|
HC RANGE OF MOTION MEAS HAND MCAL
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
901300033
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$200.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.80
|
| Rate for Payer: Dignity Health Senior |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.65
|
| Rate for Payer: Heritage Provider Network Senior |
$190.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$148.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$261.80
|
| Rate for Payer: Vantage Medical Group Senior |
$261.80
|
|
|
HC RANGE OF MOTION MEAS HAND MCAL
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
901300033
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.52
|
| Rate for Payer: Heritage Provider Network Senior |
$208.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
|
|
HC RANGE OF MOTION MEAS HAND MCAL
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
900400018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.52
|
| Rate for Payer: Heritage Provider Network Senior |
$208.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
|
|
HC RANGE OF MOTION MEAS LIMB/TRUNK MCAL
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
901300031
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$200.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.80
|
| Rate for Payer: Dignity Health Senior |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.65
|
| Rate for Payer: Heritage Provider Network Senior |
$190.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$148.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$261.80
|
| Rate for Payer: Vantage Medical Group Senior |
$261.80
|
|
|
HC RANGE OF MOTION MEAS LIMB/TRUNK MCAL
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
901300031
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.52
|
| Rate for Payer: Heritage Provider Network Senior |
$208.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
|
|
HC RANGE OF MOTION MEAS LIMB TRUNK OT
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
905104406
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.52
|
| Rate for Payer: Heritage Provider Network Senior |
$208.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
|
|
HC RANGE OF MOTION MEAS LIMB TRUNK OT
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
905104406
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$200.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.80
|
| Rate for Payer: Dignity Health Senior |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.65
|
| Rate for Payer: Heritage Provider Network Senior |
$190.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$148.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$261.80
|
| Rate for Payer: Vantage Medical Group Senior |
$261.80
|
|
|
HC RBC ANTIBODY ADSORPTION
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.15 |
| Max. Negotiated Rate |
$480.75 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$440.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.63
|
| Rate for Payer: Blue Shield of California Commercial |
$398.06
|
| Rate for Payer: Blue Shield of California EPN |
$376.27
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$416.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$396.78
|
| Rate for Payer: Heritage Provider Network Senior |
$396.78
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$76.42
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC RBC ANTIBODY ADSORPTION
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.02 |
| Max. Negotiated Rate |
$480.75 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$440.37
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.96
|
| Rate for Payer: Heritage Provider Network Senior |
$433.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.25
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
|
|
HC RBC ANTIBODY ELUTION
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$480.75 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$440.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$225.97
|
| Rate for Payer: Blue Shield of California Commercial |
$398.06
|
| Rate for Payer: Blue Shield of California EPN |
$376.27
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$416.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$396.78
|
| Rate for Payer: Heritage Provider Network Senior |
$396.78
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$213.41
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC RBC ANTIBODY ELUTION
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.02 |
| Max. Negotiated Rate |
$480.75 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$440.37
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.96
|
| Rate for Payer: Heritage Provider Network Senior |
$433.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.25
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
|
|
HC RBC PED PAK ALIQUOT
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904531
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$122.54 |
| Max. Negotiated Rate |
$596.00 |
| Rate for Payer: Adventist Health Commercial |
$135.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$465.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$293.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$388.26
|
| Rate for Payer: Blue Shield of California Commercial |
$420.42
|
| Rate for Payer: Blue Shield of California EPN |
$397.40
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$440.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$293.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.03
|
| Rate for Payer: Dignity Health Senior |
$195.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.06
|
| Rate for Payer: Heritage Provider Network Senior |
$419.06
|
| Rate for Payer: Humana Medicare |
$195.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$232.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$371.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$246.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$246.30
|
| Rate for Payer: Multiplan Commercial |
$507.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$215.03
|
| Rate for Payer: TriValley Medical Group Senior |
$195.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$293.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.03
|
| Rate for Payer: Vantage Medical Group Senior |
$195.48
|
|
|
HC RBC PED PAK ALIQUOT
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904531
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$122.54 |
| Max. Negotiated Rate |
$507.75 |
| Rate for Payer: Adventist Health Commercial |
$135.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$465.10
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$458.33
|
| Rate for Payer: Heritage Provider Network Senior |
$458.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.25
|
| Rate for Payer: Multiplan Commercial |
$507.75
|
|
|
HC RDLGC SM INT FLW THRGH STDY
|
Facility
|
IP
|
$896.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
909004248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.18 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Adventist Health Commercial |
$179.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$615.55
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.59
|
| Rate for Payer: Heritage Provider Network Senior |
$606.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
|
|
HC RDLGC SM INT FLW THRGH STDY
|
Facility
|
OP
|
$896.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
909004248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.56 |
| Max. Negotiated Rate |
$761.60 |
| Rate for Payer: Adventist Health Commercial |
$179.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$107.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$615.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$492.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.86
|
| Rate for Payer: Blue Shield of California Commercial |
$260.82
|
| Rate for Payer: Blue Shield of California EPN |
$148.32
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$582.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$761.60
|
| Rate for Payer: Dignity Health Senior |
$761.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$554.62
|
| Rate for Payer: Heritage Provider Network Senior |
$554.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$431.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$761.60
|
| Rate for Payer: Vantage Medical Group Senior |
$761.60
|
|
|
HC RDLGC XM ESPHGS DBL CNTST STY
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
909004221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.57 |
| Max. Negotiated Rate |
$473.69 |
| Rate for Payer: Adventist Health Commercial |
$105.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$167.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$362.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$473.69
|
| Rate for Payer: Blue Shield of California Commercial |
$405.37
|
| Rate for Payer: Blue Shield of California EPN |
$230.52
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$343.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.83
|
| Rate for Payer: Heritage Provider Network Senior |
$326.83
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$155.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$291.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$291.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC RDLGC XM ESPHGS DBL CNTST STY
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
909004221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.57 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Adventist Health Commercial |
$105.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$362.74
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.46
|
| Rate for Payer: Heritage Provider Network Senior |
$357.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.00
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
|
|
HC RDLGC XM ESPHGS SNGL CNTST STY
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909004220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.42 |
| Max. Negotiated Rate |
$436.16 |
| Rate for Payer: Adventist Health Commercial |
$105.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$150.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$362.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.31
|
| Rate for Payer: Blue Shield of California Commercial |
$241.76
|
| Rate for Payer: Blue Shield of California EPN |
$137.48
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$343.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.83
|
| Rate for Payer: Heritage Provider Network Senior |
$326.83
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC RDLGC XM ESPHGS SNGL CNTST STY
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909004220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.57 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Adventist Health Commercial |
$105.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$362.74
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.46
|
| Rate for Payer: Heritage Provider Network Senior |
$357.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.00
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
|
|
HC RDLGC XM UPR GI TRC DBL CNTST
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909004246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.57 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Adventist Health Commercial |
$105.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$362.74
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.46
|
| Rate for Payer: Heritage Provider Network Senior |
$357.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.00
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
|
|
HC RDLGC XM UPR GI TRC DBL CNTST
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909004246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.57 |
| Max. Negotiated Rate |
$436.16 |
| Rate for Payer: Adventist Health Commercial |
$105.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$192.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$362.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$396.03
|
| Rate for Payer: Blue Shield of California Commercial |
$337.62
|
| Rate for Payer: Blue Shield of California EPN |
$191.99
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$343.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.83
|
| Rate for Payer: Heritage Provider Network Senior |
$326.83
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$179.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC RDLGC XM UPR GI TRC SNGL CNTST
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909004240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.57 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Adventist Health Commercial |
$105.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$362.74
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.46
|
| Rate for Payer: Heritage Provider Network Senior |
$357.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.00
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
|
|
HC RDLGC XM UPR GI TRC SNGL CNTST
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909004240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.57 |
| Max. Negotiated Rate |
$436.16 |
| Rate for Payer: Adventist Health Commercial |
$105.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$173.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$362.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.01
|
| Rate for Payer: Blue Shield of California Commercial |
$297.54
|
| Rate for Payer: Blue Shield of California EPN |
$169.20
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$343.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.83
|
| Rate for Payer: Heritage Provider Network Senior |
$326.83
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$159.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC RECOVERY LEVEL I FIRST HR
|
Facility
|
IP
|
$1,381.00
|
|
| Hospital Charge Code |
907201701
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$249.96 |
| Max. Negotiated Rate |
$1,035.75 |
| Rate for Payer: Adventist Health Commercial |
$276.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$948.75
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$934.94
|
| Rate for Payer: Heritage Provider Network Senior |
$934.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.25
|
| Rate for Payer: Multiplan Commercial |
$1,035.75
|
|
|
HC RECOVERY LEVEL I FIRST HR
|
Facility
|
OP
|
$1,381.00
|
|
| Hospital Charge Code |
907201701
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$249.96 |
| Max. Negotiated Rate |
$1,173.85 |
| Rate for Payer: Adventist Health Commercial |
$276.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$738.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$948.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,173.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$759.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,035.75
|
| Rate for Payer: Blue Shield of California Commercial |
$857.60
|
| Rate for Payer: Blue Shield of California EPN |
$810.65
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$897.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,173.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,173.85
|
| Rate for Payer: Dignity Health Senior |
$1,173.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$897.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$854.84
|
| Rate for Payer: Heritage Provider Network Senior |
$854.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$665.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.25
|
| Rate for Payer: Multiplan Commercial |
$1,035.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,173.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,173.85
|
|
