|
HC MALARIA QUANTITAT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911640
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.69
|
| Rate for Payer: Heritage Provider Network Senior |
$132.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
|
|
HC MALARIA SCREEN AG TEST
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900912441
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$104.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.05
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Senior |
$16.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.32
|
| Rate for Payer: Heritage Provider Network Senior |
$121.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Senior |
$16.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC MALARIA SCREEN AG TEST
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900912441
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.69
|
| Rate for Payer: Heritage Provider Network Senior |
$132.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
|
|
HC MALARIA SMEARS
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911686
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$104.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.70
|
| Rate for Payer: Blue Shield of California Commercial |
$48.21
|
| Rate for Payer: Blue Shield of California EPN |
$38.67
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Senior |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.32
|
| Rate for Payer: Heritage Provider Network Senior |
$121.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.55
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.99
|
| Rate for Payer: TriValley Medical Group Senior |
$5.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC MALARIA SMEARS
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911686
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.69
|
| Rate for Payer: Heritage Provider Network Senior |
$132.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
|
|
HC MAMMARY DUCTOGRAM
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
909000103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$515.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$562.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$487.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$637.50
|
| Rate for Payer: Dignity Health Senior |
$637.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$464.25
|
| Rate for Payer: Heritage Provider Network Senior |
$464.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$313.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$357.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.00
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| 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 |
$637.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$637.50
|
| Rate for Payer: Vantage Medical Group Senior |
$637.50
|
|
|
HC MAMMARY DUCTOGRAM
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
909000103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.75
|
| Rate for Payer: Heritage Provider Network Senior |
$507.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.50
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
|
|
HC MAMMOGRAPHY DIGITAL BILAT
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
909002011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$141.90 |
| Max. Negotiated Rate |
$588.00 |
| Rate for Payer: Adventist Health Commercial |
$156.80
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$530.77
|
| Rate for Payer: Heritage Provider Network Senior |
$530.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
|
|
HC MAMMOGRAPHY DIGITAL BILAT
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
909002011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$141.90 |
| Max. Negotiated Rate |
$666.40 |
| Rate for Payer: Adventist Health Commercial |
$156.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$419.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$538.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$666.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$588.00
|
| Rate for Payer: Blue Shield of California Commercial |
$610.22
|
| Rate for Payer: Blue Shield of California EPN |
$490.72
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$509.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$666.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$666.40
|
| Rate for Payer: Dignity Health Senior |
$666.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$509.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$485.30
|
| Rate for Payer: Heritage Provider Network Senior |
$485.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$239.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$373.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$548.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$548.80
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$200.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$200.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$666.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$666.40
|
| Rate for Payer: Vantage Medical Group Senior |
$666.40
|
|
|
HC MAMMOGRAPHY DIGITAL UNILAT ALL VIEWS
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
909002012
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$155.25 |
| Rate for Payer: Adventist Health Commercial |
$41.40
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.14
|
| Rate for Payer: Heritage Provider Network Senior |
$140.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$155.25
|
|
|
HC MAMMOGRAPHY DIGITAL UNILAT ALL VIEWS
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
909002012
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$416.69 |
| Rate for Payer: Adventist Health Commercial |
$41.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$110.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$142.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$175.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.25
|
| Rate for Payer: Blue Shield of California Commercial |
$416.69
|
| Rate for Payer: Blue Shield of California EPN |
$335.09
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$134.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$175.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.95
|
| Rate for Payer: Dignity Health Senior |
$175.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.13
|
| Rate for Payer: Heritage Provider Network Senior |
$128.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$189.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$98.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$144.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$144.90
|
| Rate for Payer: Multiplan Commercial |
$155.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$157.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$157.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$175.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.95
|
| Rate for Payer: Vantage Medical Group Senior |
$175.95
|
|
|
HC MAMOTOME PROBE 11 GA
|
Facility
|
OP
|
$833.00
|
|
| Hospital Charge Code |
906601882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.77 |
| Max. Negotiated Rate |
$708.05 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$445.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$572.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$624.75
|
| Rate for Payer: Blue Shield of California Commercial |
$508.13
|
| Rate for Payer: Blue Shield of California EPN |
$406.50
|
| Rate for Payer: Cash Price |
$458.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$541.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$708.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$708.05
|
| Rate for Payer: Dignity Health Senior |
$708.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$515.63
|
| Rate for Payer: Heritage Provider Network Senior |
$515.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$397.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$583.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$583.10
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$416.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$416.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.05
|
| Rate for Payer: Vantage Medical Group Senior |
$708.05
|
|
|
HC MAMOTOME PROBE 11 GA
|
Facility
|
IP
|
$833.00
|
|
| Hospital Charge Code |
906601882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.77 |
| Max. Negotiated Rate |
$624.75 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Cash Price |
$458.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$563.94
|
| Rate for Payer: Heritage Provider Network Senior |
$563.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.25
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
|
|
HC MANDIBLE-COMPLETE
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
909001122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.84 |
| Max. Negotiated Rate |
$732.75 |
| Rate for Payer: Adventist Health Commercial |
$195.40
|
| Rate for Payer: Cash Price |
$537.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$661.43
|
| Rate for Payer: Heritage Provider Network Senior |
$661.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.25
|
| Rate for Payer: Multiplan Commercial |
$732.75
|
|
|
HC MANDIBLE-COMPLETE
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
909001122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.14 |
| Max. Negotiated Rate |
$732.75 |
| Rate for Payer: Adventist Health Commercial |
$195.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$522.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$671.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.39
|
| Rate for Payer: Blue Shield of California Commercial |
$131.04
|
| Rate for Payer: Blue Shield of California EPN |
$105.38
|
| Rate for Payer: Cash Price |
$537.35
|
| Rate for Payer: Cash Price |
$537.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$635.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$635.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$604.76
|
| Rate for Payer: Heritage Provider Network Senior |
$604.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$55.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$466.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$732.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC MANDIBLE LIMITED
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
909001123
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.09 |
| Max. Negotiated Rate |
$414.75 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Cash Price |
$304.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$374.38
|
| Rate for Payer: Heritage Provider Network Senior |
$374.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.25
|
| Rate for Payer: Multiplan Commercial |
$414.75
|
|
|
HC MANDIBLE LIMITED
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
909001123
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.66 |
| Max. Negotiated Rate |
$414.75 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$295.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$379.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.26
|
| Rate for Payer: Blue Shield of California Commercial |
$107.90
|
| Rate for Payer: Blue Shield of California EPN |
$86.77
|
| Rate for Payer: Cash Price |
$304.15
|
| Rate for Payer: Cash Price |
$304.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$359.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$342.31
|
| Rate for Payer: Heritage Provider Network Senior |
$342.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$263.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$414.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC MANDIBLE-PANOREX
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 70355
|
| Hospital Charge Code |
909001124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.59
|
| Rate for Payer: Heritage Provider Network Senior |
$344.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
|
|
HC MANDIBLE-PANOREX
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 70355
|
| Hospital Charge Code |
909001124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.98 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$272.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.92
|
| Rate for Payer: Blue Shield of California Commercial |
$120.91
|
| Rate for Payer: Blue Shield of California EPN |
$97.23
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$242.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$51.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN MCAL
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
901300057
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$118.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$198.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$245.65
|
| Rate for Payer: Dignity Health Senior |
$245.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.89
|
| Rate for Payer: Heritage Provider Network Senior |
$178.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$137.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$202.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$202.30
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$245.65
|
| Rate for Payer: Vantage Medical Group Senior |
$245.65
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN MCAL
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
901300057
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Adventist Health Commercial |
$57.80
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$195.65
|
| Rate for Payer: Heritage Provider Network Senior |
$195.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.25
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN MCAL
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
900400053
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$118.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$198.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$245.65
|
| Rate for Payer: Dignity Health Senior |
$245.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.89
|
| Rate for Payer: Heritage Provider Network Senior |
$178.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$137.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$202.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$202.30
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$245.65
|
| Rate for Payer: Vantage Medical Group Senior |
$245.65
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN MCAL
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
900400053
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Adventist Health Commercial |
$57.80
|
| Rate for Payer: Cash Price |
$158.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$195.65
|
| Rate for Payer: Heritage Provider Network Senior |
$195.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.25
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN OT
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
905197140
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN OT
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
905197140
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Senior |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
