|
HC INTERCOSTAL NERVE BLOCK SINGLE
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
900501673
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$168.69 |
| Max. Negotiated Rate |
$699.00 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$630.96
|
| Rate for Payer: Heritage Provider Network Senior |
$630.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
|
|
HC INTERDENTAL WIRING,OTH THN FRX
|
Facility
|
IP
|
$3,701.00
|
|
|
Service Code
|
CPT 21497
|
| Hospital Charge Code |
900501322
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$669.88 |
| Max. Negotiated Rate |
$2,775.75 |
| Rate for Payer: Adventist Health Commercial |
$740.20
|
| Rate for Payer: Cash Price |
$2,035.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,505.58
|
| Rate for Payer: Heritage Provider Network Senior |
$2,505.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$669.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$925.25
|
| Rate for Payer: Multiplan Commercial |
$2,775.75
|
|
|
HC INTERDENTAL WIRING,OTH THN FRX
|
Facility
|
OP
|
$3,701.00
|
|
|
Service Code
|
CPT 21497
|
| Hospital Charge Code |
900501322
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$740.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,542.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,035.55
|
| Rate for Payer: Cash Price |
$2,035.55
|
| Rate for Payer: Cash Price |
$2,035.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,405.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Senior |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,882.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,505.58
|
| Rate for Payer: Heritage Provider Network Senior |
$2,505.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,765.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$669.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,164.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$925.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,371.46
|
| Rate for Payer: Multiplan Commercial |
$2,775.75
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,331.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,225.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC INTERNAL CARDIOVERSION, ELECTR
|
Facility
|
IP
|
$1,161.00
|
|
|
Service Code
|
CPT 92961
|
| Hospital Charge Code |
906820077
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$210.14 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$232.20
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.25
|
| Rate for Payer: Multiplan Commercial |
$870.75
|
|
|
HC INTERNAL CARDIOVERSION, ELECTR
|
Facility
|
OP
|
$987.00
|
|
|
Service Code
|
CPT 92961
|
| Hospital Charge Code |
906812074
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$178.65 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$197.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$527.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$678.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$831.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$542.85
|
| Rate for Payer: Cash Price |
$542.85
|
| Rate for Payer: Cash Price |
$542.85
|
| Rate for Payer: Cash Price |
$542.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$641.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$914.61
|
| Rate for Payer: Dignity Health Senior |
$831.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$641.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$831.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$610.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1,022.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$279.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$831.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,579.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$956.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,047.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,047.64
|
| Rate for Payer: Multiplan Commercial |
$740.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$914.61
|
| Rate for Payer: TriValley Medical Group Senior |
$831.46
|
| 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 |
$1,247.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Vantage Medical Group Senior |
$831.46
|
|
|
HC INTERNAL CARDIOVERSION, ELECTR
|
Facility
|
IP
|
$987.00
|
|
|
Service Code
|
CPT 92961
|
| Hospital Charge Code |
906812074
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$178.65 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$197.40
|
| Rate for Payer: Cash Price |
$542.85
|
| Rate for Payer: Cash Price |
$542.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.75
|
| Rate for Payer: Multiplan Commercial |
$740.25
|
|
|
HC INTERNAL CARDIOVERSION, ELECTR
|
Facility
|
OP
|
$1,161.00
|
|
|
Service Code
|
CPT 92961
|
| Hospital Charge Code |
906820077
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$210.14 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$232.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$620.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$797.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$831.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$754.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$914.61
|
| Rate for Payer: Dignity Health Senior |
$831.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$754.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$831.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$718.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,022.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$279.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$831.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,579.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$956.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,047.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,047.64
|
| Rate for Payer: Multiplan Commercial |
$870.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$914.61
|
| Rate for Payer: TriValley Medical Group Senior |
$831.46
|
| 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 |
$1,247.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Vantage Medical Group Senior |
$831.46
|
|
|
HC INTERNAL CAROTID UNI
|
Facility
|
OP
|
$16,304.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
906820222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$3,260.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,200.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| 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 |
$8,967.20
|
| Rate for Payer: Cash Price |
$8,967.20
|
| Rate for Payer: Cash Price |
$8,967.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,597.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Senior |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,868.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,092.18
|
| Rate for Payer: Heritage Provider Network Senior |
$8,448.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$454.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,050.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,951.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,076.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,654.28
|
| Rate for Payer: Multiplan Commercial |
$12,228.00
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,555.33
|
| Rate for Payer: TriValley Medical Group Senior |
$7,555.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC INTERNAL CAROTID UNI
|
Facility
|
OP
|
$13,858.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
909020147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,771.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,520.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| 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 |
$7,621.90
|
| Rate for Payer: Cash Price |
$7,621.90
|
| Rate for Payer: Cash Price |
$7,621.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,007.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Senior |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,868.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,578.10
|
| Rate for Payer: Heritage Provider Network Senior |
$8,448.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$454.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,050.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,508.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,464.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,654.28
|
| Rate for Payer: Multiplan Commercial |
$10,393.50
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,555.33
|
| Rate for Payer: TriValley Medical Group Senior |
$7,555.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC INTERNAL CAROTID UNI
|
Facility
|
IP
|
$16,304.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
906820222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,951.02 |
| Max. Negotiated Rate |
$12,228.00 |
| Rate for Payer: Adventist Health Commercial |
$3,260.80
|
| Rate for Payer: Cash Price |
$8,967.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,037.81
|
| Rate for Payer: Heritage Provider Network Senior |
$11,037.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,951.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,076.00
|
| Rate for Payer: Multiplan Commercial |
$12,228.00
|
|
|
HC INTERNAL CAROTID UNI
|
Facility
|
IP
|
$13,858.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
909020147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,508.30 |
| Max. Negotiated Rate |
$10,393.50 |
| Rate for Payer: Adventist Health Commercial |
$2,771.60
|
| Rate for Payer: Cash Price |
$7,621.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,381.87
|
| Rate for Payer: Heritage Provider Network Senior |
$9,381.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,508.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,464.50
|
| Rate for Payer: Multiplan Commercial |
$10,393.50
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
909000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$30.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.75
|
| Rate for Payer: Blue Shield of California Commercial |
$34.77
|
| Rate for Payer: Blue Shield of California EPN |
$27.82
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.45
|
| Rate for Payer: Dignity Health Senior |
$48.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.28
|
| Rate for Payer: Heritage Provider Network Senior |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.90
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.45
|
| Rate for Payer: Vantage Medical Group Senior |
$48.45
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
906600075
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.88
|
| Rate for Payer: Heritage Provider Network Senior |
$35.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
909000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.59
|
| Rate for Payer: Heritage Provider Network Senior |
$38.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
909300075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.59
|
| Rate for Payer: Heritage Provider Network Senior |
$38.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
909200075
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.25
|
| Rate for Payer: Blue Shield of California Commercial |
$31.11
|
| Rate for Payer: Blue Shield of California EPN |
$24.89
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.35
|
| Rate for Payer: Dignity Health Senior |
$43.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.70
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.35
|
| Rate for Payer: Vantage Medical Group Senior |
$43.35
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
909200075
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.53
|
| Rate for Payer: Heritage Provider Network Senior |
$34.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.75
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$53.00
|
|
| Hospital Charge Code |
906600075
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$45.05 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.75
|
| Rate for Payer: Blue Shield of California Commercial |
$32.33
|
| Rate for Payer: Blue Shield of California EPN |
$25.86
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.05
|
| Rate for Payer: Dignity Health Senior |
$45.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.81
|
| Rate for Payer: Heritage Provider Network Senior |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.10
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.05
|
| Rate for Payer: Vantage Medical Group Senior |
$45.05
|
|
|
HC INTERPRET OUTSIDE FILMS
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
909300075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$30.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.75
|
| Rate for Payer: Blue Shield of California Commercial |
$34.77
|
| Rate for Payer: Blue Shield of California EPN |
$27.82
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.45
|
| Rate for Payer: Dignity Health Senior |
$48.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.28
|
| Rate for Payer: Heritage Provider Network Senior |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.90
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.45
|
| Rate for Payer: Vantage Medical Group Senior |
$48.45
|
|
|
HC INTERPRET OUTSIDE FILMS MRI
|
Facility
|
OP
|
$55.00
|
|
| Hospital Charge Code |
908800075
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$1,075.00 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.25
|
| Rate for Payer: Blue Shield of California Commercial |
$33.55
|
| Rate for Payer: Blue Shield of California EPN |
$26.84
|
| Rate for Payer: Cash Price |
$30.25
|
| Rate for Payer: Cash Price |
$30.25
|
| Rate for Payer: Cash Price |
$30.25
|
| Rate for Payer: Cash Price |
$30.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.75
|
| Rate for Payer: Dignity Health Senior |
$46.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.50
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: Vantage Medical Group Senior |
$46.75
|
|
|
HC INTERPRET OUTSIDE FILMS MRI
|
Facility
|
IP
|
$55.00
|
|
| Hospital Charge Code |
908800075
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$929.00 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$30.25
|
| Rate for Payer: Cash Price |
$30.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.23
|
| Rate for Payer: Heritage Provider Network Senior |
$37.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC INTERROGATE SUBQ DEFIB
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
900293261
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.53
|
| Rate for Payer: Heritage Provider Network Senior |
$78.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
|
|
HC INTERROGATE SUBQ DEFIB
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
900293261
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.38
|
| Rate for Payer: Blue Shield of California Commercial |
$70.76
|
| Rate for Payer: Blue Shield of California EPN |
$56.61
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$75.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.12
|
| Rate for Payer: Dignity Health Senior |
$47.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$47.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.80
|
| Rate for Payer: Heritage Provider Network Senior |
$71.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$55.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.70
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$52.12
|
| Rate for Payer: TriValley Medical Group Senior |
$47.38
|
| 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 |
$71.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.38
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
OP
|
$10,594.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,118.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,278.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$5,826.70
|
| Rate for Payer: Cash Price |
$5,826.70
|
| Rate for Payer: Cash Price |
$5,826.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,886.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,172.14
|
| Rate for Payer: Heritage Provider Network Senior |
$7,172.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,053.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,917.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,648.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$7,945.50
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,811.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,507.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
OP
|
$10,594.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,118.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,278.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| 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 |
$5,826.70
|
| Rate for Payer: Cash Price |
$5,826.70
|
| Rate for Payer: Cash Price |
$5,826.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,886.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,557.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,053.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,917.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,648.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$7,945.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
