|
HC INS STABL DEV WO DCMPRN
|
Facility
|
OP
|
$78,413.00
|
|
|
Service Code
|
CPT 22869
|
| Hospital Charge Code |
900102190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$58,809.75 |
| Rate for Payer: Adventist Health Commercial |
$15,682.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48,459.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,512.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$35,285.85
|
| Rate for Payer: Cash Price |
$35,285.85
|
| Rate for Payer: Cash Price |
$35,285.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50,968.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,163.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,512.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16,512.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$48,537.65
|
| Rate for Payer: Heritage Provider Network Senior |
$20,310.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31,374.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,192.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,989.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,603.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,127.00
|
| Rate for Payer: Multiplan Commercial |
$58,809.75
|
| Rate for Payer: Multiplan WC |
$26,048.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$18,163.96
|
| Rate for Payer: TriValley Medical Group Senior |
$18,163.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Vantage Medical Group Senior |
$16,512.69
|
|
|
HC INS STBL DEV WO DCMPRN 2ND LVL
|
Facility
|
IP
|
$39,206.00
|
|
|
Service Code
|
CPT 22870
|
| Hospital Charge Code |
909020154
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,096.29 |
| Max. Negotiated Rate |
$29,404.50 |
| Rate for Payer: Adventist Health Commercial |
$7,841.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,248.66
|
| Rate for Payer: Cash Price |
$17,642.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,542.46
|
| Rate for Payer: Heritage Provider Network Senior |
$26,542.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,096.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,801.50
|
| Rate for Payer: Multiplan Commercial |
$29,404.50
|
|
|
HC INS STBL DEV WO DCMPRN 2ND LVL
|
Facility
|
OP
|
$39,206.00
|
|
|
Service Code
|
CPT 22870
|
| Hospital Charge Code |
909020154
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$33,325.10 |
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Adventist Health Commercial |
$7,841.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,229.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,325.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,563.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29,404.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$17,642.70
|
| Rate for Payer: Cash Price |
$17,642.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25,483.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,325.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$33,325.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33,325.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,268.51
|
| Rate for Payer: Heritage Provider Network Senior |
$24,268.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18,701.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,096.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,801.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,444.20
|
| Rate for Payer: Multiplan Commercial |
$29,404.50
|
| 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 |
$33,325.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33,325.10
|
| Rate for Payer: Vantage Medical Group Senior |
$33,325.10
|
|
|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
OP
|
$14,325.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906813406
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,592.82 |
| Max. Negotiated Rate |
$20,222.71 |
| Rate for Payer: Adventist Health Commercial |
$2,865.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,852.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,643.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$6,446.25
|
| Rate for Payer: Cash Price |
$6,446.25
|
| Rate for Payer: Cash Price |
$6,446.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,311.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,707.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,643.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,643.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,867.17
|
| Rate for Payer: Heritage Provider Network Senior |
$13,091.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20,222.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,592.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,240.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,581.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,262.33
|
| Rate for Payer: Multiplan Commercial |
$10,743.75
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,707.88
|
| Rate for Payer: TriValley Medical Group Senior |
$11,707.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Vantage Medical Group Senior |
$10,643.53
|
|
|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
IP
|
$14,325.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906813406
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,592.82 |
| Max. Negotiated Rate |
$10,743.75 |
| Rate for Payer: Adventist Health Commercial |
$2,865.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,225.30
|
| Rate for Payer: Cash Price |
$6,446.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,698.02
|
| Rate for Payer: Heritage Provider Network Senior |
$9,698.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,592.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,581.25
|
| Rate for Payer: Multiplan Commercial |
$10,743.75
|
|
|
HC INST OR RPLCMT SPNL NEUROSTIM
|
Facility
|
OP
|
$142,285.00
|
|
|
Service Code
|
CPT 63685
|
| Hospital Charge Code |
900100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,158.00 |
| Max. Negotiated Rate |
$106,713.75 |
| Rate for Payer: Adventist Health Commercial |
$28,457.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87,932.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59,532.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43,656.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39,688.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$64,028.25
|
| Rate for Payer: Cash Price |
$64,028.25
|
| Rate for Payer: Cash Price |
$64,028.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92,485.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59,532.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$43,656.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39,688.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$85,371.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$39,688.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$88,074.41
|
| Rate for Payer: Heritage Provider Network Senior |
$48,816.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39,688.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$75,407.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,753.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45,641.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35,571.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53,182.13
|
| Rate for Payer: Multiplan Commercial |
$106,713.75
|
| Rate for Payer: Multiplan WC |
$61,693.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$43,656.98
|
| Rate for Payer: TriValley Medical Group Senior |
$43,656.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,939.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59,532.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43,656.98
|
| Rate for Payer: Vantage Medical Group Senior |
$39,688.16
|
|
|
HC INST OR RPLCMT SPNL NEUROSTIM
|
Facility
|
IP
|
$142,285.00
|
|
|
Service Code
|
CPT 63685
|
| Hospital Charge Code |
900100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25,753.58 |
| Max. Negotiated Rate |
$106,713.75 |
| Rate for Payer: Adventist Health Commercial |
$28,457.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$91,631.54
|
| Rate for Payer: Cash Price |
$64,028.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$96,326.95
|
| Rate for Payer: Heritage Provider Network Senior |
$96,326.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,753.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35,571.25
|
| Rate for Payer: Multiplan Commercial |
$106,713.75
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
IP
|
$9,164.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,658.68 |
| Max. Negotiated Rate |
$6,873.00 |
| Rate for Payer: Adventist Health Commercial |
$1,832.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,901.62
|
| Rate for Payer: Cash Price |
$4,123.80
|
| Rate for Payer: Cash Price |
$4,123.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,658.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,291.00
|
| Rate for Payer: Multiplan Commercial |
$6,873.00
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
OP
|
$9,164.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,832.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,663.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,583.83
|
| 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 |
$4,123.80
|
| Rate for Payer: Cash Price |
$4,123.80
|
| Rate for Payer: Cash Price |
$4,123.80
|
| Rate for Payer: Cash Price |
$4,123.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,956.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,406.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,672.52
|
| Rate for Payer: Heritage Provider Network Senior |
$203.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$314.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,658.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,291.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$6,873.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$182.04
|
| Rate for Payer: TriValley Medical Group Senior |
$165.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC INSULIN
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
900912130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$115.28
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.18
|
| Rate for Payer: Heritage Provider Network Senior |
$121.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.75
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
|
|
HC INSULIN
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
900912130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$108.54 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.54
|
| Rate for Payer: Blue Shield of California Commercial |
$92.04
|
| Rate for Payer: Blue Shield of California Commercial |
$92.04
|
| Rate for Payer: Blue Shield of California EPN |
$73.83
|
| Rate for Payer: Blue Shield of California EPN |
$73.83
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$116.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.33
|
| Rate for Payer: Heritage Provider Network Senior |
$110.80
|
| Rate for Payer: Heritage Provider Network Senior |
$30.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$85.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.43
|
| Rate for Payer: TriValley Medical Group Senior |
$11.43
|
| Rate for Payer: TriValley Medical Group Senior |
$11.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.57
|
| Rate for Payer: Vantage Medical Group Senior |
$11.43
|
| Rate for Payer: Vantage Medical Group Senior |
$11.43
|
|
|
HC INTACT PTH
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
900910942
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$138.10 |
| Max. Negotiated Rate |
$572.25 |
| Rate for Payer: Adventist Health Commercial |
$152.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$491.37
|
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$516.55
|
| Rate for Payer: Heritage Provider Network Senior |
$516.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.75
|
| Rate for Payer: Multiplan Commercial |
$572.25
|
|
|
HC INTACT PTH
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
900910942
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$572.25 |
| Rate for Payer: Adventist Health Commercial |
$152.60
|
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$124.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$471.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$391.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$391.91
|
| Rate for Payer: Blue Shield of California Commercial |
$332.18
|
| Rate for Payer: Blue Shield of California Commercial |
$332.18
|
| Rate for Payer: Blue Shield of California EPN |
$266.44
|
| Rate for Payer: Blue Shield of California EPN |
$266.44
|
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$131.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$495.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$41.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$41.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$472.30
|
| Rate for Payer: Heritage Provider Network Senior |
$125.04
|
| Rate for Payer: Heritage Provider Network Senior |
$472.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$96.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$363.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.32
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Multiplan Commercial |
$572.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.28
|
| Rate for Payer: TriValley Medical Group Senior |
$41.28
|
| Rate for Payer: TriValley Medical Group Senior |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$44.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$44.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.41
|
| Rate for Payer: Vantage Medical Group Senior |
$41.28
|
| Rate for Payer: Vantage Medical Group Senior |
$41.28
|
|
|
HC INT AUDITORY MEATUS
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
CPT 70134
|
| Hospital Charge Code |
909001133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$1,054.17 |
| Rate for Payer: Adventist Health Commercial |
$84.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$261.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.35
|
| Rate for Payer: Blue Shield of California Commercial |
$156.72
|
| Rate for Payer: Blue Shield of California EPN |
$126.03
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$274.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$249.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$702.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.84
|
| Rate for Payer: Heritage Provider Network Senior |
$261.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$201.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$808.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$317.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$702.78
|
| Rate for Payer: TriValley Medical Group Senior |
$702.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
HC INT AUDITORY MEATUS
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 70134
|
| Hospital Charge Code |
909001133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Adventist Health Commercial |
$84.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$272.41
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$286.37
|
| Rate for Payer: Heritage Provider Network Senior |
$286.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.75
|
| Rate for Payer: Multiplan Commercial |
$317.25
|
|
|
HC INT DEV EVAL CRTD SNS BAT MOD SYS WO PRGMG
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 93145
|
| Hospital Charge Code |
906811868
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$208.08
|
| 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 |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.44
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$257.50
|
| Rate for Payer: Heritage Provider Network Senior |
$203.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$314.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$182.04
|
| Rate for Payer: TriValley Medical Group Senior |
$165.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$208.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$208.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC INT DEV EVAL CRTD SNS BAT MOD SYS WO PRGMG
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 93145
|
| Hospital Charge Code |
906811868
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$267.90
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
|
|
HC INT DEV EVAL CRTD SNS BAT MOD SYS W PRGMG
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 93146
|
| Hospital Charge Code |
906811869
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$208.08
|
| 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 |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.44
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$257.50
|
| Rate for Payer: Heritage Provider Network Senior |
$203.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$314.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$182.04
|
| Rate for Payer: TriValley Medical Group Senior |
$165.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$208.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$208.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC INT DEV EVAL CRTD SNS BAT MOD SYS W PRGMG
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 93146
|
| Hospital Charge Code |
906811869
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$267.90
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
|
|
HC INTERCOSTAL NERVE BLOCK SINGLE
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
900501673
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$168.69 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$575.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| 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 |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$605.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$559.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$576.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,724.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$998.67
|
| 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 |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC INTERCOSTAL NERVE BLOCK SINGLE
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
900501673
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$168.69 |
| Max. Negotiated Rate |
$699.00 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$600.21
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$630.96
|
| Rate for Payer: Heritage Provider Network Senior |
$630.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
|
|
HC INTERDENTAL WIRING,OTH THN FRX
|
Facility
|
IP
|
$3,701.00
|
|
|
Service Code
|
CPT 21497
|
| Hospital Charge Code |
900501322
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$669.88 |
| Max. Negotiated Rate |
$2,775.75 |
| Rate for Payer: Adventist Health Commercial |
$740.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,383.44
|
| Rate for Payer: Cash Price |
$1,665.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,505.58
|
| Rate for Payer: Heritage Provider Network Senior |
$2,505.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$669.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$925.25
|
| Rate for Payer: Multiplan Commercial |
$2,775.75
|
|
|
HC INTERDENTAL WIRING,OTH THN FRX
|
Facility
|
OP
|
$3,701.00
|
|
|
Service Code
|
CPT 21497
|
| Hospital Charge Code |
900501322
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$669.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$740.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,287.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,757.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,398.98
|
| Rate for Payer: Cash Price |
$1,665.45
|
| Rate for Payer: Cash Price |
$1,665.45
|
| Rate for Payer: Cash Price |
$1,665.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,405.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,995.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,505.58
|
| Rate for Payer: Heritage Provider Network Senior |
$2,505.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,765.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$669.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,294.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$925.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$2,775.75
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,220.60
|
| Rate for Payer: TriValley Medical Group Senior |
$2,220.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC INTERLEUKIN 6
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.71
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.59
|
| Rate for Payer: Heritage Provider Network Senior |
$38.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
|
|
HC INTERLEUKIN 6
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$122.92 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.92
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| 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: Cigna of CA HMO/PPO |
$37.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.28
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$35.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$27.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
