|
HC PT SUBSTITUTION
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
900910105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.92
|
| Rate for Payer: Heritage Provider Network Senior |
$125.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
|
|
HC PT SUBSTITUTION
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
900910105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.97
|
| Rate for Payer: Blue Shield of California Commercial |
$30.80
|
| Rate for Payer: Blue Shield of California EPN |
$24.08
|
| 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 |
$5.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.33
|
| Rate for Payer: Dignity Health Senior |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$3.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.96
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.94
|
| Rate for Payer: TriValley Medical Group Senior |
$3.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Vantage Medical Group Senior |
$3.94
|
|
|
HC PTT
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$50.27 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.27
|
| Rate for Payer: Blue Shield of California Commercial |
$46.84
|
| Rate for Payer: Blue Shield of California EPN |
$36.62
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Senior |
$6.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.00
|
| Rate for Payer: Heritage Provider Network Senior |
$13.00
|
| Rate for Payer: Humana Medicare |
$6.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.57
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Senior |
$6.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC PTT
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.28
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.34
|
| Rate for Payer: Heritage Provider Network Senior |
$131.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
|
|
HC PTT SUBSTITUTION
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910106
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.15
|
| Rate for Payer: Blue Shield of California Commercial |
$50.53
|
| Rate for Payer: Blue Shield of California EPN |
$39.50
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Humana Medicare |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC PTT SUBSTITUTION
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910106
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.28
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.34
|
| Rate for Payer: Heritage Provider Network Senior |
$131.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
OP
|
$2,688.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906811417
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$145.39 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$537.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,846.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,284.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,478.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,016.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$1,209.60
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,284.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,284.80
|
| Rate for Payer: Dignity Health Senior |
$2,284.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,747.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,663.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,663.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,295.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$486.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$672.00
|
| Rate for Payer: Multiplan Commercial |
$2,016.00
|
| 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 |
$2,284.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,284.80
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
OP
|
$2,445.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906820074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$145.39 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$489.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,679.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,078.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,344.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,833.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$1,100.25
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,078.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,078.25
|
| Rate for Payer: Dignity Health Senior |
$2,078.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,589.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,513.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,513.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,178.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$442.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.25
|
| Rate for Payer: Multiplan Commercial |
$1,833.75
|
| 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 |
$2,078.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,078.25
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
IP
|
$2,688.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906811417
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$486.53 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$537.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,846.66
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$486.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$672.00
|
| Rate for Payer: Multiplan Commercial |
$2,016.00
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
IP
|
$2,445.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906820074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$442.54 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$489.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,679.72
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$442.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.25
|
| Rate for Payer: Multiplan Commercial |
$1,833.75
|
|
|
HC PULM PERFUSION SCAN
|
Facility
|
OP
|
$1,762.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
909301400
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$1,321.50 |
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$391.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,210.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$699.84
|
| Rate for Payer: Blue Shield of California EPN |
$397.98
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,145.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,145.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,090.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,090.68
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC PULM PERFUSION SCAN
|
Facility
|
IP
|
$1,762.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
909301400
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$318.92 |
| Max. Negotiated Rate |
$1,321.50 |
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,210.49
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,192.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,192.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.50
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
|
|
HC PULM PERF & VENT/VQ
|
Facility
|
OP
|
$2,175.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
909301403
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$393.68 |
| Max. Negotiated Rate |
$1,883.64 |
| Rate for Payer: Adventist Health Commercial |
$435.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$608.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,494.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,883.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,563.20
|
| Rate for Payer: Blue Shield of California EPN |
$888.94
|
| Rate for Payer: Cash Price |
$978.75
|
| Rate for Payer: Cash Price |
$978.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,413.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: Dignity Health Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,413.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$675.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,346.32
|
| Rate for Payer: Heritage Provider Network Senior |
$1,346.32
|
| Rate for Payer: Humana Medicare |
$675.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$453.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,283.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$796.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$850.92
|
| Rate for Payer: Multiplan Commercial |
$1,631.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$742.86
|
| Rate for Payer: TriValley Medical Group Senior |
$675.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC PULM PERF & VENT/VQ
|
Facility
|
IP
|
$2,175.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
909301403
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$393.68 |
| Max. Negotiated Rate |
$1,631.25 |
| Rate for Payer: Adventist Health Commercial |
$435.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,494.22
|
| Rate for Payer: Cash Price |
$978.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,472.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,472.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.75
|
| Rate for Payer: Multiplan Commercial |
$1,631.25
|
|
|
HC PULM STRESS TEST COMPLEX
|
Facility
|
OP
|
$3,286.00
|
|
|
Service Code
|
CPT 94621
|
| Hospital Charge Code |
900801021
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$155.39 |
| Max. Negotiated Rate |
$2,464.50 |
| Rate for Payer: Adventist Health Commercial |
$657.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$226.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,257.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Blue Shield of California Commercial |
$333.66
|
| Rate for Payer: Blue Shield of California EPN |
$189.74
|
| Rate for Payer: Cash Price |
$1,478.70
|
| Rate for Payer: Cash Price |
$1,478.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,135.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,135.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,034.03
|
| Rate for Payer: Heritage Provider Network Senior |
$2,034.03
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$155.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$745.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$594.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$821.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$2,464.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$431.39
|
| Rate for Payer: TriValley Medical Group Senior |
$392.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC PULM STRESS TEST COMPLEX
|
Facility
|
IP
|
$3,286.00
|
|
|
Service Code
|
CPT 94621
|
| Hospital Charge Code |
900801021
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$594.77 |
| Max. Negotiated Rate |
$2,464.50 |
| Rate for Payer: Adventist Health Commercial |
$657.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,257.48
|
| Rate for Payer: Cash Price |
$1,478.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,224.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2,224.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$594.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$821.50
|
| Rate for Payer: Multiplan Commercial |
$2,464.50
|
|
|
HC PULM STRESS TEST SIMPLE
|
Facility
|
IP
|
$1,997.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
900801020
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$361.46 |
| Max. Negotiated Rate |
$1,497.75 |
| Rate for Payer: Adventist Health Commercial |
$399.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,371.94
|
| Rate for Payer: Cash Price |
$898.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,351.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,351.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.25
|
| Rate for Payer: Multiplan Commercial |
$1,497.75
|
|
|
HC PULM STRESS TEST SIMPLE
|
Facility
|
OP
|
$1,997.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
900801020
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$27.39 |
| Max. Negotiated Rate |
$1,497.75 |
| Rate for Payer: Adventist Health Commercial |
$399.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,371.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Blue Shield of California Commercial |
$62.21
|
| Rate for Payer: Blue Shield of California EPN |
$35.38
|
| Rate for Payer: Cash Price |
$898.65
|
| Rate for Payer: Cash Price |
$898.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,298.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,298.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,236.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,236.14
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$1,497.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.56
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC PULSE OXIMETRY MULT DETER
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
900800106
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$343.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22.14
|
| Rate for Payer: Blue Shield of California EPN |
$12.59
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$325.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$425.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.00
|
| Rate for Payer: Dignity Health Senior |
$425.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$309.50
|
| Rate for Payer: Heritage Provider Network Senior |
$309.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$241.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.00
|
| Rate for Payer: Vantage Medical Group Senior |
$425.00
|
|
|
HC PULSE OXIMETRY MULT DETER
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
900800106
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$343.50
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$338.50
|
| Rate for Payer: Heritage Provider Network Senior |
$338.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: Dignity Health Senior |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.32
|
| Rate for Payer: Heritage Provider Network Senior |
$152.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$108.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$81.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$75.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$168.75 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.32
|
| Rate for Payer: Heritage Provider Network Senior |
$152.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.75
|
| Rate for Payer: Blue Shield of California Commercial |
$10.67
|
| Rate for Payer: Blue Shield of California EPN |
$6.07
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: Dignity Health Senior |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.28
|
| Rate for Payer: Heritage Provider Network Senior |
$139.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$108.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$168.75 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.32
|
| Rate for Payer: Heritage Provider Network Senior |
$152.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
|
|
HC PUNCH BX SKIN EA SEP/ADD LSN
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
900511105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.63
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.19
|
| Rate for Payer: Heritage Provider Network Senior |
$165.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
|
