|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.65
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.98
|
| Rate for Payer: Heritage Provider Network Senior |
$129.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908603211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.91 |
| Max. Negotiated Rate |
$335.25 |
| Rate for Payer: Adventist Health Commercial |
$89.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$276.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.59
|
| Rate for Payer: Blue Shield of California Commercial |
$272.67
|
| Rate for Payer: Blue Shield of California EPN |
$218.14
|
| Rate for Payer: Cash Price |
$201.15
|
| Rate for Payer: Cash Price |
$201.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$276.69
|
| Rate for Payer: Heritage Provider Network Senior |
$276.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$213.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$335.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$223.50
|
| Rate for Payer: TriValley Medical Group Senior |
$223.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$223.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$223.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.13 |
| Max. Negotiated Rate |
$294.75 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$253.09
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$266.06
|
| Rate for Payer: Heritage Provider Network Senior |
$266.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.25
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.13 |
| Max. Negotiated Rate |
$294.75 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$242.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$196.58
|
| Rate for Payer: Blue Shield of California Commercial |
$239.73
|
| Rate for Payer: Blue Shield of California EPN |
$191.78
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$231.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$243.27
|
| Rate for Payer: Heritage Provider Network Senior |
$243.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$187.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$196.50
|
| Rate for Payer: TriValley Medical Group Senior |
$196.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$196.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$196.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.22
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.63
|
| Rate for Payer: Heritage Provider Network Senior |
$172.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.55
|
| Rate for Payer: Blue Shield of California Commercial |
$155.55
|
| Rate for Payer: Blue Shield of California EPN |
$124.44
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.84
|
| Rate for Payer: Heritage Provider Network Senior |
$157.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$121.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.36
|
| Rate for Payer: TriValley Medical Group Senior |
$188.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$127.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$127.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908603211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.91 |
| Max. Negotiated Rate |
$335.25 |
| Rate for Payer: Adventist Health Commercial |
$89.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$287.87
|
| Rate for Payer: Cash Price |
$201.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$302.62
|
| Rate for Payer: Heritage Provider Network Senior |
$302.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.75
|
| Rate for Payer: Multiplan Commercial |
$335.25
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$229.91
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.69
|
| Rate for Payer: Heritage Provider Network Senior |
$241.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.25
|
| Rate for Payer: Multiplan Commercial |
$267.75
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$220.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.57
|
| Rate for Payer: Blue Shield of California Commercial |
$217.77
|
| Rate for Payer: Blue Shield of California EPN |
$174.22
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.98
|
| Rate for Payer: Heritage Provider Network Senior |
$220.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$170.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$267.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$178.50
|
| Rate for Payer: TriValley Medical Group Senior |
$178.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$178.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$178.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTRADIOL
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
900912127
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.61 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$162.29
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$170.60
|
| Rate for Payer: Heritage Provider Network Senior |
$170.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
|
|
HC ESTRADIOL
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
900912127
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$265.34 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.34
|
| Rate for Payer: Blue Shield of California Commercial |
$224.87
|
| Rate for Payer: Blue Shield of California Commercial |
$224.87
|
| Rate for Payer: Blue Shield of California EPN |
$180.36
|
| Rate for Payer: Blue Shield of California EPN |
$180.36
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$163.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.99
|
| Rate for Payer: Heritage Provider Network Senior |
$118.85
|
| Rate for Payer: Heritage Provider Network Senior |
$155.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$91.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$120.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.94
|
| Rate for Payer: TriValley Medical Group Senior |
$27.94
|
| Rate for Payer: TriValley Medical Group Senior |
$27.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$30.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$30.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Vantage Medical Group Senior |
$27.94
|
| Rate for Payer: Vantage Medical Group Senior |
$27.94
|
|
|
HC ETHIODOL (LIPIODOL)
|
Facility
|
IP
|
$700.00
|
|
| Hospital Charge Code |
909001008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Adventist Health Commercial |
$140.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$450.80
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$473.90
|
| Rate for Payer: Heritage Provider Network Senior |
$473.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$126.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$525.00
|
|
|
HC ETHIODOL (LIPIODOL)
|
Facility
|
OP
|
$700.00
|
|
| Hospital Charge Code |
909001008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Adventist Health Commercial |
$140.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$432.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$595.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$385.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$525.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.14
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$341.60
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$455.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$595.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$595.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$595.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.30
|
| Rate for Payer: Heritage Provider Network Senior |
$433.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$333.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$126.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$490.00
|
| Rate for Payer: Multiplan Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$280.00
|
| Rate for Payer: TriValley Medical Group Senior |
$280.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$350.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$350.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$595.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$595.00
|
| Rate for Payer: Vantage Medical Group Senior |
$595.00
|
|
|
HC EVAC OF SUBUNG HEMATOMA
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
900501016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$69.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$164.35
|
| Rate for Payer: Blue Shield of California EPN |
$130.79
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$224.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$234.24
|
| Rate for Payer: Heritage Provider Network Senior |
$234.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$165.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$259.50
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$207.60
|
| Rate for Payer: TriValley Medical Group Senior |
$207.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC EVAC OF SUBUNG HEMATOMA
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
900501016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.63 |
| Max. Negotiated Rate |
$259.50 |
| Rate for Payer: Adventist Health Commercial |
$69.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$222.82
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$234.24
|
| Rate for Payer: Heritage Provider Network Senior |
$234.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.50
|
| Rate for Payer: Multiplan Commercial |
$259.50
|
|
|
HC EVACUATE MOLE OF UTERUS
|
Facility
|
OP
|
$4,641.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
900501632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$840.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,868.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,204.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,754.30
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,016.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,163.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,141.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,141.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,213.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,788.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,784.60
|
| Rate for Payer: TriValley Medical Group Senior |
$2,784.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC EVACUATE MOLE OF UTERUS
|
Facility
|
IP
|
$4,641.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
900501632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$840.02 |
| Max. Negotiated Rate |
$3,480.75 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,988.80
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,141.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,141.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
|
|
HC EVAL AUD REHAB STATUS 1ST HR
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
905601903
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$202.86
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.25
|
| Rate for Payer: Heritage Provider Network Senior |
$213.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
|
|
HC EVAL AUD REHAB STATUS 1ST HR
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
905601903
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$129.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$194.67
|
| 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 |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.75
|
| 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 |
$204.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.99
|
| Rate for Payer: Heritage Provider Network Senior |
$194.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$150.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC EVAL AUD REHAB STATUS ADD 15 M
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
905601904
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$31.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.04
|
| Rate for Payer: Heritage Provider Network Senior |
$47.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC EVAL AUD REHAB STATUS ADD 15 M
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
905601904
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.94
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.45
|
| Rate for Payer: Heritage Provider Network Senior |
$51.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
|
|
HC EVAL FOR PRESCRIPT VOICE PROST
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
905601758
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$91.04 |
| Max. Negotiated Rate |
$377.25 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$323.93
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$340.53
|
| Rate for Payer: Heritage Provider Network Senior |
$340.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.75
|
| Rate for Payer: Multiplan Commercial |
$377.25
|
|
|
HC EVAL FOR PRESCRIPT VOICE PROST
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
905601758
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$91.04 |
| Max. Negotiated Rate |
$427.55 |
| Rate for Payer: Adventist Health Commercial |
$206.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$310.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$377.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$326.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$311.36
|
| Rate for Payer: Heritage Provider Network Senior |
$311.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$239.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$377.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.55
|
| Rate for Payer: Vantage Medical Group Senior |
$427.55
|
|
|
HC EVAL OF FNA,EA ADDLL SITE PG
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800217
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$42.76 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.76
|
| Rate for Payer: Blue Shield of California Commercial |
$37.82
|
| Rate for Payer: Blue Shield of California EPN |
$30.42
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.67
|
| Rate for Payer: Heritage Provider Network Senior |
$8.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.90
|
| Rate for Payer: Vantage Medical Group Senior |
$11.90
|
|
|
HC EVAL OF FNA,EA ADDLL SITE PG
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800217
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.02
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.48
|
| Rate for Payer: Heritage Provider Network Senior |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
|
