|
HC FNA INTERP & RPT PG
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800218
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.89
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.90
|
| Rate for Payer: Heritage Provider Network Senior |
$102.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
|
|
HC FO FINGER KNUCKLE BENDER PF
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905103948
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$74.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$238.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$149.14
|
| Rate for Payer: Blue Shield of California EPN |
$149.14
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$170.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.77
|
| Rate for Payer: Heritage Provider Network Senior |
$171.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$185.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$185.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.75
|
| Rate for Payer: Multiplan Commercial |
$278.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$134.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$122.84
|
|
|
HC FO FINGER KNUCKLE BENDER PF
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905103948
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$152.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$229.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$315.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$204.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$278.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$149.14
|
| Rate for Payer: Blue Shield of California EPN |
$149.14
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$170.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$315.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$315.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$315.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.77
|
| Rate for Payer: Heritage Provider Network Senior |
$171.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$185.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$185.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$259.70
|
| Rate for Payer: Multiplan Commercial |
$278.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$134.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$122.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$315.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$315.35
|
| Rate for Payer: Vantage Medical Group Senior |
$315.35
|
|
|
HC FOLIC ACID (SERUM)
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
900910817
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.61
|
| Rate for Payer: Blue Shield of California Commercial |
$118.31
|
| Rate for Payer: Blue Shield of California Commercial |
$118.31
|
| Rate for Payer: Blue Shield of California EPN |
$94.89
|
| Rate for Payer: Blue Shield of California EPN |
$94.89
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$69.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$66.23
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$51.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$128.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.70
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.70
|
| Rate for Payer: TriValley Medical Group Senior |
$14.70
|
| Rate for Payer: TriValley Medical Group Senior |
$14.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Vantage Medical Group Senior |
$14.70
|
| Rate for Payer: Vantage Medical Group Senior |
$14.70
|
|
|
HC FOLIC ACID (SERUM)
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
900910817
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.88
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC FOLLOW-UP ANGIO-EXISTING CATH
|
Facility
|
OP
|
$1,811.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
909081647
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Adventist Health Commercial |
$362.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,119.20
|
| 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 |
$244.76
|
| Rate for Payer: Blue Shield of California Commercial |
$222.77
|
| Rate for Payer: Blue Shield of California EPN |
$179.14
|
| Rate for Payer: Cash Price |
$814.95
|
| Rate for Payer: Cash Price |
$814.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,177.15
|
| 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 |
$1,068.49
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,121.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,121.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$863.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$327.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$1,358.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| 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 FOLLOW-UP ANGIO-EXISTING CATH
|
Facility
|
IP
|
$1,811.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
909081647
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$327.79 |
| Max. Negotiated Rate |
$1,358.25 |
| Rate for Payer: Adventist Health Commercial |
$362.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,166.28
|
| Rate for Payer: Cash Price |
$814.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,226.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1,226.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$327.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.75
|
| Rate for Payer: Multiplan Commercial |
$1,358.25
|
|
|
HC FO MODIFIED PIN
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
901309136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$53.06
|
| Rate for Payer: Blue Shield of California EPN |
$53.06
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.12
|
| Rate for Payer: Heritage Provider Network Senior |
$61.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC FO MODIFIED PIN
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
901309136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$53.06
|
| Rate for Payer: Blue Shield of California EPN |
$53.06
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.12
|
| Rate for Payer: Heritage Provider Network Senior |
$61.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.71
|
|
|
HC FOOT COMPLETE
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
909001631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.89 |
| Max. Negotiated Rate |
$517.50 |
| Rate for Payer: Adventist Health Commercial |
$138.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$444.36
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$467.13
|
| Rate for Payer: Heritage Provider Network Senior |
$467.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.50
|
| Rate for Payer: Multiplan Commercial |
$517.50
|
|
|
HC FOOT COMPLETE
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
909001631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$517.50 |
| Rate for Payer: Adventist Health Commercial |
$138.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$426.42
|
| 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 |
$144.08
|
| Rate for Payer: Blue Shield of California Commercial |
$109.97
|
| Rate for Payer: Blue Shield of California EPN |
$88.43
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$448.50
|
| 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 |
$407.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$427.11
|
| Rate for Payer: Heritage Provider Network Senior |
$427.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$329.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$517.50
|
| 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
|
|
|
HC FOOT LIMITED 2 VIEWS
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
909001632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$327.80
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.59
|
| Rate for Payer: Heritage Provider Network Senior |
$344.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
|
|
HC FOOT LIMITED 2 VIEWS
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
909001632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$314.56
|
| 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 |
$133.98
|
| Rate for Payer: Blue Shield of California Commercial |
$101.86
|
| Rate for Payer: Blue Shield of California EPN |
$81.91
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| 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 |
$300.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$242.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| 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
|
|
|
HC FOREARM
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
909001513
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.25 |
| Max. Negotiated Rate |
$440.25 |
| Rate for Payer: Adventist Health Commercial |
$117.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$378.03
|
| Rate for Payer: Cash Price |
$264.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$397.40
|
| Rate for Payer: Heritage Provider Network Senior |
$397.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.75
|
| Rate for Payer: Multiplan Commercial |
$440.25
|
|
|
HC FOREARM
|
Facility
|
OP
|
$587.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
909001513
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$440.25 |
| Rate for Payer: Adventist Health Commercial |
$117.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$362.77
|
| 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 |
$141.78
|
| Rate for Payer: Blue Shield of California Commercial |
$107.90
|
| Rate for Payer: Blue Shield of California EPN |
$86.77
|
| Rate for Payer: Cash Price |
$264.15
|
| Rate for Payer: Cash Price |
$264.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$381.55
|
| 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 |
$346.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$363.35
|
| Rate for Payer: Heritage Provider Network Senior |
$363.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$280.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$440.25
|
| 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
|
|
|
HC FOREIGN BODY NOSE/RECTUM CHILD
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
909001710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$296.64
|
| 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 |
$150.02
|
| Rate for Payer: Blue Shield of California Commercial |
$107.90
|
| Rate for Payer: Blue Shield of California EPN |
$86.77
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$312.00
|
| 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 |
$283.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$297.12
|
| Rate for Payer: Heritage Provider Network Senior |
$297.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$228.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| 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
|
|
|
HC FOREIGN BODY NOSE/RECTUM CHILD
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
909001710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$309.12
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.96
|
| Rate for Payer: Heritage Provider Network Senior |
$324.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
|
|
HC FORESKIN MANIPULATION
|
Facility
|
OP
|
$1,026.00
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
908710164
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$185.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$205.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$634.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$487.35
|
| Rate for Payer: Blue Shield of California EPN |
$387.83
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$666.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$321.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$694.60
|
| Rate for Payer: Heritage Provider Network Senior |
$694.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$489.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$769.50
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$615.60
|
| Rate for Payer: TriValley Medical Group Senior |
$615.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC FORESKIN MANIPULATION
|
Facility
|
IP
|
$1,026.00
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
908710164
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$185.71 |
| Max. Negotiated Rate |
$769.50 |
| Rate for Payer: Adventist Health Commercial |
$205.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$660.74
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$694.60
|
| Rate for Payer: Heritage Provider Network Senior |
$694.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.50
|
| Rate for Payer: Multiplan Commercial |
$769.50
|
|
|
HC FO SAFETY PIN WIRE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
901309135
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.25 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Vantage Medical Group Senior |
$123.25
|
| Rate for Payer: Adventist Health Commercial |
$59.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$89.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$123.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$58.29
|
| Rate for Payer: Blue Shield of California EPN |
$58.29
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$123.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.14
|
| Rate for Payer: Heritage Provider Network Senior |
$67.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$72.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$72.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.50
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$52.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$48.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$123.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.25
|
|
|
HC FO SAFETY PIN WIRE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
901309135
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$93.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$58.29
|
| Rate for Payer: Blue Shield of California EPN |
$58.29
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.14
|
| Rate for Payer: Heritage Provider Network Senior |
$67.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$72.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$72.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.25
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$52.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$48.01
|
|
|
HC FREE T4 BY EIA
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900912111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.88
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC FREE T4 BY EIA
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900912111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$85.59 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.59
|
| Rate for Payer: Blue Shield of California Commercial |
$72.58
|
| Rate for Payer: Blue Shield of California Commercial |
$72.58
|
| Rate for Payer: Blue Shield of California EPN |
$58.21
|
| Rate for Payer: Blue Shield of California EPN |
$58.21
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.95
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$56.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$128.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$43.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.09
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.02
|
| Rate for Payer: TriValley Medical Group Senior |
$9.02
|
| Rate for Payer: TriValley Medical Group Senior |
$9.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Vantage Medical Group Senior |
$9.02
|
| Rate for Payer: Vantage Medical Group Senior |
$9.02
|
|
|
HC FROZEN SECTION
|
Facility
|
OP
|
$597.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
903800035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$79.36 |
| Max. Negotiated Rate |
$447.75 |
| Rate for Payer: Adventist Health Commercial |
$119.40
|
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$368.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.18
|
| Rate for Payer: Blue Shield of California Commercial |
$98.69
|
| Rate for Payer: Blue Shield of California Commercial |
$98.69
|
| Rate for Payer: Blue Shield of California EPN |
$79.36
|
| Rate for Payer: Blue Shield of California EPN |
$79.36
|
| Rate for Payer: Cash Price |
$268.65
|
| Rate for Payer: Cash Price |
$268.65
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$388.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$369.54
|
| Rate for Payer: Heritage Provider Network Senior |
$105.23
|
| Rate for Payer: Heritage Provider Network Senior |
$369.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$81.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$284.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Multiplan Commercial |
$447.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC FROZEN SECTION
|
Facility
|
IP
|
$597.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
903800035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$108.06 |
| Max. Negotiated Rate |
$447.75 |
| Rate for Payer: Adventist Health Commercial |
$119.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.47
|
| Rate for Payer: Cash Price |
$268.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.17
|
| Rate for Payer: Heritage Provider Network Senior |
$404.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.25
|
| Rate for Payer: Multiplan Commercial |
$447.75
|
|
