|
HC MATRIX 3D FIRM/STD 10 COIL
|
Facility
|
IP
|
$2,325.00
|
|
| Hospital Charge Code |
909081831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$465.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$934.65
|
| Rate for Payer: Blue Shield of California EPN |
$934.65
|
| Rate for Payer: Cash Price |
$1,278.75
|
| Rate for Payer: Cash Price |
$1,278.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,069.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,255.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,076.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,076.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,162.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,162.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,162.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.25
|
| Rate for Payer: Multiplan Commercial |
$1,743.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$840.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$769.81
|
|
|
HC MATRIX 3D STANDARD 3-8 COIL
|
Facility
|
IP
|
$3,985.00
|
|
| Hospital Charge Code |
909081832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$797.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,912.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,601.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,601.97
|
| Rate for Payer: Cash Price |
$2,191.75
|
| Rate for Payer: Cash Price |
$2,191.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,833.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,151.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,845.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,845.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,992.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,992.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.25
|
| Rate for Payer: Multiplan Commercial |
$2,988.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,439.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,319.43
|
|
|
HC MATRIX 3D STANDARD 3-8 COIL
|
Facility
|
OP
|
$3,985.00
|
|
| Hospital Charge Code |
909081832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$797.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,912.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,737.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,191.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,988.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,601.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,601.97
|
| Rate for Payer: Cash Price |
$2,191.75
|
| Rate for Payer: Cash Price |
$2,191.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,833.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,387.25
|
| Rate for Payer: Dignity Health Senior |
$3,387.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,550.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,845.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,845.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,992.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,992.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,789.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,789.50
|
| Rate for Payer: Multiplan Commercial |
$2,988.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,439.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,319.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,387.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,387.25
|
|
|
HC MATRIX 3D X-FIRM COIL
|
Facility
|
IP
|
$4,400.00
|
|
| Hospital Charge Code |
909081830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$880.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,112.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,768.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,768.80
|
| Rate for Payer: Cash Price |
$2,420.00
|
| Rate for Payer: Cash Price |
$2,420.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,024.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,376.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,037.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,037.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,200.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,200.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,100.00
|
| Rate for Payer: Multiplan Commercial |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,589.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,456.84
|
|
|
HC MATRIX 3D X-FIRM COIL
|
Facility
|
OP
|
$4,400.00
|
|
| Hospital Charge Code |
909081830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$880.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,112.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,022.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,420.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,768.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,768.80
|
| Rate for Payer: Cash Price |
$2,420.00
|
| Rate for Payer: Cash Price |
$2,420.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,024.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,740.00
|
| Rate for Payer: Dignity Health Senior |
$3,740.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,816.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,037.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,037.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,200.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,200.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,080.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,080.00
|
| Rate for Payer: Multiplan Commercial |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,589.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,456.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,740.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,740.00
|
|
|
HC MAXILLOFACIAL FIXATION
|
Facility
|
OP
|
$10,460.00
|
|
|
Service Code
|
CPT 21100
|
| Hospital Charge Code |
900501456
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$11,976.10 |
| Rate for Payer: Adventist Health Commercial |
$2,092.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,186.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,516.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$5,753.00
|
| Rate for Payer: Cash Price |
$5,753.00
|
| Rate for Payer: Cash Price |
$5,753.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,799.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,268.08
|
| Rate for Payer: Dignity Health Senior |
$7,516.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,516.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,081.42
|
| Rate for Payer: Heritage Provider Network Senior |
$7,081.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,516.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,989.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,893.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,643.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,615.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,470.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,470.71
|
| Rate for Payer: Multiplan Commercial |
$7,845.00
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,763.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,463.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Vantage Medical Group Senior |
$7,516.44
|
|
|
HC MAXILLOFACIAL FIXATION
|
Facility
|
IP
|
$10,460.00
|
|
|
Service Code
|
CPT 21100
|
| Hospital Charge Code |
900501456
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,893.26 |
| Max. Negotiated Rate |
$7,845.00 |
| Rate for Payer: Adventist Health Commercial |
$2,092.00
|
| Rate for Payer: Cash Price |
$5,753.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,081.42
|
| Rate for Payer: Heritage Provider Network Senior |
$7,081.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,893.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,615.00
|
| Rate for Payer: Multiplan Commercial |
$7,845.00
|
|
|
HC MEASLES AB
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913530
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$112.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.64
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$100.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC MEASLES AB
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913530
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC MECHANICAL CHEST WALL OSCILL
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
900100003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$30.41 |
| Max. Negotiated Rate |
$387.64 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$89.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$115.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| 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 |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Senior |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.99
|
| Rate for Payer: Heritage Provider Network Senior |
$103.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$325.62
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| 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 |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC MECHANICAL CHEST WALL OSCILL
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
900100003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$30.41 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.74
|
| Rate for Payer: Heritage Provider Network Senior |
$113.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
|
|
HC MECH CORO THROMBECTOMY UNLIST
|
Facility
|
IP
|
$14,829.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820328
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,684.05 |
| Max. Negotiated Rate |
$11,121.75 |
| Rate for Payer: Adventist Health Commercial |
$2,965.80
|
| Rate for Payer: Cash Price |
$8,155.95
|
| Rate for Payer: Cash Price |
$8,155.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,684.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,707.25
|
| Rate for Payer: Multiplan Commercial |
$11,121.75
|
|
|
HC MECH CORO THROMBECTOMY UNLIST
|
Facility
|
OP
|
$14,829.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820328
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$11,121.75 |
| Rate for Payer: Adventist Health Commercial |
$2,965.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,926.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,187.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| 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 |
$8,155.95
|
| Rate for Payer: Cash Price |
$8,155.95
|
| Rate for Payer: Cash Price |
$8,155.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,638.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,179.15
|
| Rate for Payer: Heritage Provider Network Senior |
$244.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$377.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,684.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,707.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$11,121.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$218.68
|
| Rate for Payer: TriValley Medical Group Senior |
$198.80
|
| 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 |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC MECKELS SCAN
|
Facility
|
OP
|
$1,964.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
909301366
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$175.19 |
| Max. Negotiated Rate |
$1,473.00 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,049.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,349.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$641.23
|
| Rate for Payer: Blue Shield of California EPN |
$515.66
|
| Rate for Payer: Cash Price |
$1,080.20
|
| Rate for Payer: Cash Price |
$1,080.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,276.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,276.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,215.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,215.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$936.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$1,473.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$982.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$982.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC MECKELS SCAN
|
Facility
|
IP
|
$1,964.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
909301366
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$355.48 |
| Max. Negotiated Rate |
$1,473.00 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| Rate for Payer: Cash Price |
$1,080.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,329.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,329.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.00
|
| Rate for Payer: Multiplan Commercial |
$1,473.00
|
|
|
HC MEDCOMP TEMP DIALYSIS CATH
|
Facility
|
IP
|
$441.60
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
909081724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$88.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$211.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$177.52
|
| Rate for Payer: Blue Shield of California EPN |
$177.52
|
| Rate for Payer: Cash Price |
$242.88
|
| Rate for Payer: Cash Price |
$242.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$203.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.46
|
| Rate for Payer: Heritage Provider Network Senior |
$204.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$220.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.40
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$146.21
|
|
|
HC MEDCOMP TEMP DIALYSIS CATH
|
Facility
|
OP
|
$441.60
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
909081724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$88.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$211.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$303.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$331.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$177.52
|
| Rate for Payer: Blue Shield of California EPN |
$177.52
|
| Rate for Payer: Cash Price |
$242.88
|
| Rate for Payer: Cash Price |
$242.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$203.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$375.36
|
| Rate for Payer: Dignity Health Senior |
$375.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.46
|
| Rate for Payer: Heritage Provider Network Senior |
$204.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$220.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$309.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$309.12
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$146.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$375.36
|
| Rate for Payer: Vantage Medical Group Senior |
$375.36
|
|
|
HC MEMORY CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9168
|
| Hospital Charge Code |
900018233
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MEMORY CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9168
|
| Hospital Charge Code |
900018233
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9168
|
| Hospital Charge Code |
900018433
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MEMORY CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9168
|
| Hospital Charge Code |
900018433
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9168
|
| Hospital Charge Code |
900018133
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MEMORY CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9168
|
| Hospital Charge Code |
900018133
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9170
|
| Hospital Charge Code |
900018235
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9170
|
| Hospital Charge Code |
900018135
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
