|
HC RECOVERY LEVEL II FIRST HOUR
|
Facility
|
IP
|
$1,828.00
|
|
| Hospital Charge Code |
907201703
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$330.87 |
| Max. Negotiated Rate |
$1,371.00 |
| Rate for Payer: Adventist Health Commercial |
$365.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,255.84
|
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,237.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1,237.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.00
|
| Rate for Payer: Multiplan Commercial |
$1,371.00
|
|
|
HC RECOVERY LEVEL II FIRST HOUR
|
Facility
|
OP
|
$1,828.00
|
|
| Hospital Charge Code |
907201703
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$330.87 |
| Max. Negotiated Rate |
$1,553.80 |
| Rate for Payer: Adventist Health Commercial |
$365.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$977.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,255.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,553.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,005.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,371.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,135.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,073.04
|
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,188.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,553.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,553.80
|
| Rate for Payer: Dignity Health Senior |
$1,553.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,188.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,131.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,131.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$881.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.00
|
| Rate for Payer: Multiplan Commercial |
$1,371.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,553.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,553.80
|
|
|
HC RECOVERY LEVEL III EA ADDL 30
|
Facility
|
IP
|
$1,301.00
|
|
| Hospital Charge Code |
907201706
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$975.75 |
| Rate for Payer: Adventist Health Commercial |
$260.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$893.79
|
| Rate for Payer: Cash Price |
$585.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$880.78
|
| Rate for Payer: Heritage Provider Network Senior |
$880.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.25
|
| Rate for Payer: Multiplan Commercial |
$975.75
|
|
|
HC RECOVERY LEVEL III EA ADDL 30
|
Facility
|
OP
|
$1,301.00
|
|
| Hospital Charge Code |
907201706
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$1,105.85 |
| Rate for Payer: Adventist Health Commercial |
$260.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$695.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$893.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,105.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$715.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$975.75
|
| Rate for Payer: Blue Shield of California Commercial |
$807.92
|
| Rate for Payer: Blue Shield of California EPN |
$763.69
|
| Rate for Payer: Cash Price |
$585.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$845.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,105.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,105.85
|
| Rate for Payer: Dignity Health Senior |
$1,105.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$845.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$805.32
|
| Rate for Payer: Heritage Provider Network Senior |
$805.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$627.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.25
|
| Rate for Payer: Multiplan Commercial |
$975.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,105.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,105.85
|
|
|
HC RECOVERY LEVEL III FIRST HOUR
|
Facility
|
OP
|
$2,351.00
|
|
| Hospital Charge Code |
907201705
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$425.53 |
| Max. Negotiated Rate |
$1,998.35 |
| Rate for Payer: Adventist Health Commercial |
$470.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,256.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,615.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,998.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,293.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,763.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,459.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,380.04
|
| Rate for Payer: Cash Price |
$1,057.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,528.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,998.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,998.35
|
| Rate for Payer: Dignity Health Senior |
$1,998.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,528.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,455.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1,455.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,133.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.75
|
| Rate for Payer: Multiplan Commercial |
$1,763.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,998.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,998.35
|
|
|
HC RECOVERY LEVEL III FIRST HOUR
|
Facility
|
IP
|
$2,351.00
|
|
| Hospital Charge Code |
907201705
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$425.53 |
| Max. Negotiated Rate |
$1,763.25 |
| Rate for Payer: Adventist Health Commercial |
$470.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,615.14
|
| Rate for Payer: Cash Price |
$1,057.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,591.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,591.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.75
|
| Rate for Payer: Multiplan Commercial |
$1,763.25
|
|
|
HC RECOVERY LEVEL IV FIRST HOUR
|
Facility
|
IP
|
$2,614.00
|
|
| Hospital Charge Code |
907201707
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$473.13 |
| Max. Negotiated Rate |
$1,960.50 |
| Rate for Payer: Adventist Health Commercial |
$522.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,795.82
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,769.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,769.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.50
|
| Rate for Payer: Multiplan Commercial |
$1,960.50
|
|
|
HC RECOVERY LEVEL IV FIRST HOUR
|
Facility
|
OP
|
$2,614.00
|
|
| Hospital Charge Code |
907201707
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$473.13 |
| Max. Negotiated Rate |
$2,221.90 |
| Rate for Payer: Adventist Health Commercial |
$522.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,397.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,795.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,221.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,437.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,960.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,623.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,534.42
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,699.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,221.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,221.90
|
| Rate for Payer: Dignity Health Senior |
$2,221.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,699.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,618.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1,618.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,259.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.50
|
| Rate for Payer: Multiplan Commercial |
$1,960.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,221.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,221.90
|
|
|
HC RECOVERY LEVL I EA ADDL 30 MIN
|
Facility
|
OP
|
$695.00
|
|
| Hospital Charge Code |
907201702
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$590.75 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$371.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$477.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$382.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$521.25
|
| Rate for Payer: Blue Shield of California Commercial |
$431.60
|
| Rate for Payer: Blue Shield of California EPN |
$407.96
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$451.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$590.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.75
|
| Rate for Payer: Dignity Health Senior |
$590.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$430.20
|
| Rate for Payer: Heritage Provider Network Senior |
$430.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$334.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.75
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.75
|
| Rate for Payer: Vantage Medical Group Senior |
$590.75
|
|
|
HC RECOVERY LEVL I EA ADDL 30 MIN
|
Facility
|
IP
|
$695.00
|
|
| Hospital Charge Code |
907201702
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$521.25 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$477.46
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$470.52
|
| Rate for Payer: Heritage Provider Network Senior |
$470.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.75
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
|
|
HC RECOVERY LEVL II EA ADDL 30 MIN
|
Facility
|
OP
|
$881.00
|
|
| Hospital Charge Code |
907201704
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$159.46 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$470.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$748.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$660.75
|
| Rate for Payer: Blue Shield of California Commercial |
$547.10
|
| Rate for Payer: Blue Shield of California EPN |
$517.15
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$572.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$748.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$748.85
|
| Rate for Payer: Dignity Health Senior |
$748.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$545.34
|
| Rate for Payer: Heritage Provider Network Senior |
$545.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$424.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.25
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$748.85
|
| Rate for Payer: Vantage Medical Group Senior |
$748.85
|
|
|
HC RECOVERY LEVL II EA ADDL 30 MIN
|
Facility
|
IP
|
$881.00
|
|
| Hospital Charge Code |
907201704
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$159.46 |
| Max. Negotiated Rate |
$660.75 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.25
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.44
|
| Rate for Payer: Heritage Provider Network Senior |
$596.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.25
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
|
|
HC RECOVERY LEVL IV EA ADDL 30 MIN
|
Facility
|
IP
|
$1,463.00
|
|
| Hospital Charge Code |
907201708
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$1,097.25 |
| Rate for Payer: Adventist Health Commercial |
$292.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,005.08
|
| Rate for Payer: Cash Price |
$658.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$990.45
|
| Rate for Payer: Heritage Provider Network Senior |
$990.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.75
|
| Rate for Payer: Multiplan Commercial |
$1,097.25
|
|
|
HC RECOVERY LEVL IV EA ADDL 30 MIN
|
Facility
|
OP
|
$1,463.00
|
|
| Hospital Charge Code |
907201708
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Adventist Health Commercial |
$292.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$781.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,005.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,243.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$804.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,097.25
|
| Rate for Payer: Blue Shield of California Commercial |
$908.52
|
| Rate for Payer: Blue Shield of California EPN |
$858.78
|
| Rate for Payer: Cash Price |
$658.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$950.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,243.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,243.55
|
| Rate for Payer: Dignity Health Senior |
$1,243.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$950.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$905.60
|
| Rate for Payer: Heritage Provider Network Senior |
$905.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$705.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.75
|
| Rate for Payer: Multiplan Commercial |
$1,097.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,243.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,243.55
|
|
|
HC RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
CPT 91120
|
| Hospital Charge Code |
906791120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$419.25 |
| Rate for Payer: Adventist Health Commercial |
$111.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.03
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$378.44
|
| Rate for Payer: Heritage Provider Network Senior |
$378.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.75
|
| Rate for Payer: Multiplan Commercial |
$419.25
|
|
|
HC RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 91120
|
| Hospital Charge Code |
906791120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$807.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$168.32
|
| 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 |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$159.25
|
| 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 |
$147.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$151.66
|
| Rate for Payer: Heritage Provider Network Senior |
$482.37
|
| Rate for Payer: Humana Medicare |
$392.17
|
| 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 |
$44.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.25
|
| 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 |
$183.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| 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 RED CELL MASS
|
Facility
|
IP
|
$1,649.00
|
|
|
Service Code
|
CPT 78122
|
| Hospital Charge Code |
909301332
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$298.47 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: Adventist Health Commercial |
$329.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,132.86
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,116.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.25
|
| Rate for Payer: Multiplan Commercial |
$1,236.75
|
|
|
HC RED CELL MASS
|
Facility
|
OP
|
$1,649.00
|
|
|
Service Code
|
CPT 78122
|
| Hospital Charge Code |
909301332
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$137.78 |
| Max. Negotiated Rate |
$1,283.13 |
| Rate for Payer: Adventist Health Commercial |
$329.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,132.86
|
| 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: Blue Shield of California Commercial |
$939.64
|
| Rate for Payer: Blue Shield of California EPN |
$534.35
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,071.85
|
| 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 |
$1,071.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$675.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,020.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,020.73
|
| Rate for Payer: Humana Medicare |
$675.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$137.78
|
| 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 |
$298.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$796.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.25
|
| 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 |
$1,236.75
|
| 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 RED CELL SUR/HEP SEQ
|
Facility
|
OP
|
$1,492.00
|
|
|
Service Code
|
CPT 78140
|
| Hospital Charge Code |
909301336
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$134.97 |
| Max. Negotiated Rate |
$1,119.00 |
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$241.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,025.00
|
| 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 |
$804.08
|
| Rate for Payer: Blue Shield of California EPN |
$457.26
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$969.80
|
| 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 |
$969.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$923.55
|
| Rate for Payer: Heritage Provider Network Senior |
$923.55
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$134.97
|
| 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 |
$270.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.00
|
| 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 |
$1,119.00
|
| 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 RED CELL SUR/HEP SEQ
|
Facility
|
IP
|
$1,492.00
|
|
|
Service Code
|
CPT 78140
|
| Hospital Charge Code |
909301336
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$270.05 |
| Max. Negotiated Rate |
$1,119.00 |
| Rate for Payer: Adventist Health Commercial |
$298.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,025.00
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,010.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,010.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.00
|
| Rate for Payer: Multiplan Commercial |
$1,119.00
|
|
|
HC RED CELL SURVIVAL
|
Facility
|
OP
|
$1,722.00
|
|
|
Service Code
|
CPT 78130
|
| Hospital Charge Code |
909301334
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$134.97 |
| Max. Negotiated Rate |
$1,291.50 |
| Rate for Payer: Adventist Health Commercial |
$344.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$275.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,183.01
|
| 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 |
$580.50
|
| Rate for Payer: Blue Shield of California EPN |
$330.11
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,119.30
|
| 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 |
$1,119.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,065.92
|
| Rate for Payer: Heritage Provider Network Senior |
$1,065.92
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$134.97
|
| 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 |
$311.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$430.50
|
| 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 |
$1,291.50
|
| 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 RED CELL SURVIVAL
|
Facility
|
IP
|
$1,722.00
|
|
|
Service Code
|
CPT 78130
|
| Hospital Charge Code |
909301334
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$311.68 |
| Max. Negotiated Rate |
$1,291.50 |
| Rate for Payer: Adventist Health Commercial |
$344.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,183.01
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,165.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,165.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$430.50
|
| Rate for Payer: Multiplan Commercial |
$1,291.50
|
|
|
HC RED OF PROCIDENTIA UND ANESTH
|
Facility
|
OP
|
$1,285.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
900501155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$232.58 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$257.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$882.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$835.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$869.94
|
| Rate for Payer: Heritage Provider Network Senior |
$869.94
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$619.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$963.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$466.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$429.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC RED OF PROCIDENTIA UND ANESTH
|
Facility
|
IP
|
$1,285.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
900501155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$232.58 |
| Max. Negotiated Rate |
$963.75 |
| Rate for Payer: Adventist Health Commercial |
$257.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$882.80
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$869.94
|
| Rate for Payer: Heritage Provider Network Senior |
$869.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.25
|
| Rate for Payer: Multiplan Commercial |
$963.75
|
|
|
HC REDUCING SUBSTANCE
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
900910318
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$18.09 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.09
|
| Rate for Payer: Blue Shield of California Commercial |
$16.94
|
| Rate for Payer: Blue Shield of California EPN |
$13.24
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.39
|
| Rate for Payer: Dignity Health Senior |
$2.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Humana Medicare |
$2.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.73
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.17
|
| Rate for Payer: TriValley Medical Group Senior |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2.17
|
|
