|
HC NEFF SET
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.81 |
| Max. Negotiated Rate |
$384.20 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$241.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$310.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$275.72
|
| Rate for Payer: Blue Shield of California EPN |
$220.58
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$293.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$384.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$384.20
|
| Rate for Payer: Dignity Health Senior |
$384.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$279.79
|
| Rate for Payer: Heritage Provider Network Senior |
$279.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$316.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$316.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$226.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$226.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$384.20
|
| Rate for Payer: Vantage Medical Group Senior |
$384.20
|
|
|
HC NEFF SET
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.81 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$306.00
|
| Rate for Payer: Heritage Provider Network Senior |
$306.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
|
|
HC NEGATIVE URINE COMBO PANEL 61
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912450
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.59
|
| Rate for Payer: Heritage Provider Network Senior |
$147.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
|
|
HC NEGATIVE URINE COMBO PANEL 61
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912450
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$116.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.69
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.94
|
| Rate for Payer: Heritage Provider Network Senior |
$134.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NEG PRESS WOUND THERAPY MECH GT 50 SQ CM
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
900101508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.27 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$134.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$358.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$460.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Blue Shield of California Commercial |
$408.70
|
| Rate for Payer: Blue Shield of California EPN |
$326.96
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$435.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Senior |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.73
|
| Rate for Payer: Heritage Provider Network Senior |
$414.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$319.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.63
|
| Rate for Payer: Multiplan Commercial |
$502.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$558.40
|
| Rate for Payer: TriValley Medical Group Senior |
$558.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$335.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$335.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC NEG PRESS WOUND THERAPY MECH GT 50 SQ CM
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
900101508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.27 |
| Max. Negotiated Rate |
$502.50 |
| Rate for Payer: Adventist Health Commercial |
$134.00
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$453.59
|
| Rate for Payer: Heritage Provider Network Senior |
$453.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.50
|
| Rate for Payer: Multiplan Commercial |
$502.50
|
|
|
HC NEG PRESS WOUND THERAPY MECH LT 50 SQ CM
|
Facility
|
OP
|
$706.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
900101534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.79 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$141.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$377.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$485.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Blue Shield of California Commercial |
$430.66
|
| Rate for Payer: Blue Shield of California EPN |
$344.53
|
| Rate for Payer: Cash Price |
$388.30
|
| Rate for Payer: Cash Price |
$388.30
|
| Rate for Payer: Cash Price |
$388.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$458.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Senior |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.01
|
| Rate for Payer: Heritage Provider Network Senior |
$437.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$336.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.63
|
| Rate for Payer: Multiplan Commercial |
$529.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$558.40
|
| Rate for Payer: TriValley Medical Group Senior |
$558.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$353.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$353.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC NEG PRESS WOUND THERAPY MECH LT 50 SQ CM
|
Facility
|
IP
|
$706.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
900101534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.79 |
| Max. Negotiated Rate |
$529.50 |
| Rate for Payer: Adventist Health Commercial |
$141.20
|
| Rate for Payer: Cash Price |
$388.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$477.96
|
| Rate for Payer: Heritage Provider Network Senior |
$477.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.50
|
| Rate for Payer: Multiplan Commercial |
$529.50
|
|
|
HC NEG PRES WOUND THRPY GT 50 SQ CM
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
903501029
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$249.14
|
| Rate for Payer: Heritage Provider Network Senior |
$249.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
|
|
HC NEG PRES WOUND THRPY GT 50 SQ CM
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
903501029
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$196.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$252.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Blue Shield of California Commercial |
$224.48
|
| Rate for Payer: Blue Shield of California EPN |
$179.58
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$239.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Senior |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$227.79
|
| Rate for Payer: Heritage Provider Network Senior |
$227.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$175.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.63
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$558.40
|
| Rate for Payer: TriValley Medical Group Senior |
$558.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$184.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$184.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.73 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$232.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$298.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Blue Shield of California Commercial |
$265.35
|
| Rate for Payer: Blue Shield of California EPN |
$212.28
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$282.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.26
|
| Rate for Payer: Heritage Provider Network Senior |
$269.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$207.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$277.72
|
| Rate for Payer: TriValley Medical Group Senior |
$277.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$217.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$217.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$78.73 |
| Max. Negotiated Rate |
$326.25 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.50
|
| Rate for Payer: Heritage Provider Network Senior |
$294.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.75
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$78.73 |
| Max. Negotiated Rate |
$526.00 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$232.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$298.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Blue Shield of California Commercial |
$265.35
|
| Rate for Payer: Blue Shield of California EPN |
$212.28
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$282.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.26
|
| Rate for Payer: Heritage Provider Network Senior |
$269.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$207.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$277.72
|
| Rate for Payer: TriValley Medical Group Senior |
$252.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$526.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$443.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.73 |
| Max. Negotiated Rate |
$326.25 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.50
|
| Rate for Payer: Heritage Provider Network Senior |
$294.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.75
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
|
|
HC NEONATAL RESUSCITATION
|
Facility
|
OP
|
$4,684.00
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
900800498
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$197.64 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$936.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,503.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,217.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$831.46
|
| 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 |
$2,576.20
|
| Rate for Payer: Cash Price |
$2,576.20
|
| Rate for Payer: Cash Price |
$2,576.20
|
| Rate for Payer: Cash Price |
$2,576.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,044.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$914.61
|
| Rate for Payer: Dignity Health Senior |
$831.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,044.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$831.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,899.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,022.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$197.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$831.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,579.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$847.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$956.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,047.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,047.64
|
| Rate for Payer: Multiplan Commercial |
$3,513.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$914.61
|
| Rate for Payer: TriValley Medical Group Senior |
$831.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Vantage Medical Group Senior |
$831.46
|
|
|
HC NEONATAL RESUSCITATION
|
Facility
|
IP
|
$4,684.00
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
900800498
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$847.80 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$936.80
|
| Rate for Payer: Cash Price |
$2,576.20
|
| Rate for Payer: Cash Price |
$2,576.20
|
| 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 |
$847.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.00
|
| Rate for Payer: Multiplan Commercial |
$3,513.00
|
|
|
HC NEPHROSTOMY CATH KIT
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$214.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$125.42
|
| Rate for Payer: Blue Shield of California EPN |
$125.42
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$143.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$265.20
|
| Rate for Payer: Dignity Health Senior |
$265.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.46
|
| Rate for Payer: Heritage Provider Network Senior |
$144.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$156.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$156.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$112.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$103.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$265.20
|
| Rate for Payer: Vantage Medical Group Senior |
$265.20
|
|
|
HC NEPHROSTOMY CATH KIT
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$125.42
|
| Rate for Payer: Blue Shield of California EPN |
$125.42
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$143.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.46
|
| Rate for Payer: Heritage Provider Network Senior |
$144.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$156.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$156.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$112.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$103.30
|
|
|
HC NEPHROSTOMY TRACT DILITATN
|
Facility
|
IP
|
$11,847.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
909001936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,144.31 |
| Max. Negotiated Rate |
$8,885.25 |
| Rate for Payer: Adventist Health Commercial |
$2,369.40
|
| Rate for Payer: Cash Price |
$6,515.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,020.42
|
| Rate for Payer: Heritage Provider Network Senior |
$8,020.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,144.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,961.75
|
| Rate for Payer: Multiplan Commercial |
$8,885.25
|
|
|
HC NEPHROSTOMY TRACT DILITATN
|
Facility
|
OP
|
$11,847.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
909001936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$134.48 |
| Max. Negotiated Rate |
$8,885.25 |
| Rate for Payer: Adventist Health Commercial |
$2,369.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,332.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,138.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$822.56
|
| Rate for Payer: Blue Shield of California Commercial |
$664.90
|
| Rate for Payer: Blue Shield of California EPN |
$534.69
|
| Rate for Payer: Cash Price |
$6,515.85
|
| Rate for Payer: Cash Price |
$6,515.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,700.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Senior |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,700.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,602.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,333.29
|
| Rate for Payer: Heritage Provider Network Senior |
$7,333.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$134.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,651.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,144.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,993.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,961.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,279.58
|
| Rate for Payer: Multiplan Commercial |
$8,885.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,602.84
|
| Rate for Payer: TriValley Medical Group Senior |
$2,602.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,957.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,957.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
IP
|
$5,844.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,057.76 |
| Max. Negotiated Rate |
$4,383.00 |
| Rate for Payer: Adventist Health Commercial |
$1,168.80
|
| Rate for Payer: Cash Price |
$3,214.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,956.39
|
| Rate for Payer: Heritage Provider Network Senior |
$3,956.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,057.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,461.00
|
| Rate for Payer: Multiplan Commercial |
$4,383.00
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
OP
|
$5,844.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,168.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,014.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$3,214.20
|
| Rate for Payer: Cash Price |
$3,214.20
|
| Rate for Payer: Cash Price |
$3,214.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,798.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Senior |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,602.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,956.39
|
| Rate for Payer: Heritage Provider Network Senior |
$3,956.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,787.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,057.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,993.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,461.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,279.58
|
| Rate for Payer: Multiplan Commercial |
$4,383.00
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,102.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,934.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC NERVE BLOCK INJ-CERVICAL PLEXU
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 64413
|
| Hospital Charge Code |
900501738
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.69 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$498.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$640.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$792.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$512.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$699.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$605.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$792.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$792.20
|
| Rate for Payer: Dignity Health Senior |
$792.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$630.96
|
| Rate for Payer: Heritage Provider Network Senior |
$630.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$444.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$652.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$652.40
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$335.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$308.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$792.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$792.20
|
| Rate for Payer: Vantage Medical Group Senior |
$792.20
|
|
|
HC NERVE BLOCK INJ-CERVICAL PLEXU
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 64413
|
| Hospital Charge Code |
900501738
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.69 |
| Max. Negotiated Rate |
$699.00 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$630.96
|
| Rate for Payer: Heritage Provider Network Senior |
$630.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN
|
Facility
|
IP
|
$1,023.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
905601804
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$185.16 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Adventist Health Commercial |
$204.60
|
| Rate for Payer: Cash Price |
$562.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$692.57
|
| Rate for Payer: Heritage Provider Network Senior |
$692.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.75
|
| Rate for Payer: Multiplan Commercial |
$767.25
|
|
