|
HC NEUROSTIM REMOVAL, REPL GEN
|
Facility
|
IP
|
$125,023.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906820310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$22,629.16 |
| Max. Negotiated Rate |
$93,767.25 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Cash Price |
$56,260.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$84,640.57
|
| Rate for Payer: Heritage Provider Network Senior |
$84,640.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,629.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31,255.75
|
| Rate for Payer: Multiplan Commercial |
$93,767.25
|
|
|
HC NEUROSTIM REMOVAL SENS LEAD
|
Facility
|
IP
|
$13,518.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906820308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,446.76 |
| Max. Negotiated Rate |
$10,138.50 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,151.69
|
| Rate for Payer: Heritage Provider Network Senior |
$9,151.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,446.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,379.50
|
| Rate for Payer: Multiplan Commercial |
$10,138.50
|
|
|
HC NEUROSTIM REMOVAL SENS LEAD
|
Facility
|
OP
|
$13,518.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906820308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,446.76 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,286.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,434.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,138.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,786.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,490.30
|
| Rate for Payer: Dignity Health Senior |
$11,490.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,367.64
|
| Rate for Payer: Heritage Provider Network Senior |
$8,367.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,448.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,446.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,379.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,462.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,462.60
|
| Rate for Payer: Multiplan Commercial |
$10,138.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Senior |
$11,490.30
|
|
|
HC NEUROSTIM REMOVAL STIM LEAD
|
Facility
|
OP
|
$13,518.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906820309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,446.76 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,286.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,434.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,138.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,786.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,490.30
|
| Rate for Payer: Dignity Health Senior |
$11,490.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,367.64
|
| Rate for Payer: Heritage Provider Network Senior |
$8,367.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,448.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,446.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,379.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,462.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,462.60
|
| Rate for Payer: Multiplan Commercial |
$10,138.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Senior |
$11,490.30
|
|
|
HC NEUROSTIM REMOVAL STIM LEAD
|
Facility
|
IP
|
$13,518.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906820309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,446.76 |
| Max. Negotiated Rate |
$10,138.50 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,151.69
|
| Rate for Payer: Heritage Provider Network Senior |
$9,151.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,446.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,379.50
|
| Rate for Payer: Multiplan Commercial |
$10,138.50
|
|
|
HC NEUROSTIM REPOSITION STIM LEAD
|
Facility
|
IP
|
$13,518.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906820311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,446.76 |
| Max. Negotiated Rate |
$10,138.50 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,151.69
|
| Rate for Payer: Heritage Provider Network Senior |
$9,151.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,446.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,379.50
|
| Rate for Payer: Multiplan Commercial |
$10,138.50
|
|
|
HC NEUROSTIM REPOSITION STIM LEAD
|
Facility
|
OP
|
$13,518.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906820311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,446.76 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,286.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,434.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,138.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,786.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,490.30
|
| Rate for Payer: Dignity Health Senior |
$11,490.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,367.64
|
| Rate for Payer: Heritage Provider Network Senior |
$8,367.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,448.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,446.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,379.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,462.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,462.60
|
| Rate for Payer: Multiplan Commercial |
$10,138.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Senior |
$11,490.30
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$245.67 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Blue Shield of California Commercial |
$94.66
|
| Rate for Payer: Blue Shield of California EPN |
$76.12
|
| 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 |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Senior |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$88.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.36
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$180.16
|
| Rate for Payer: TriValley Medical Group Senior |
$163.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$92.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$92.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| 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 Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC NEWBORN SCREENING PANEL
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT S3620
|
| Hospital Charge Code |
903100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.99 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.06
|
| Rate for Payer: Heritage Provider Network Senior |
$157.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
|
|
HC NEWBORN SCREENING PANEL
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT S3620
|
| Hospital Charge Code |
903100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.99 |
| Max. Negotiated Rate |
$341.82 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.00
|
| Rate for Payer: Blue Shield of California Commercial |
$141.52
|
| Rate for Payer: Blue Shield of California EPN |
$113.22
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$150.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.20
|
| Rate for Payer: Dignity Health Senior |
$197.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.61
|
| Rate for Payer: Heritage Provider Network Senior |
$143.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$341.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.40
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$116.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$116.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.20
|
| Rate for Payer: Vantage Medical Group Senior |
$197.20
|
|
|
HC N GONNORHOEAE AMPLIFICATION
|
Facility
|
OP
|
$115.04
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$23.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$51.77
|
| Rate for Payer: Cash Price |
$51.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.21
|
| Rate for Payer: Heritage Provider Network Senior |
$71.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$54.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$86.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC N GONNORHOEAE AMPLIFICATION
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.82 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.94
|
| Rate for Payer: Heritage Provider Network Senior |
$148.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.00
|
| Rate for Payer: Multiplan Commercial |
$165.00
|
|
|
HC NICU TRANSPORT PER HOUR
|
Facility
|
IP
|
$2,394.00
|
|
| Hospital Charge Code |
905200001
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$433.31 |
| Max. Negotiated Rate |
$4,915.00 |
| Rate for Payer: Adventist Health Commercial |
$478.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$1,077.30
|
| Rate for Payer: Cash Price |
$1,077.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,620.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,620.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$433.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$598.50
|
| Rate for Payer: Multiplan Commercial |
$1,795.50
|
|
|
HC NID
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.20
|
| Rate for Payer: Heritage Provider Network Senior |
$35.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
|
|
HC NID
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$73.69 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.72
|
| 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 |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.80
|
| 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 |
$33.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Heritage Provider Network Senior |
$32.19
|
| 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 |
$24.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| 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 |
$39.00
|
| 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 NITINAL WIRES/SHORT
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.19
|
| Rate for Payer: Heritage Provider Network Senior |
$165.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
|
|
HC NITINAL WIRES/SHORT
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$130.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$183.00
|
| Rate for Payer: Blue Shield of California Commercial |
$148.84
|
| Rate for Payer: Blue Shield of California EPN |
$119.07
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$158.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$207.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.40
|
| Rate for Payer: Dignity Health Senior |
$207.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$151.04
|
| Rate for Payer: Heritage Provider Network Senior |
$151.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$116.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$122.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$122.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.40
|
| Rate for Payer: Vantage Medical Group Senior |
$207.40
|
|
|
HC NITRIC OXIDE/HELIOX THRPY PER DAY
|
Facility
|
IP
|
$2,615.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800400
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$473.31 |
| Max. Negotiated Rate |
$1,961.25 |
| Rate for Payer: Adventist Health Commercial |
$523.00
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,770.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,770.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.75
|
| Rate for Payer: Multiplan Commercial |
$1,961.25
|
|
|
HC NITRIC OXIDE/HELIOX THRPY PER DAY
|
Facility
|
OP
|
$2,615.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800400
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$1,961.25 |
| Rate for Payer: Adventist Health Commercial |
$523.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,397.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,796.51
|
| 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 |
$1,595.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,276.12
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,699.75
|
| 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 |
$1,699.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,618.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,618.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,247.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.75
|
| 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 |
$1,961.25
|
| 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 |
$1,307.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,307.50
|
| 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 NMIC306
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC NMIC306
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$73.69 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| 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 |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| 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 |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| 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 |
$23.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| 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 |
$37.50
|
| 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 NM MYCRD IMG PET RST & STRS CT
|
Facility
|
IP
|
$4,751.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
909308431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$859.93 |
| Max. Negotiated Rate |
$3,563.25 |
| Rate for Payer: Adventist Health Commercial |
$950.20
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,216.43
|
| Rate for Payer: Heritage Provider Network Senior |
$3,216.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.75
|
| Rate for Payer: Multiplan Commercial |
$3,563.25
|
|
|
HC NM MYCRD IMG PET RST & STRS CT
|
Facility
|
OP
|
$4,751.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
909308431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$129.71 |
| Max. Negotiated Rate |
$4,289.23 |
| Rate for Payer: Adventist Health Commercial |
$950.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,539.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,263.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,289.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,145.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,859.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2,898.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,318.49
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,088.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,289.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,145.44
|
| Rate for Payer: Dignity Health Senior |
$2,859.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,088.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,859.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,940.87
|
| Rate for Payer: Heritage Provider Network Senior |
$2,940.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,859.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,266.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,288.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,602.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,602.96
|
| Rate for Payer: Multiplan Commercial |
$3,563.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,145.44
|
| Rate for Payer: TriValley Medical Group Senior |
$2,859.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,375.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,375.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,289.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,145.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,859.49
|
|
|
HC NM MYCRD IMG PET RST/STRS W/CT
|
Facility
|
OP
|
$3,046.00
|
|
|
Service Code
|
CPT 78430
|
| Hospital Charge Code |
909308430
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$111.39 |
| Max. Negotiated Rate |
$2,779.92 |
| Rate for Payer: Adventist Health Commercial |
$609.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,628.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,092.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,858.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,486.45
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,979.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Senior |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,979.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,853.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,885.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,885.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$111.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,452.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,131.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$761.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,335.13
|
| Rate for Payer: Multiplan Commercial |
$2,284.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,038.61
|
| Rate for Payer: TriValley Medical Group Senior |
$1,853.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,523.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,523.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
