|
HC EXT ECG > 48HR TO 21 DAY RCRD
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 0296T
|
| Hospital Charge Code |
900000296
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$361.50 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$310.41
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.31
|
| Rate for Payer: Heritage Provider Network Senior |
$326.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
900203242
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$48.04 |
| Max. Negotiated Rate |
$390.00 |
| 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 |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| 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: Cash Price |
$216.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.36
|
| Rate for Payer: Heritage Provider Network Senior |
$298.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$229.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$52.84
|
| Rate for Payer: TriValley Medical Group Senior |
$48.04
|
| 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 |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
900203242
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$361.50 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$310.41
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.31
|
| Rate for Payer: Heritage Provider Network Senior |
$326.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD SA
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
900203243
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$361.50 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$310.41
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.31
|
| Rate for Payer: Heritage Provider Network Senior |
$326.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD SA
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
900203243
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$390.00 |
| 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 |
$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 |
$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: Cash Price |
$216.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.30
|
| 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 |
$284.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.36
|
| Rate for Payer: Heritage Provider Network Senior |
$298.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$229.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| 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 |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| 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 EXT ECG GT 7 DAY TO 15 DAY RCRD
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
900203246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$48.04 |
| Max. Negotiated Rate |
$390.00 |
| 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 |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| 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: Cash Price |
$216.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.36
|
| Rate for Payer: Heritage Provider Network Senior |
$298.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$229.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$52.84
|
| Rate for Payer: TriValley Medical Group Senior |
$48.04
|
| 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 |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC EXT ECG GT 7 DAY TO 15 DAY RCRD
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
900203246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$361.50 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$310.41
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.31
|
| Rate for Payer: Heritage Provider Network Senior |
$326.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
|
|
HC EXT ECG GT 7 DY TO 15 DY RCRD SA
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
900203247
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$390.00 |
| 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 |
$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 |
$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: Cash Price |
$216.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.30
|
| 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 |
$284.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.36
|
| Rate for Payer: Heritage Provider Network Senior |
$298.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$229.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| 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 |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| 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 EXT ECG GT 7 DY TO 15 DY RCRD SA
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
900203247
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$361.50 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$310.41
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.31
|
| Rate for Payer: Heritage Provider Network Senior |
$326.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.50
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
|
|
HC EXTENDED LENGTH TRACH TUBE
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.57 |
| Max. Negotiated Rate |
$636.65 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$462.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$636.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$411.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$561.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$374.65
|
| Rate for Payer: Blue Shield of California Commercial |
$456.89
|
| Rate for Payer: Blue Shield of California EPN |
$365.51
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$486.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$636.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$636.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$636.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.63
|
| Rate for Payer: Heritage Provider Network Senior |
$463.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$357.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$524.30
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$374.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$374.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$636.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$636.65
|
| Rate for Payer: Vantage Medical Group Senior |
$636.65
|
|
|
HC EXTENDED LENGTH TRACH TUBE
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.57 |
| Max. Negotiated Rate |
$561.75 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$482.36
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.07
|
| Rate for Payer: Heritage Provider Network Senior |
$507.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
|
|
HC EXTERNAL EAR, UNLISTED PROCEDU
|
Facility
|
IP
|
$883.00
|
|
|
Service Code
|
CPT 69399
|
| Hospital Charge Code |
900501298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.82 |
| Max. Negotiated Rate |
$662.25 |
| Rate for Payer: Adventist Health Commercial |
$176.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.65
|
| Rate for Payer: Cash Price |
$397.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$597.79
|
| Rate for Payer: Heritage Provider Network Senior |
$597.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.75
|
| Rate for Payer: Multiplan Commercial |
$662.25
|
|
|
HC EXTERNAL EAR, UNLISTED PROCEDU
|
Facility
|
OP
|
$883.00
|
|
|
Service Code
|
CPT 69399
|
| Hospital Charge Code |
900501298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.82 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$176.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$545.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$419.43
|
| Rate for Payer: Blue Shield of California EPN |
$333.77
|
| Rate for Payer: Cash Price |
$397.35
|
| Rate for Payer: Cash Price |
$397.35
|
| Rate for Payer: Cash Price |
$397.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$573.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$597.79
|
| Rate for Payer: Heritage Provider Network Senior |
$597.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$421.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$662.25
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$529.80
|
| Rate for Payer: TriValley Medical Group Senior |
$529.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$8,848.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,601.49 |
| Max. Negotiated Rate |
$6,636.00 |
| Rate for Payer: Adventist Health Commercial |
$1,769.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,698.11
|
| Rate for Payer: Cash Price |
$3,981.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,990.10
|
| Rate for Payer: Heritage Provider Network Senior |
$5,990.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,601.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,212.00
|
| Rate for Payer: Multiplan Commercial |
$6,636.00
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$8,848.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,769.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,468.06
|
| 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 |
$4,656.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,397.28
|
| Rate for Payer: Blue Shield of California EPN |
$4,317.82
|
| Rate for Payer: Cash Price |
$3,981.60
|
| Rate for Payer: Cash Price |
$3,981.60
|
| Rate for Payer: Cash Price |
$3,981.60
|
| Rate for Payer: Cash Price |
$3,981.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,751.20
|
| 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 |
$5,476.91
|
| Rate for Payer: Heritage Provider Network Senior |
$5,476.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,220.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,601.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,788.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,212.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$6,636.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,579.83
|
| Rate for Payer: TriValley Medical Group Senior |
$4,163.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| 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 EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
|
OP
|
$3,810.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$689.61 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$762.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,354.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,809.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,440.18
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,476.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,264.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,579.37
|
| Rate for Payer: Heritage Provider Network Senior |
$2,579.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,817.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$689.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,903.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$952.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$2,857.50
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,286.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,286.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
|
IP
|
$3,810.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$689.61 |
| Max. Negotiated Rate |
$2,857.50 |
| Rate for Payer: Adventist Health Commercial |
$762.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,453.64
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,579.37
|
| Rate for Payer: Heritage Provider Network Senior |
$2,579.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$689.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$952.50
|
| Rate for Payer: Multiplan Commercial |
$2,857.50
|
|
|
HC EXTREMITY STUDY COMPLEX
|
Facility
|
OP
|
$1,509.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
908100119
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$273.13 |
| Max. Negotiated Rate |
$1,131.75 |
| Rate for Payer: Adventist Health Commercial |
$301.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$932.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$754.80
|
| Rate for Payer: Blue Shield of California Commercial |
$607.49
|
| Rate for Payer: Blue Shield of California EPN |
$488.52
|
| Rate for Payer: Cash Price |
$679.05
|
| Rate for Payer: Cash Price |
$679.05
|
| Rate for Payer: Cash Price |
$679.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$980.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$890.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$277.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$934.07
|
| Rate for Payer: Heritage Provider Network Senior |
$934.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$719.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$273.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$1,131.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$305.48
|
| Rate for Payer: TriValley Medical Group Senior |
$277.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC EXTREMITY STUDY COMPLEX
|
Facility
|
IP
|
$1,509.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
908100119
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$273.13 |
| Max. Negotiated Rate |
$1,131.75 |
| Rate for Payer: Adventist Health Commercial |
$301.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$971.80
|
| Rate for Payer: Cash Price |
$679.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,021.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,021.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$273.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.25
|
| Rate for Payer: Multiplan Commercial |
$1,131.75
|
|
|
HC EXTREMITY STUDY SIMPLE
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
900803200
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$162.54 |
| Max. Negotiated Rate |
$673.50 |
| Rate for Payer: Adventist Health Commercial |
$179.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$578.31
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$607.95
|
| Rate for Payer: Heritage Provider Network Senior |
$607.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.50
|
| Rate for Payer: Multiplan Commercial |
$673.50
|
|
|
HC EXTREMITY STUDY SIMPLE
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
900803200
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$162.54 |
| Max. Negotiated Rate |
$1,077.00 |
| Rate for Payer: Adventist Health Commercial |
$179.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$554.96
|
| 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 |
$449.18
|
| Rate for Payer: Blue Shield of California Commercial |
$390.48
|
| Rate for Payer: Blue Shield of California EPN |
$314.01
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$583.70
|
| 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 |
$529.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.86
|
| Rate for Payer: Heritage Provider Network Senior |
$555.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$428.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$673.50
|
| 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 |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| 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 EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
IP
|
$3,864.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$699.38 |
| Max. Negotiated Rate |
$2,898.00 |
| Rate for Payer: Adventist Health Commercial |
$772.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,488.42
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,615.93
|
| Rate for Payer: Heritage Provider Network Senior |
$2,615.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$699.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$966.00
|
| Rate for Payer: Multiplan Commercial |
$2,898.00
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
OP
|
$3,864.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$699.38 |
| Max. Negotiated Rate |
$4,723.01 |
| Rate for Payer: Adventist Health Commercial |
$772.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,387.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,835.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,460.59
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,511.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,511.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,057.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,615.93
|
| Rate for Payer: Heritage Provider Network Senior |
$2,615.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,843.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$699.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$966.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$2,898.00
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,318.40
|
| Rate for Payer: TriValley Medical Group Senior |
$2,318.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC EYE FOR FOREIGN BODY
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
909001113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.22 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Adventist Health Commercial |
$147.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$473.98
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$498.27
|
| Rate for Payer: Heritage Provider Network Senior |
$498.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.00
|
| Rate for Payer: Multiplan Commercial |
$552.00
|
|
|
HC EYE FOR FOREIGN BODY
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
909001113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.94 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Adventist Health Commercial |
$147.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$454.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.44
|
| Rate for Payer: Blue Shield of California Commercial |
$85.73
|
| Rate for Payer: Blue Shield of California EPN |
$68.94
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$478.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$455.58
|
| Rate for Payer: Heritage Provider Network Senior |
$455.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$351.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$552.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| 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 |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
