payer: TriValley Medical Group Senior |
$555.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$333.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$333.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
|
HC HAST
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 94452
|
| Hospital Charge Code |
900801034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$181.54 |
| Max. Negotiated Rate |
$752.25 |
| Rate for Payer: Adventist Health Commercial |
$200.60
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$679.03
|
| Rate for Payer: Heritage Provider Network Senior |
$679.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.75
|
| Rate for Payer: Multiplan Commercial |
$752.25
|
|
|
HC HAST
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 94452
|
| Hospital Charge Code |
900801034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$153.40 |
| Max. Negotiated Rate |
$752.25 |
| Rate for Payer: Adventist Health Commercial |
$200.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$536.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$689.06
|
| 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 |
$190.75
|
| Rate for Payer: Blue Shield of California EPN |
$153.40
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$651.95
|
| 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 |
$651.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.86
|
| Rate for Payer: Heritage Provider Network Senior |
$620.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$478.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.75
|
| 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 |
$752.25
|
| 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 |
$501.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.50
|
| 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 HAST W/02 TITRATE
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT 94453
|
| Hospital Charge Code |
900801035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$163.78 |
| Max. Negotiated Rate |
$707.25 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$504.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$647.84
|
| 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 |
$283.68
|
| Rate for Payer: Blue Shield of California EPN |
$228.13
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$612.95
|
| 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 |
$612.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$583.72
|
| Rate for Payer: Heritage Provider Network Senior |
$583.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$449.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.75
|
| 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 |
$707.25
|
| 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 |
$471.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$471.50
|
| 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 HAST W/02 TITRATE
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
CPT 94453
|
| Hospital Charge Code |
900801035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$170.68 |
| Max. Negotiated Rate |
$707.25 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$638.41
|
| Rate for Payer: Heritage Provider Network Senior |
$638.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.75
|
| Rate for Payer: Multiplan Commercial |
$707.25
|
|
|
HC HBO THERAPY INTL 15 MIN INCREM
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
CPT Z7606
|
| Hospital Charge Code |
900803114
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$31.96 |
| Max. Negotiated Rate |
$2,336.00 |
| Rate for Payer: Adventist Health Commercial |
$92.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$246.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$317.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$392.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$254.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$346.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$281.82
|
| Rate for Payer: Blue Shield of California EPN |
$225.46
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$300.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$392.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$392.70
|
| Rate for Payer: Dignity Health Senior |
$392.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$285.98
|
| Rate for Payer: Heritage Provider Network Senior |
$285.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$220.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$323.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$323.40
|
| Rate for Payer: Multiplan Commercial |
$346.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,336.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,963.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$392.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$392.70
|
| Rate for Payer: Vantage Medical Group Senior |
$392.70
|
|
|
HC HBO THERAPY INTL 15 MIN INCREM
|
Facility
|
IP
|
$621.00
|
|
| Hospital Charge Code |
900803110
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$465.75 |
| Rate for Payer: Adventist Health Commercial |
$124.20
|
| Rate for Payer: Cash Price |
$279.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$420.42
|
| Rate for Payer: Heritage Provider Network Senior |
$420.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.25
|
| Rate for Payer: Multiplan Commercial |
$465.75
|
|
|
HC HBO THERAPY INTL 15 MIN INCREM
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
CPT Z7606
|
| Hospital Charge Code |
900803114
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$83.62 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Adventist Health Commercial |
$92.40
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.77
|
| Rate for Payer: Heritage Provider Network Senior |
$312.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.50
|
| Rate for Payer: Multiplan Commercial |
$346.50
|
|
|
HC HBO THERAPY INTL 15 MIN INCREM
|
Facility
|
OP
|
$621.00
|
|
| Hospital Charge Code |
900803110
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$2,336.00 |
| Rate for Payer: Adventist Health Commercial |
$124.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$331.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$426.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$527.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$378.81
|
| Rate for Payer: Blue Shield of California EPN |
$303.05
|
| Rate for Payer: Cash Price |
$279.45
|
| Rate for Payer: Cash Price |
$279.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$403.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$527.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.85
|
| Rate for Payer: Dignity Health Senior |
$527.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$403.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$384.40
|
| Rate for Payer: Heritage Provider Network Senior |
$384.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$296.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$434.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$434.70
|
| Rate for Payer: Multiplan Commercial |
$465.75
|
| 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 |
$2,336.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,963.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$527.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.85
|
| Rate for Payer: Vantage Medical Group Senior |
$527.85
|
|
|
HC HBO THERAPY PER 30 MINUTES
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
CPT G0277
|
| Hospital Charge Code |
900803100
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$2,336.00 |
| Rate for Payer: Adventist Health Commercial |
$253.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,467.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$869.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$262.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$772.26
|
| Rate for Payer: Blue Shield of California EPN |
$617.81
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$822.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$262.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.74
|
| Rate for Payer: Dignity Health Senior |
$175.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$822.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$175.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$783.65
|
| Rate for Payer: Heritage Provider Network Senior |
$783.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$175.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$603.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$220.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$220.78
|
| Rate for Payer: Multiplan Commercial |
$949.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,336.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,963.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$262.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.74
|
| Rate for Payer: Vantage Medical Group Senior |
$175.22
|
|
|
HC HBO THERAPY PER 30 MINUTES
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
CPT G0277
|
| Hospital Charge Code |
900803100
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$229.15 |
| Max. Negotiated Rate |
$949.50 |
| Rate for Payer: Adventist Health Commercial |
$253.20
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$857.08
|
| Rate for Payer: Heritage Provider Network Senior |
$857.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.50
|
| Rate for Payer: Multiplan Commercial |
$949.50
|
|
|
HC HBO THERAPY SUB 15 MIN INCREM
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
CPT Z7608
|
| Hospital Charge Code |
900803115
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$83.62 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Adventist Health Commercial |
$92.40
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.77
|
| Rate for Payer: Heritage Provider Network Senior |
$312.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.50
|
| Rate for Payer: Multiplan Commercial |
$346.50
|
|
|
HC HBO THERAPY SUB 15 MIN INCREM
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
CPT Z7608
|
| Hospital Charge Code |
900803115
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$31.96 |
| Max. Negotiated Rate |
$2,336.00 |
| Rate for Payer: Adventist Health Commercial |
$92.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$246.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$317.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$392.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$254.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$346.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$281.82
|
| Rate for Payer: Blue Shield of California EPN |
$225.46
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$300.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$392.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$392.70
|
| Rate for Payer: Dignity Health Senior |
$392.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$285.98
|
| Rate for Payer: Heritage Provider Network Senior |
$285.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$220.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$323.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$323.40
|
| Rate for Payer: Multiplan Commercial |
$346.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,336.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,963.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$392.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$392.70
|
| Rate for Payer: Vantage Medical Group Senior |
$392.70
|
|
|
HC HBO THERAPY SUB 15 MIN INCREM
|
Facility
|
OP
|
$621.00
|
|
| Hospital Charge Code |
900803111
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$2,336.00 |
| Rate for Payer: Adventist Health Commercial |
$124.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$331.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$426.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$527.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$378.81
|
| Rate for Payer: Blue Shield of California EPN |
$303.05
|
| Rate for Payer: Cash Price |
$279.45
|
| Rate for Payer: Cash Price |
$279.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$403.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$527.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.85
|
| Rate for Payer: Dignity Health Senior |
$527.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$403.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$384.40
|
| Rate for Payer: Heritage Provider Network Senior |
$384.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$296.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$434.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$434.70
|
| Rate for Payer: Multiplan Commercial |
$465.75
|
| 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 |
$2,336.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,963.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$527.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.85
|
| Rate for Payer: Vantage Medical Group Senior |
$527.85
|
|
|
HC HBO THERAPY SUB 15 MIN INCREM
|
Facility
|
IP
|
$621.00
|
|
| Hospital Charge Code |
900803111
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$465.75 |
| Rate for Payer: Adventist Health Commercial |
$124.20
|
| Rate for Payer: Cash Price |
$279.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$420.42
|
| Rate for Payer: Heritage Provider Network Senior |
$420.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.25
|
| Rate for Payer: Multiplan Commercial |
$465.75
|
|
|
HC HCV RNA QUANT
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$116.38 |
| Max. Negotiated Rate |
$482.25 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$435.31
|
| Rate for Payer: Heritage Provider Network Senior |
$435.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.75
|
| Rate for Payer: Multiplan Commercial |
$482.25
|
|
