|
HC INFUSION EA ADD HOUR
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$80.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Senior |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$58.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.21
|
| Rate for Payer: Heritage Provider Network Senior |
$79.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$55.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.87
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Multiplan WC |
$93.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$42.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
HC INFUSION INITAL HOUR GT 16MIN
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
940100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$101.41 |
| Max. Negotiated Rate |
$771.75 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$550.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$706.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$565.95
|
| Rate for Payer: Cash Price |
$565.95
|
| Rate for Payer: Cash Price |
$565.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$668.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$668.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$636.95
|
| Rate for Payer: Heritage Provider Network Senior |
$636.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$101.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$490.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.30
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.47
|
| Rate for Payer: TriValley Medical Group Senior |
$267.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC INFUSION INITAL HOUR GT 16MIN
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
949000306
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$101.41 |
| Max. Negotiated Rate |
$771.75 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$550.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$706.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$565.95
|
| Rate for Payer: Cash Price |
$565.95
|
| Rate for Payer: Cash Price |
$565.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$668.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$668.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$636.95
|
| Rate for Payer: Heritage Provider Network Senior |
$636.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$101.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$490.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.30
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.47
|
| Rate for Payer: TriValley Medical Group Senior |
$267.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC INFUSION INITAL HOUR GT 16MIN
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
940100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$186.25 |
| Max. Negotiated Rate |
$771.75 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Cash Price |
$565.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$696.63
|
| Rate for Payer: Heritage Provider Network Senior |
$696.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.25
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
|
|
HC INFUSION INITAL HOUR GT 16MIN
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
949000306
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$186.25 |
| Max. Negotiated Rate |
$771.75 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Cash Price |
$565.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$696.63
|
| Rate for Payer: Heritage Provider Network Senior |
$696.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.25
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
906820203
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$198.01 |
| Max. Negotiated Rate |
$820.50 |
| Rate for Payer: Adventist Health Commercial |
$218.80
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$740.64
|
| Rate for Payer: Heritage Provider Network Senior |
$740.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.50
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
906820203
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$101.41 |
| Max. Negotiated Rate |
$820.50 |
| Rate for Payer: Adventist Health Commercial |
$218.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$584.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$751.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$711.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$677.19
|
| Rate for Payer: Heritage Provider Network Senior |
$677.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$101.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$521.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.30
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.47
|
| Rate for Payer: TriValley Medical Group Senior |
$267.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
OP
|
$733.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$101.41 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$146.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$391.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$503.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$476.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$453.73
|
| Rate for Payer: Heritage Provider Network Senior |
$453.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$101.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$349.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.30
|
| Rate for Payer: Multiplan Commercial |
$549.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.47
|
| Rate for Payer: TriValley Medical Group Senior |
$267.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
IP
|
$733.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.67 |
| Max. Negotiated Rate |
$549.75 |
| Rate for Payer: Adventist Health Commercial |
$146.60
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$496.24
|
| Rate for Payer: Heritage Provider Network Senior |
$496.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.25
|
| Rate for Payer: Multiplan Commercial |
$549.75
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
IP
|
$733.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$132.67 |
| Max. Negotiated Rate |
$549.75 |
| Rate for Payer: Adventist Health Commercial |
$146.60
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$496.24
|
| Rate for Payer: Heritage Provider Network Senior |
$496.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.25
|
| Rate for Payer: Multiplan Commercial |
$549.75
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
OP
|
$733.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.67 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$146.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$391.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$503.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$476.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$496.24
|
| Rate for Payer: Heritage Provider Network Senior |
$496.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$349.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.30
|
| Rate for Payer: Multiplan Commercial |
$549.75
|
| Rate for Payer: Multiplan WC |
$426.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$263.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$242.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC INFUSION/THROMBOLYSIS,CEREBRAL
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
909081375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.59 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$419.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$336.05
|
| Rate for Payer: Cash Price |
$336.05
|
| Rate for Payer: Cash Price |
$336.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$397.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Senior |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$421.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$378.21
|
| Rate for Payer: Heritage Provider Network Senior |
$518.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$402.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$800.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$531.03
|
| Rate for Payer: Multiplan Commercial |
$458.25
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$463.60
|
| Rate for Payer: TriValley Medical Group Senior |
$463.60
|
| 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 |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC INFUSION/THROMBOLYSIS,CEREBRAL
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
909081375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.59 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Cash Price |
$336.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$413.65
|
| Rate for Payer: Heritage Provider Network Senior |
$413.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.75
|
| Rate for Payer: Multiplan Commercial |
$458.25
|
|
|
HC INFUSION WIRE
|
Facility
|
OP
|
$504.00
|
|
| Hospital Charge Code |
909081247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$269.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$346.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.00
|
| Rate for Payer: Blue Shield of California Commercial |
$307.44
|
| Rate for Payer: Blue Shield of California EPN |
$245.95
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$327.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$428.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$428.40
|
| Rate for Payer: Dignity Health Senior |
$428.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$311.98
|
| Rate for Payer: Heritage Provider Network Senior |
$311.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$240.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.80
|
| Rate for Payer: Multiplan Commercial |
$378.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$252.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$252.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$428.40
|
| Rate for Payer: Vantage Medical Group Senior |
$428.40
|
|
|
HC INFUSION WIRE
|
Facility
|
IP
|
$504.00
|
|
| Hospital Charge Code |
909081247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$341.21
|
| Rate for Payer: Heritage Provider Network Senior |
$341.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$378.00
|
|
|
HC INHALED NITRIC OXIDE PER HR
|
Facility
|
OP
|
$435.00
|
|
| Hospital Charge Code |
900800402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.73 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$232.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$298.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$326.25
|
| Rate for Payer: Blue Shield of California Commercial |
$265.35
|
| Rate for Payer: Blue Shield of California EPN |
$212.28
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$282.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: Dignity Health Senior |
$369.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.26
|
| Rate for Payer: Heritage Provider Network Senior |
$269.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$207.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$304.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$217.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$217.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC INHALED NITRIC OXIDE PER HR
|
Facility
|
IP
|
$435.00
|
|
| Hospital Charge Code |
900800402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.73 |
| Max. Negotiated Rate |
$326.25 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.50
|
| Rate for Payer: Heritage Provider Network Senior |
$294.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.75
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$1,027.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$185.89 |
| Max. Negotiated Rate |
$770.25 |
| Rate for Payer: Adventist Health Commercial |
$205.40
|
| Rate for Payer: Cash Price |
$564.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$695.28
|
| Rate for Payer: Heritage Provider Network Senior |
$695.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.75
|
| Rate for Payer: Multiplan Commercial |
$770.25
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$1,027.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$163.74 |
| Max. Negotiated Rate |
$770.25 |
| Rate for Payer: Adventist Health Commercial |
$205.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$548.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$705.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Blue Shield of California Commercial |
$626.47
|
| Rate for Payer: Blue Shield of California EPN |
$501.18
|
| Rate for Payer: Cash Price |
$564.85
|
| Rate for Payer: Cash Price |
$564.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Senior |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$667.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$635.71
|
| Rate for Payer: Heritage Provider Network Senior |
$635.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$489.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.31
|
| Rate for Payer: Multiplan Commercial |
$770.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$513.50
|
| Rate for Payer: TriValley Medical Group Senior |
$513.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$513.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$513.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.25 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.78
|
| Rate for Payer: Heritage Provider Network Senior |
$247.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.50
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.25 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$195.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$251.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Blue Shield of California Commercial |
$223.26
|
| Rate for Payer: Blue Shield of California EPN |
$178.61
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Senior |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$226.55
|
| Rate for Payer: Heritage Provider Network Senior |
$226.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$174.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.31
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$183.00
|
| Rate for Payer: TriValley Medical Group Senior |
$183.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$183.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$183.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC INITIAL OP VISIT MINOR
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$245.61 |
| Rate for Payer: Adventist Health Commercial |
$55.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$148.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Blue Shield of California Commercial |
$168.97
|
| Rate for Payer: Blue Shield of California EPN |
$135.18
|
| Rate for Payer: Cash Price |
$152.35
|
| Rate for Payer: Cash Price |
$152.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Senior |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.46
|
| Rate for Payer: Heritage Provider Network Senior |
$171.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$132.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.31
|
| Rate for Payer: Multiplan Commercial |
$207.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$138.50
|
| Rate for Payer: TriValley Medical Group Senior |
$138.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$138.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$138.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC INITIAL OP VISIT MINOR
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$207.75 |
| Rate for Payer: Adventist Health Commercial |
$55.40
|
| Rate for Payer: Cash Price |
$152.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.53
|
| Rate for Payer: Heritage Provider Network Senior |
$187.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.25
|
| Rate for Payer: Multiplan Commercial |
$207.75
|
|
|
HC INITIAL OP VISIT MODERATE
|
Facility
|
IP
|
$539.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.56 |
| Max. Negotiated Rate |
$404.25 |
| Rate for Payer: Adventist Health Commercial |
$107.80
|
| Rate for Payer: Cash Price |
$296.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$364.90
|
| Rate for Payer: Heritage Provider Network Senior |
$364.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.75
|
| Rate for Payer: Multiplan Commercial |
$404.25
|
|
|
HC INITIAL OP VISIT MODERATE
|
Facility
|
OP
|
$539.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.56 |
| Max. Negotiated Rate |
$404.25 |
| Rate for Payer: Adventist Health Commercial |
$107.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$288.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$370.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Blue Shield of California Commercial |
$328.79
|
| Rate for Payer: Blue Shield of California EPN |
$263.03
|
| Rate for Payer: Cash Price |
$296.45
|
| Rate for Payer: Cash Price |
$296.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Senior |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.64
|
| Rate for Payer: Heritage Provider Network Senior |
$333.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$257.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.31
|
| Rate for Payer: Multiplan Commercial |
$404.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$269.50
|
| Rate for Payer: TriValley Medical Group Senior |
$269.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$269.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$269.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
