|
HC LIGATION HEMORRHOID(S)
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
906746221
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$468.61 |
| Max. Negotiated Rate |
$1,941.75 |
| Rate for Payer: Adventist Health Commercial |
$517.80
|
| Rate for Payer: Cash Price |
$1,423.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,752.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1,752.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$468.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.25
|
| Rate for Payer: Multiplan Commercial |
$1,941.75
|
|
|
HC LIGATION HEMORRHOID(S)
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
906746221
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$468.61 |
| Max. Negotiated Rate |
$1,941.75 |
| Rate for Payer: Adventist Health Commercial |
$517.80
|
| Rate for Payer: Cash Price |
$1,423.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,752.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1,752.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$468.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.25
|
| Rate for Payer: Multiplan Commercial |
$1,941.75
|
|
|
HC LIGATION HEMORRHOID(S)
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
906746221
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$517.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,778.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| 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 |
$1,423.95
|
| Rate for Payer: Cash Price |
$1,423.95
|
| Rate for Payer: Cash Price |
$1,423.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,682.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Senior |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,158.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,602.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,424.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$124.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,234.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$468.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,332.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,459.61
|
| Rate for Payer: Multiplan Commercial |
$1,941.75
|
| 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 |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC LIGATION OF EXTREMITY ARTERY
|
Facility
|
OP
|
$4,357.00
|
|
|
Service Code
|
CPT 37618
|
| Hospital Charge Code |
900501675
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$788.62 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$871.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,328.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,993.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,703.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,396.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,267.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$2,396.35
|
| Rate for Payer: Cash Price |
$2,396.35
|
| Rate for Payer: Cash Price |
$2,396.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,832.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,703.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,703.45
|
| Rate for Payer: Dignity Health Senior |
$3,703.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,949.69
|
| Rate for Payer: Heritage Provider Network Senior |
$2,949.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,078.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,089.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,049.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,049.90
|
| Rate for Payer: Multiplan Commercial |
$3,267.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,567.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,442.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,703.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,703.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,703.45
|
|
|
HC LIGATION OF EXTREMITY ARTERY
|
Facility
|
OP
|
$4,357.00
|
|
|
Service Code
|
CPT 37618
|
| Hospital Charge Code |
900501144
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$788.62 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$871.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,993.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,703.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,396.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,267.75
|
| 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 |
$2,396.35
|
| Rate for Payer: Cash Price |
$2,396.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,832.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,703.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,703.45
|
| Rate for Payer: Dignity Health Senior |
$3,703.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,696.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,696.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,078.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,089.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,049.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,049.90
|
| Rate for Payer: Multiplan Commercial |
$3,267.75
|
| 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 |
$3,703.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,703.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,703.45
|
|
|
HC LIGATION OF EXTREMITY ARTERY
|
Facility
|
IP
|
$4,357.00
|
|
|
Service Code
|
CPT 37618
|
| Hospital Charge Code |
900501144
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$788.62 |
| Max. Negotiated Rate |
$3,267.75 |
| Rate for Payer: Adventist Health Commercial |
$871.40
|
| Rate for Payer: Cash Price |
$2,396.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,949.69
|
| Rate for Payer: Heritage Provider Network Senior |
$2,949.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,089.25
|
| Rate for Payer: Multiplan Commercial |
$3,267.75
|
|
|
HC LIGATION OF EXTREMITY ARTERY
|
Facility
|
IP
|
$4,357.00
|
|
|
Service Code
|
CPT 37618
|
| Hospital Charge Code |
900501675
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$788.62 |
| Max. Negotiated Rate |
$3,267.75 |
| Rate for Payer: Adventist Health Commercial |
$871.40
|
| Rate for Payer: Cash Price |
$2,396.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,949.69
|
| Rate for Payer: Heritage Provider Network Senior |
$2,949.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,089.25
|
| Rate for Payer: Multiplan Commercial |
$3,267.75
|
|
|
HC LIGATION OF NECK ARTERY
|
Facility
|
IP
|
$4,038.00
|
|
|
Service Code
|
CPT 37615
|
| Hospital Charge Code |
900501435
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$730.88 |
| Max. Negotiated Rate |
$3,028.50 |
| Rate for Payer: Adventist Health Commercial |
$807.60
|
| Rate for Payer: Cash Price |
$2,220.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,733.73
|
| Rate for Payer: Heritage Provider Network Senior |
$2,733.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,009.50
|
| Rate for Payer: Multiplan Commercial |
$3,028.50
|
|
|
HC LIGATION OF NECK ARTERY
|
Facility
|
OP
|
$4,038.00
|
|
|
Service Code
|
CPT 37615
|
| Hospital Charge Code |
900501435
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$730.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$807.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,158.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,774.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$2,220.90
|
| Rate for Payer: Cash Price |
$2,220.90
|
| Rate for Payer: Cash Price |
$2,220.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,624.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,733.73
|
| Rate for Payer: Heritage Provider Network Senior |
$2,733.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,926.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,009.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$3,028.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,452.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,336.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC LIMB MUSCLE TESTING MANUAL MCAL
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
900400008
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$87.42 |
| Max. Negotiated Rate |
$410.55 |
| Rate for Payer: Adventist Health Commercial |
$198.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$258.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$331.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$362.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$265.65
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$410.55
|
| Rate for Payer: Dignity Health Senior |
$410.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.98
|
| Rate for Payer: Heritage Provider Network Senior |
$298.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$230.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.10
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| 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 |
$410.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$410.55
|
| Rate for Payer: Vantage Medical Group Senior |
$410.55
|
|
|
HC LIMB MUSCLE TESTING MANUAL MCAL
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
901300023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$87.42 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.99
|
| Rate for Payer: Heritage Provider Network Senior |
$326.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.75
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
|
|
HC LIMB MUSCLE TESTING MANUAL MCAL
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
900400008
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$87.42 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.99
|
| Rate for Payer: Heritage Provider Network Senior |
$326.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.75
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
|
|
HC LIMB MUSCLE TESTING MANUAL MCAL
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
901300023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$87.42 |
| Max. Negotiated Rate |
$410.55 |
| Rate for Payer: Adventist Health Commercial |
$198.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$258.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$331.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$362.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$265.65
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$410.55
|
| Rate for Payer: Dignity Health Senior |
$410.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.98
|
| Rate for Payer: Heritage Provider Network Senior |
$298.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$230.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.10
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| 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 |
$410.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$410.55
|
| Rate for Payer: Vantage Medical Group Senior |
$410.55
|
|
|
HC LIMB MUSCLE TESTING MANUAL OT
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
905104402
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$87.42 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.99
|
| Rate for Payer: Heritage Provider Network Senior |
$326.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.75
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
|
|
HC LIMB MUSCLE TESTING MANUAL OT
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
905104402
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$87.42 |
| Max. Negotiated Rate |
$410.55 |
| Rate for Payer: Adventist Health Commercial |
$198.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$258.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$331.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$362.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$265.65
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$410.55
|
| Rate for Payer: Dignity Health Senior |
$410.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.98
|
| Rate for Payer: Heritage Provider Network Senior |
$298.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$230.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.10
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| 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 |
$410.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$410.55
|
| Rate for Payer: Vantage Medical Group Senior |
$410.55
|
|
|
HC LIMB MUSCLE TESTING MANUAL PT
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
905103402
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$95.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$125.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$198.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$152.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$198.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.90
|
| Rate for Payer: Dignity Health Senior |
$198.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.85
|
| Rate for Payer: Heritage Provider Network Senior |
$144.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$111.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$163.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$175.50
|
| 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 |
$198.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.90
|
| Rate for Payer: Vantage Medical Group Senior |
$198.90
|
|
|
HC LIMB MUSCLE TESTING MANUAL PT
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
905103402
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Adventist Health Commercial |
$46.80
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$158.42
|
| Rate for Payer: Heritage Provider Network Senior |
$158.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$175.50
|
|
|
HC LIMB MUSCLE TESTING MANUAL PT
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
900419057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.73 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$178.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$232.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$298.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$326.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$239.25
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$282.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: Dignity Health Senior |
$369.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.26
|
| Rate for Payer: Heritage Provider Network Senior |
$269.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$207.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$304.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$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 |
$369.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC LIMB MUSCLE TESTING MANUAL PT
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
900419057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.73 |
| Max. Negotiated Rate |
$326.25 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.50
|
| Rate for Payer: Heritage Provider Network Senior |
$294.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.75
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
|
|
HC LIPASE
|
Facility
|
IP
|
$206.40
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900910334
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.36 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Adventist Health Commercial |
$41.28
|
| Rate for Payer: Cash Price |
$113.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.73
|
| Rate for Payer: Heritage Provider Network Senior |
$139.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: Multiplan Commercial |
$154.80
|
|
|
HC LIPASE
|
Facility
|
OP
|
$206.40
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900910334
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Adventist Health Commercial |
$41.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$110.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$141.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.82
|
| Rate for Payer: Blue Shield of California Commercial |
$55.41
|
| Rate for Payer: Blue Shield of California EPN |
$44.44
|
| Rate for Payer: Cash Price |
$113.52
|
| Rate for Payer: Cash Price |
$113.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$134.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Senior |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.76
|
| Rate for Payer: Heritage Provider Network Senior |
$127.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$98.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$154.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.89
|
| Rate for Payer: TriValley Medical Group Senior |
$6.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC LIPASE BODY FLUID
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900912244
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.39
|
| Rate for Payer: Heritage Provider Network Senior |
$47.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
|
|
HC LIPASE BODY FLUID
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900912244
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$62.82 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.82
|
| Rate for Payer: Blue Shield of California Commercial |
$55.41
|
| Rate for Payer: Blue Shield of California EPN |
$44.44
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Senior |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.89
|
| Rate for Payer: TriValley Medical Group Senior |
$6.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC LIPID PANEL MC
|
Facility
|
IP
|
$44.02
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
900912170
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$33.02 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Cash Price |
$24.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.80
|
| Rate for Payer: Heritage Provider Network Senior |
$29.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.01
|
| Rate for Payer: Multiplan Commercial |
$33.02
|
|
|
HC LIPID PANEL MC
|
Facility
|
OP
|
$44.02
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
900912170
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$122.25 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.25
|
| Rate for Payer: Blue Shield of California Commercial |
$107.83
|
| Rate for Payer: Blue Shield of California EPN |
$86.49
|
| Rate for Payer: Cash Price |
$24.21
|
| Rate for Payer: Cash Price |
$24.21
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.73
|
| Rate for Payer: Dignity Health Senior |
$13.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.25
|
| Rate for Payer: Heritage Provider Network Senior |
$27.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.87
|
| Rate for Payer: Multiplan Commercial |
$33.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.39
|
| Rate for Payer: TriValley Medical Group Senior |
$13.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.73
|
| Rate for Payer: Vantage Medical Group Senior |
$13.39
|
|
