|
HC INCSNAL BX SKIN EA SEP/ADD LSN
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
900511107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.79 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$292.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$402.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$260.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$355.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$308.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$402.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$402.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$293.41
|
| Rate for Payer: Heritage Provider Network Senior |
$293.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$226.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$331.80
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$402.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$402.90
|
| Rate for Payer: Vantage Medical Group Senior |
$402.90
|
|
|
HC INCSNAL BX SKIN EA SEP/ADD LSN
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
900511107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.79 |
| Max. Negotiated Rate |
$355.50 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$305.26
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.90
|
| Rate for Payer: Heritage Provider Network Senior |
$320.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.50
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
|
|
HC INDR HAUSDORF-LOCK
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812556
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.52
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.66
|
| Rate for Payer: Heritage Provider Network Senior |
$392.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
|
|
HC INDR HAUSDORF-LOCK
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812556
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$358.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$290.12
|
| Rate for Payer: Blue Shield of California Commercial |
$353.80
|
| Rate for Payer: Blue Shield of California EPN |
$283.04
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$377.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$359.02
|
| Rate for Payer: Heritage Provider Network Senior |
$359.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$276.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$290.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC INDR MICROPUNCTURE NEEDLE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.28
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
|
HC INDR MICROPUNCTURE NEEDLE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.02
|
| Rate for Payer: Blue Shield of California Commercial |
$73.20
|
| Rate for Payer: Blue Shield of California EPN |
$58.56
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$60.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC INFANT LOWER EXT 2 VIEW
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
909001630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$492.75 |
| Rate for Payer: Adventist Health Commercial |
$131.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$406.03
|
| 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 |
$295.65
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$427.05
|
| 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 |
$387.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$406.68
|
| Rate for Payer: Heritage Provider Network Senior |
$406.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$313.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$492.75
|
| 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 INFANT LOWER EXT 2 VIEW
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
909001630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.92 |
| Max. Negotiated Rate |
$492.75 |
| Rate for Payer: Adventist Health Commercial |
$131.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.11
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$444.79
|
| Rate for Payer: Heritage Provider Network Senior |
$444.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.25
|
| Rate for Payer: Multiplan Commercial |
$492.75
|
|
|
HC INFANT UPPER EXT 2 VIEW
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
909001555
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.91 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$430.19
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$452.24
|
| Rate for Payer: Heritage Provider Network Senior |
$452.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
|
|
HC INFANT UPPER EXT 2 VIEW
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
909001555
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$412.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| 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 |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$434.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$413.49
|
| Rate for Payer: Heritage Provider Network Senior |
$413.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$318.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| 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 |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC INFLUENZA A ANTIGEN
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
900911778
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.80
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC INFLUENZA A ANTIGEN
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
900911778
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$74.76 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.11
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.93
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.13
|
| Rate for Payer: TriValley Medical Group Senior |
$14.13
|
| Rate for Payer: TriValley Medical Group Senior |
$14.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14.13
|
| Rate for Payer: Vantage Medical Group Senior |
$14.13
|
|
|
HC INFLUENZA A, B AG
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
900913680
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.11
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.76
|
| Rate for Payer: Heritage Provider Network Senior |
$63.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$49.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.93
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.13
|
| Rate for Payer: TriValley Medical Group Senior |
$14.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14.13
|
|
|
HC INFLUENZA A, B AG
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
900913680
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.33
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.73
|
| Rate for Payer: Heritage Provider Network Senior |
$69.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
|
|
HC INFRARED MCAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
901300047
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC INFRARED MCAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
901300047
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC INFRARED OT
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
905103161
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC INFRARED OT
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
905103161
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC INFRARED PT
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
905103162
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC INFRARED PT
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
900417040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC INFRARED PT
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
900417040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC INFRARED PT
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
905103162
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$60.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.42
|
| Rate for Payer: Heritage Provider Network Senior |
$72.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$55.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$66.25
|
| Rate for Payer: TriValley Medical Group Senior |
$60.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$55.58
|
| Rate for Payer: Blue Shield of California EPN |
$44.23
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$60.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.21
|
| Rate for Payer: Heritage Provider Network Senior |
$79.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$55.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Multiplan WC |
$93.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$70.20
|
| Rate for Payer: TriValley Medical Group Senior |
$70.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.35
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.21
|
| Rate for Payer: Heritage Provider Network Senior |
$79.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.25
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
|
