|
HC INTRO CATH SUP/INF VENA CAVA
|
Facility
|
OP
|
$496.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081308
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$99.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$306.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$421.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$272.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$372.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$235.60
|
| Rate for Payer: Blue Shield of California EPN |
$187.49
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$322.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$421.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$421.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$335.79
|
| Rate for Payer: Heritage Provider Network Senior |
$335.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$236.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$347.20
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$297.60
|
| Rate for Payer: TriValley Medical Group Senior |
$297.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$421.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$421.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.60
|
|
|
HC INTRO NEEDLE OR INTRACATH EXTREMITY ARTERY
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
909081371
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.47 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$343.25
|
| Rate for Payer: Cash Price |
$239.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$360.84
|
| Rate for Payer: Heritage Provider Network Senior |
$360.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.25
|
| Rate for Payer: Multiplan Commercial |
$399.75
|
|
|
HC INTRO NEEDLE OR INTRACATH EXTREMITY ARTERY
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
909081371
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.47 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$453.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$399.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$253.18
|
| Rate for Payer: Blue Shield of California EPN |
$201.47
|
| Rate for Payer: Cash Price |
$239.85
|
| Rate for Payer: Cash Price |
$239.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$346.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$453.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$453.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$360.84
|
| Rate for Payer: Heritage Provider Network Senior |
$360.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$254.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$373.10
|
| Rate for Payer: Multiplan Commercial |
$399.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$319.80
|
| Rate for Payer: TriValley Medical Group Senior |
$319.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$453.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$453.05
|
| Rate for Payer: Vantage Medical Group Senior |
$453.05
|
|
|
HC INTRO NEEDLE OR INTRACATH EXTREMITY ARTERY
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
909081371
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.47 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$343.25
|
| Rate for Payer: Cash Price |
$239.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$360.84
|
| Rate for Payer: Heritage Provider Network Senior |
$360.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.25
|
| Rate for Payer: Multiplan Commercial |
$399.75
|
|
|
HC INTRO NEEDLE OR INTRACATH EXTREMITY ARTERY
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
909081371
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.47 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$453.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$399.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$239.85
|
| Rate for Payer: Cash Price |
$239.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$346.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$453.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$453.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.93
|
| Rate for Payer: Heritage Provider Network Senior |
$329.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$254.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$373.10
|
| Rate for Payer: Multiplan Commercial |
$399.75
|
| 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 |
$453.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$453.05
|
| Rate for Payer: Vantage Medical Group Senior |
$453.05
|
|
|
HC INTRPRCDRL CRNRY FFR W 3D MAPPING
|
Facility
|
IP
|
$8,023.00
|
|
|
Service Code
|
CPT 0523T
|
| Hospital Charge Code |
906811881
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,452.16 |
| Max. Negotiated Rate |
$6,017.25 |
| Rate for Payer: Adventist Health Commercial |
$1,604.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,166.81
|
| Rate for Payer: Cash Price |
$3,610.35
|
| Rate for Payer: Cash Price |
$3,610.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,452.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,005.75
|
| Rate for Payer: Multiplan Commercial |
$6,017.25
|
|
|
HC INTRPRCDRL CRNRY FFR W 3D MAPPING
|
Facility
|
OP
|
$8,023.00
|
|
|
Service Code
|
CPT 0523T
|
| Hospital Charge Code |
906811881
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,604.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,958.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,819.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,412.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,017.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,013.10
|
| 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 |
$3,610.35
|
| Rate for Payer: Cash Price |
$3,610.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,819.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,819.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,819.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,966.24
|
| Rate for Payer: Heritage Provider Network Senior |
$4,966.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,826.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,452.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,005.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,616.10
|
| Rate for Payer: Multiplan Commercial |
$6,017.25
|
| 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 |
$6,819.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,819.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6,819.55
|
|
|
HC INTUSSUSCEPTION REDUCTION SYST
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
909001061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.53
|
| Rate for Payer: Blue Shield of California Commercial |
$82.35
|
| Rate for Payer: Blue Shield of California EPN |
$65.88
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.56
|
| Rate for Payer: Heritage Provider Network Senior |
$83.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC INTUSSUSCEPTION REDUCTION SYST
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
909001061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.94
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.39
|
| Rate for Payer: Heritage Provider Network Senior |
$91.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
|
|
HC IOC TOUCH-PREP ADDL SITE PG
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 88334
|
| Hospital Charge Code |
903800222
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$95.31 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.31
|
| Rate for Payer: Blue Shield of California Commercial |
$71.57
|
| Rate for Payer: Blue Shield of California EPN |
$57.55
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.57
|
| Rate for Payer: Heritage Provider Network Senior |
$31.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.70
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.35
|
| Rate for Payer: Vantage Medical Group Senior |
$43.35
|
|
|
HC IOC TOUCH-PREP ADDL SITE PG
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 88334
|
| Hospital Charge Code |
903800222
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.84
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.53
|
| Rate for Payer: Heritage Provider Network Senior |
$34.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.75
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
|
|
HC IOC TOUCH-PREP INITIAL PG
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
903800221
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$93.99 |
| Max. Negotiated Rate |
$1,554.36 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$583.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.84
|
| Rate for Payer: Blue Shield of California Commercial |
$116.88
|
| Rate for Payer: Blue Shield of California EPN |
$93.99
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$613.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$613.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,036.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$584.34
|
| Rate for Payer: Heritage Provider Network Senior |
$584.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$450.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,036.24
|
| Rate for Payer: TriValley Medical Group Senior |
$1,036.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$722.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$722.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
|
|
HC IOC TOUCH-PREP INITIAL PG
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
903800221
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$170.86 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$607.94
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$639.09
|
| Rate for Payer: Heritage Provider Network Senior |
$639.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.00
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
|
|
HC IONIZED CALCIUM
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
900912257
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$163.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.55
|
| Rate for Payer: Blue Shield of California Commercial |
$24.40
|
| Rate for Payer: Blue Shield of California Commercial |
$161.65
|
| Rate for Payer: Blue Shield of California EPN |
$129.32
|
| Rate for Payer: Blue Shield of California EPN |
$19.52
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$172.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$164.03
|
| Rate for Payer: Heritage Provider Network Senior |
$164.03
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$126.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$132.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$132.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.00
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$34.00
|
|
|
HC IONIZED CALCIUM
|
Facility
|
IP
|
$265.00
|
|
| Hospital Charge Code |
900912257
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.97 |
| Max. Negotiated Rate |
$198.75 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$170.66
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$179.41
|
| Rate for Payer: Heritage Provider Network Senior |
$179.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.25
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
|
|
HC IONTOPHORESIS 15 MIN MCAL
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900400027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.14
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC IONTOPHORESIS 15 MIN MCAL
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900400027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$75.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| 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 |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$129.50
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| 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 |
$157.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Vantage Medical Group Senior |
$157.25
|
|
|
HC IONTOPHORESIS 15 MIN MCARE COMM
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900407033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.14
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC IONTOPHORESIS 15 MIN MCARE COMM
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900407033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$75.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| 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 |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$129.50
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| 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 |
$157.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Vantage Medical Group Senior |
$157.25
|
|
|
HC IONTOPHORESIS 15 MIN PT
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900417033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$75.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| 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 |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$129.50
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| 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 |
$157.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Vantage Medical Group Senior |
$157.25
|
|
|
HC IONTOPHORESIS 15 MIN PT
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900417033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.14
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC IONTOPHORESIS 15 MIN PT
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
905103123
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$75.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| 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 |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$129.50
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| 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 |
$157.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Vantage Medical Group Senior |
$157.25
|
|
|
HC IONTOPHORESIS 15 MIN PT
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
905103123
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.14
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC IPV INITIAL
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800320
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$327.80
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.59
|
| Rate for Payer: Heritage Provider Network Senior |
$344.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
|
|
HC IPV INITIAL
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800320
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$422.46 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$314.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| 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 |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$281.64
|
| 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) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$242.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| 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 |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
