|
HC EXC TST BRNCHSPSM WO EC RCRDG
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
900894619
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$28.78 |
| Max. Negotiated Rate |
$119.25 |
| Rate for Payer: Adventist Health Commercial |
$31.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.53
|
| Rate for Payer: Blue Shield of California Commercial |
$96.99
|
| Rate for Payer: Blue Shield of California EPN |
$77.59
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$103.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.42
|
| Rate for Payer: Heritage Provider Network Senior |
$98.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$75.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$119.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.46
|
| Rate for Payer: TriValley Medical Group Senior |
$75.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$79.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$79.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC EXC TST BRNCHSPSM WO EC RCRDG
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
900894619
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$28.78 |
| Max. Negotiated Rate |
$119.25 |
| Rate for Payer: Adventist Health Commercial |
$31.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$102.40
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.64
|
| Rate for Payer: Heritage Provider Network Senior |
$107.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.75
|
| Rate for Payer: Multiplan Commercial |
$119.25
|
|
|
HC EXERCISE TEST BRONCHOSPASM
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
900894620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$227.25 |
| Rate for Payer: Adventist Health Commercial |
$60.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$195.13
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.13
|
| Rate for Payer: Heritage Provider Network Senior |
$205.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
|
|
HC EXERCISE TEST BRONCHOSPASM
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
900894620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Adventist Health Commercial |
$60.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$187.25
|
| 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 |
$151.56
|
| Rate for Payer: Blue Shield of California Commercial |
$184.83
|
| Rate for Payer: Blue Shield of California EPN |
$147.86
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$196.95
|
| 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 |
$178.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.56
|
| Rate for Payer: Heritage Provider Network Senior |
$187.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$144.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$227.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.23
|
| Rate for Payer: TriValley Medical Group Senior |
$171.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$151.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$151.50
|
| 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 EX FOR SPEECH DEVICE RX ADDL
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
905601817
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$89.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.50
|
| 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 |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.94
|
| Rate for Payer: Heritage Provider Network Senior |
$134.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$103.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$152.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| 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 |
$185.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.30
|
| Rate for Payer: Vantage Medical Group Senior |
$185.30
|
|
|
HC EX FOR SPEECH DEVICE RX ADDL
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
905601817
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.39
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.59
|
| Rate for Payer: Heritage Provider Network Senior |
$147.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
|
|
HC EX OF NAIL & MAT PART OR COMP
|
Facility
|
IP
|
$1,239.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
900501017
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.26 |
| Max. Negotiated Rate |
$929.25 |
| Rate for Payer: Adventist Health Commercial |
$247.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$797.92
|
| Rate for Payer: Cash Price |
$557.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$838.80
|
| Rate for Payer: Heritage Provider Network Senior |
$838.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$224.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.75
|
| Rate for Payer: Multiplan Commercial |
$929.25
|
|
|
HC EX OF NAIL & MAT PART OR COMP
|
Facility
|
OP
|
$1,239.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
900501017
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$247.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$765.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$588.52
|
| Rate for Payer: Blue Shield of California EPN |
$468.34
|
| Rate for Payer: Cash Price |
$557.55
|
| Rate for Payer: Cash Price |
$557.55
|
| Rate for Payer: Cash Price |
$557.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$805.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$838.80
|
| Rate for Payer: Heritage Provider Network Senior |
$838.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$591.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$224.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$929.25
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$743.40
|
| Rate for Payer: TriValley Medical Group Senior |
$743.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC EXPIRED CARBON DIOXIDE DETERM
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 94770
|
| Hospital Charge Code |
900800104
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$317.49
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.76
|
| Rate for Payer: Heritage Provider Network Senior |
$333.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
|
|
HC EXPIRED CARBON DIOXIDE DETERM
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 94770
|
| Hospital Charge Code |
900800104
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$419.05 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$304.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$419.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$369.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.60
|
| Rate for Payer: Blue Shield of California Commercial |
$300.73
|
| Rate for Payer: Blue Shield of California EPN |
$240.58
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$320.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$419.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$419.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$419.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.17
|
| Rate for Payer: Heritage Provider Network Senior |
$305.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$235.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.10
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$246.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$246.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$419.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$419.05
|
| Rate for Payer: Vantage Medical Group Senior |
$419.05
|
|
|
HC EXPIRED CO2 DETERM
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800910
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$61.72 |
| Max. Negotiated Rate |
$255.75 |
| Rate for Payer: Adventist Health Commercial |
$68.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$210.74
|
| 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 |
$170.57
|
| Rate for Payer: Blue Shield of California Commercial |
$208.01
|
| Rate for Payer: Blue Shield of California EPN |
$166.41
|
| Rate for Payer: Cash Price |
$153.45
|
| Rate for Payer: Cash Price |
$153.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$221.65
|
| 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 |
$201.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.08
|
| Rate for Payer: Heritage Provider Network Senior |
$211.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$162.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$255.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$182.04
|
| Rate for Payer: TriValley Medical Group Senior |
$165.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$170.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$170.50
|
| 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 EXPIRED CO2 DETERM
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800910
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$61.72 |
| Max. Negotiated Rate |
$255.75 |
| Rate for Payer: Adventist Health Commercial |
$68.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$219.60
|
| Rate for Payer: Cash Price |
$153.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$230.86
|
| Rate for Payer: Heritage Provider Network Senior |
$230.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.25
|
| Rate for Payer: Multiplan Commercial |
$255.75
|
|
|
HC EXPLORATION OF NECK WOUND
|
Facility
|
IP
|
$1,666.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
900501384
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.55 |
| Max. Negotiated Rate |
$1,249.50 |
| Rate for Payer: Adventist Health Commercial |
$333.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,072.90
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,127.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$301.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.50
|
| Rate for Payer: Multiplan Commercial |
$1,249.50
|
|
|
HC EXPLORATION OF NECK WOUND
|
Facility
|
OP
|
$1,666.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
900501384
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.55 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$333.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,029.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$791.35
|
| Rate for Payer: Blue Shield of California EPN |
$629.75
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,082.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$693.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,127.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$794.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$301.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$797.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$1,249.50
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$999.60
|
| Rate for Payer: TriValley Medical Group Senior |
$999.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC EXPLORE KNEE I & D W/F.B. RMVL
|
Facility
|
OP
|
$7,359.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
900501671
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,331.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,471.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,547.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,495.53
|
| Rate for Payer: Blue Shield of California EPN |
$2,781.70
|
| Rate for Payer: Cash Price |
$3,311.55
|
| Rate for Payer: Cash Price |
$3,311.55
|
| Rate for Payer: Cash Price |
$3,311.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,783.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,982.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,510.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,331.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$5,519.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,415.40
|
| Rate for Payer: TriValley Medical Group Senior |
$4,415.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC EXPLORE KNEE I & D W/F.B. RMVL
|
Facility
|
IP
|
$7,359.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
900501671
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,331.98 |
| Max. Negotiated Rate |
$5,519.25 |
| Rate for Payer: Adventist Health Commercial |
$1,471.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,739.20
|
| Rate for Payer: Cash Price |
$3,311.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,982.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,331.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.75
|
| Rate for Payer: Multiplan Commercial |
$5,519.25
|
|
|
HC EXPLORE LIMB VESSELS
|
Facility
|
IP
|
$5,764.00
|
|
|
Service Code
|
CPT 35860
|
| Hospital Charge Code |
900501597
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,043.28 |
| Max. Negotiated Rate |
$4,323.00 |
| Rate for Payer: Adventist Health Commercial |
$1,152.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,712.02
|
| Rate for Payer: Cash Price |
$2,593.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,902.23
|
| Rate for Payer: Heritage Provider Network Senior |
$3,902.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,043.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,441.00
|
| Rate for Payer: Multiplan Commercial |
$4,323.00
|
|
|
HC EXPLORE LIMB VESSELS
|
Facility
|
OP
|
$5,764.00
|
|
|
Service Code
|
CPT 35860
|
| Hospital Charge Code |
900501597
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,043.28 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,152.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,562.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,737.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,178.79
|
| Rate for Payer: Cash Price |
$2,593.80
|
| Rate for Payer: Cash Price |
$2,593.80
|
| Rate for Payer: Cash Price |
$2,593.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,746.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,902.23
|
| Rate for Payer: Heritage Provider Network Senior |
$3,902.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,749.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,043.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,441.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$4,323.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,458.40
|
| Rate for Payer: TriValley Medical Group Senior |
$3,458.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC EXPLORE/TREAT FINGER JOINT EA
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
900501434
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,569.56
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
|
|
HC EXPLORE/TREAT FINGER JOINT EA
|
Facility
|
OP
|
$3,990.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
900501434
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,465.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,895.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,508.22
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,593.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,903.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,394.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,394.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC EXPLOR W/RMVL DEEP F.B.FOREARM
|
Facility
|
IP
|
$5,215.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
900501469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$943.91 |
| Max. Negotiated Rate |
$3,911.25 |
| Rate for Payer: Adventist Health Commercial |
$1,043.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,358.46
|
| Rate for Payer: Cash Price |
$2,346.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,530.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,530.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$943.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,303.75
|
| Rate for Payer: Multiplan Commercial |
$3,911.25
|
|
|
HC EXPLOR W/RMVL DEEP F.B.FOREARM
|
Facility
|
OP
|
$5,215.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
900501469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$943.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,043.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,222.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,477.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,971.27
|
| Rate for Payer: Cash Price |
$2,346.75
|
| Rate for Payer: Cash Price |
$2,346.75
|
| Rate for Payer: Cash Price |
$2,346.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,389.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,068.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,530.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,530.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,487.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$943.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,303.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$3,911.25
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,129.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,129.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC EXT CAROTID UNI
|
Facility
|
IP
|
$20,686.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909020160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,744.17 |
| Max. Negotiated Rate |
$15,514.50 |
| Rate for Payer: Adventist Health Commercial |
$4,137.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,321.78
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,004.42
|
| Rate for Payer: Heritage Provider Network Senior |
$14,004.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,744.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,171.50
|
| Rate for Payer: Multiplan Commercial |
$15,514.50
|
|
|
HC EXT CAROTID UNI
|
Facility
|
OP
|
$20,686.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909020160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$17,583.10 |
| Rate for Payer: Adventist Health Commercial |
$4,137.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,783.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,583.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,377.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,514.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$9,308.70
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,445.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,583.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,583.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,804.63
|
| Rate for Payer: Heritage Provider Network Senior |
$12,804.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,867.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,744.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,171.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,480.20
|
| Rate for Payer: Multiplan Commercial |
$15,514.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,583.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,583.10
|
| Rate for Payer: Vantage Medical Group Senior |
$17,583.10
|
|
|
HC EXT ECG > 48HR TO 21 DAY RCRD
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 0296T
|
| Hospital Charge Code |
900000296
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$409.70 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.70
|
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$297.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$361.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.10
|
| Rate for Payer: Blue Shield of California Commercial |
$294.02
|
| Rate for Payer: Blue Shield of California EPN |
$235.22
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$409.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.36
|
| Rate for Payer: Heritage Provider Network Senior |
$298.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$229.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$337.40
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Vantage Medical Group Senior |
$409.70
|
|
