|
HC POOL EXERCISE EA ADDL 15 MIN PT
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$228.75 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$209.54
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$206.48
|
| Rate for Payer: Heritage Provider Network Senior |
$206.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.25
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
|
|
HC POOL EXERCISE EA ADDL 15 MIN PT
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$209.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$198.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.25
|
| Rate for Payer: Dignity Health Senior |
$259.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.80
|
| Rate for Payer: Heritage Provider Network Senior |
$188.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$147.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.25
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.25
|
| Rate for Payer: Vantage Medical Group Senior |
$259.25
|
|
|
HC POOL EXERCISE INIT 30 MIN PT
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400412
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$313.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$342.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$296.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$387.60
|
| Rate for Payer: Dignity Health Senior |
$387.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$282.26
|
| Rate for Payer: Heritage Provider Network Senior |
$282.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$219.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$387.60
|
| Rate for Payer: Vantage Medical Group Senior |
$387.60
|
|
|
HC POOL EXERCISE INIT 30 MIN PT
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400412
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$82.54 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$313.27
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$308.71
|
| Rate for Payer: Heritage Provider Network Senior |
$308.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$342.00
|
|
|
HC POOLING COMPONENTS
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$405.48 |
| Rate for Payer: Adventist Health Commercial |
$68.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$234.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.63
|
| Rate for Payer: Blue Shield of California Commercial |
$212.38
|
| Rate for Payer: Blue Shield of California EPN |
$200.75
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$222.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$222.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.70
|
| Rate for Payer: Heritage Provider Network Senior |
$211.70
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$256.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$213.41
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| 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: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC POOLING COMPONENTS
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Adventist Health Commercial |
$68.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$234.95
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$231.53
|
| Rate for Payer: Heritage Provider Network Senior |
$231.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.50
|
| Rate for Payer: Multiplan Commercial |
$256.50
|
|
|
HC POOL THRPY W/EXERCISE ADD 15 M
|
Facility
|
OP
|
$228.00
|
|
| Hospital Charge Code |
905103312
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$121.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$156.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$148.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.80
|
| Rate for Payer: Dignity Health Senior |
$193.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.13
|
| Rate for Payer: Heritage Provider Network Senior |
$141.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$109.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$171.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.80
|
| Rate for Payer: Vantage Medical Group Senior |
$193.80
|
|
|
HC POOL THRPY W/EXERCISE ADD 15 M
|
Facility
|
IP
|
$228.00
|
|
| Hospital Charge Code |
905103312
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$156.64
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$154.36
|
| Rate for Payer: Heritage Provider Network Senior |
$154.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$171.00
|
|
|
HC POOL THRPY W EXERCISE ADD 15 MIN MCAL
|
Facility
|
OP
|
$248.00
|
|
| Hospital Charge Code |
900419081
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.89 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$132.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$170.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$210.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$161.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$210.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$210.80
|
| Rate for Payer: Dignity Health Senior |
$210.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$153.51
|
| Rate for Payer: Heritage Provider Network Senior |
$153.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$119.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$210.80
|
| Rate for Payer: Vantage Medical Group Senior |
$210.80
|
|
|
HC POOL THRPY W EXERCISE ADD 15 MIN MCAL
|
Facility
|
IP
|
$248.00
|
|
| Hospital Charge Code |
900419081
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.89 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$170.38
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.90
|
| Rate for Payer: Heritage Provider Network Senior |
$167.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
|
|
HC POOL THRPY W/EXERCISE INTL 30
|
Facility
|
OP
|
$280.00
|
|
| Hospital Charge Code |
905103311
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.00
|
| Rate for Payer: Dignity Health Senior |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.32
|
| Rate for Payer: Heritage Provider Network Senior |
$173.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$134.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.00
|
| Rate for Payer: Vantage Medical Group Senior |
$238.00
|
|
|
HC POOL THRPY W/EXERCISE INTL 30
|
Facility
|
IP
|
$280.00
|
|
| Hospital Charge Code |
905103311
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.36
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.56
|
| Rate for Payer: Heritage Provider Network Senior |
$189.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
|
|
HC POOL THRPY W EXERCISE INTL 30 MCAL
|
Facility
|
OP
|
$388.00
|
|
| Hospital Charge Code |
900419080
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.23 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$77.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$207.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$266.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$329.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$213.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$291.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$252.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$329.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$329.80
|
| Rate for Payer: Dignity Health Senior |
$329.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$240.17
|
| Rate for Payer: Heritage Provider Network Senior |
$240.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$187.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.00
|
| Rate for Payer: Multiplan Commercial |
$291.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$329.80
|
| Rate for Payer: Vantage Medical Group Senior |
$329.80
|
|
|
HC POOL THRPY W EXERCISE INTL 30 MCAL
|
Facility
|
IP
|
$388.00
|
|
| Hospital Charge Code |
900419080
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.23 |
| Max. Negotiated Rate |
$291.00 |
| Rate for Payer: Adventist Health Commercial |
$77.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$266.56
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$262.68
|
| Rate for Payer: Heritage Provider Network Senior |
$262.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.00
|
| Rate for Payer: Multiplan Commercial |
$291.00
|
|
|
HC PORPHOBILINOGEN QUAL
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 84106
|
| Hospital Charge Code |
900910297
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.81
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.59
|
| Rate for Payer: Heritage Provider Network Senior |
$82.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.50
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
|
|
HC PORPHOBILINOGEN QUAL
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84106
|
| Hospital Charge Code |
900910297
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$35.84 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.84
|
| Rate for Payer: Blue Shield of California Commercial |
$33.48
|
| Rate for Payer: Blue Shield of California EPN |
$26.18
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Senior |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$5.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.33
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC PORT A CATH PERITONEAL PERM
|
Facility
|
OP
|
$1,318.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$263.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$632.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$905.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,120.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$724.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$988.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$818.48
|
| Rate for Payer: Blue Shield of California EPN |
$773.67
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$606.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,120.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,120.30
|
| Rate for Payer: Dignity Health Senior |
$1,120.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$843.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$610.23
|
| Rate for Payer: Heritage Provider Network Senior |
$610.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$659.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$659.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$659.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.50
|
| Rate for Payer: Multiplan Commercial |
$988.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$480.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$440.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,120.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,120.30
|
|
|
HC PORT A CATH PERITONEAL PERM
|
Facility
|
IP
|
$1,318.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$263.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$632.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$905.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$606.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$892.29
|
| Rate for Payer: Heritage Provider Network Senior |
$892.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$659.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$659.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$659.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.50
|
| Rate for Payer: Multiplan Commercial |
$988.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$480.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$440.34
|
|
|
HC PORTAL VEIN CATHETER
|
Facility
|
OP
|
$3,790.00
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
909081327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$454.18 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$758.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,603.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,221.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,084.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,842.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,463.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,221.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,221.50
|
| Rate for Payer: Dignity Health Senior |
$3,221.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,346.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2,346.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$454.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,826.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$947.50
|
| Rate for Payer: Multiplan Commercial |
$2,842.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,221.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,221.50
|
|
|
HC PORTAL VEIN CATHETER
|
Facility
|
IP
|
$3,790.00
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
909081327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$685.99 |
| Max. Negotiated Rate |
$2,842.50 |
| Rate for Payer: Adventist Health Commercial |
$758.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,603.73
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,565.83
|
| Rate for Payer: Heritage Provider Network Senior |
$2,565.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$947.50
|
| Rate for Payer: Multiplan Commercial |
$2,842.50
|
|
|
HC PORTEX DIC INNER CANNULA 10.0
|
Facility
|
IP
|
$37.47
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800824
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$28.10 |
| Rate for Payer: Adventist Health Commercial |
$7.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.74
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.37
|
| Rate for Payer: Heritage Provider Network Senior |
$25.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.37
|
| Rate for Payer: Multiplan Commercial |
$28.10
|
|
|
HC PORTEX DIC INNER CANNULA 10.0
|
Facility
|
OP
|
$37.47
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800824
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Adventist Health Commercial |
$7.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.10
|
| Rate for Payer: Blue Shield of California Commercial |
$23.27
|
| Rate for Payer: Blue Shield of California EPN |
$21.99
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.85
|
| Rate for Payer: Dignity Health Senior |
$31.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.19
|
| Rate for Payer: Heritage Provider Network Senior |
$23.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.37
|
| Rate for Payer: Multiplan Commercial |
$28.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.85
|
| Rate for Payer: Vantage Medical Group Senior |
$31.85
|
|
|
HC PORTEX DIC INNER CANNULA 6.0
|
Facility
|
IP
|
$35.26
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$26.44 |
| Rate for Payer: Adventist Health Commercial |
$7.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.22
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.87
|
| Rate for Payer: Heritage Provider Network Senior |
$23.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$26.44
|
|
|
HC PORTEX DIC INNER CANNULA 6.0
|
Facility
|
OP
|
$35.26
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$29.97 |
| Rate for Payer: Adventist Health Commercial |
$7.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.44
|
| Rate for Payer: Blue Shield of California Commercial |
$21.90
|
| Rate for Payer: Blue Shield of California EPN |
$20.70
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.97
|
| Rate for Payer: Dignity Health Senior |
$29.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.83
|
| Rate for Payer: Heritage Provider Network Senior |
$21.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$26.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.97
|
| Rate for Payer: Vantage Medical Group Senior |
$29.97
|
|
|
HC PORTEX DIC INNER CANNULA 7.0
|
Facility
|
IP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$26.81 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.56
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.20
|
| Rate for Payer: Heritage Provider Network Senior |
$24.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
|
