|
HC SBBB UNIT SEARCH CHARGE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC SBBB VOLUME REDUCTION
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 86960
|
| Hospital Charge Code |
900904615
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$596.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.35
|
| Rate for Payer: Blue Shield of California Commercial |
$62.10
|
| Rate for Payer: Blue Shield of California EPN |
$58.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.90
|
| Rate for Payer: Heritage Provider Network Senior |
$61.90
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$234.75
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC SBBB VOLUME REDUCTION
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86960
|
| Hospital Charge Code |
900904615
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Senior |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
|
|
HC SBBB WASHING OF COMPONENTS
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$80.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Blue Shield of California Commercial |
$93.15
|
| Rate for Payer: Blue Shield of California EPN |
$88.05
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| Rate for Payer: Humana Medicare |
$37.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.87
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC SBBB WASHING OF COMPONENTS
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC SCAN & EVAL TESTICLE
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
906601409
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$247.97 |
| Max. Negotiated Rate |
$1,027.50 |
| Rate for Payer: Adventist Health Commercial |
$274.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$941.19
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$927.49
|
| Rate for Payer: Heritage Provider Network Senior |
$927.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.50
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
|
|
HC SCAN & EVAL TESTICLE
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
906601409
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$93.26 |
| Max. Negotiated Rate |
$1,027.50 |
| Rate for Payer: Adventist Health Commercial |
$274.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$205.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$941.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$312.13
|
| Rate for Payer: Blue Shield of California EPN |
$177.50
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$890.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$890.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$848.03
|
| Rate for Payer: Heritage Provider Network Senior |
$848.03
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$93.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,027.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC SCAPULA
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
909001479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$396.75 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$363.42
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$358.13
|
| Rate for Payer: Heritage Provider Network Senior |
$358.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.25
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
|
|
HC SCAPULA
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
909001479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.37 |
| Max. Negotiated Rate |
$396.75 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$363.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.99
|
| Rate for Payer: Blue Shield of California Commercial |
$104.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.57
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$343.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$327.45
|
| Rate for Payer: Heritage Provider Network Senior |
$327.45
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC SCL 70 AB
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913525
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$140.09 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.47
|
| Rate for Payer: Blue Shield of California Commercial |
$140.09
|
| Rate for Payer: Blue Shield of California EPN |
$109.51
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.59
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SCL 70 AB
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913525
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.29
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.67
|
| Rate for Payer: Heritage Provider Network Senior |
$109.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION
|
Facility
|
IP
|
$3,550.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
909049185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$642.55 |
| Max. Negotiated Rate |
$2,662.50 |
| Rate for Payer: Adventist Health Commercial |
$710.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,438.85
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,403.35
|
| Rate for Payer: Heritage Provider Network Senior |
$2,403.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.50
|
| Rate for Payer: Multiplan Commercial |
$2,662.50
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION
|
Facility
|
OP
|
$3,550.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
909049185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$642.55 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$710.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,438.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,307.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,197.45
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,436.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$2,662.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.19 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$197.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$224.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$212.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: Dignity Health Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$497.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.38
|
| Rate for Payer: Heritage Provider Network Senior |
$221.38
|
| Rate for Payer: Humana Medicare |
$497.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$157.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.25
|
| Rate for Payer: Multiplan Commercial |
$245.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$118.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$109.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.19 |
| Max. Negotiated Rate |
$245.25 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$224.65
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.38
|
| Rate for Payer: Heritage Provider Network Senior |
$221.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.75
|
| Rate for Payer: Multiplan Commercial |
$245.25
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
|
OP
|
$1,379.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$3,205.66 |
| Rate for Payer: Adventist Health Commercial |
$275.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$947.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,172.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,034.25
|
| Rate for Payer: Blue Shield of California Commercial |
$3,205.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,822.96
|
| Rate for Payer: Cash Price |
$620.55
|
| Rate for Payer: Cash Price |
$620.55
|
| Rate for Payer: Cash Price |
$620.55
|
| Rate for Payer: Cash Price |
$620.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,172.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,172.15
|
| Rate for Payer: Dignity Health Senior |
$1,172.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$664.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.75
|
| Rate for Payer: Multiplan Commercial |
$1,034.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,113.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,113.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,172.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,172.15
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
|
IP
|
$2,457.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$444.72 |
| Max. Negotiated Rate |
$1,842.75 |
| Rate for Payer: Adventist Health Commercial |
$491.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,687.96
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,663.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,663.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.25
|
| Rate for Payer: Multiplan Commercial |
$1,842.75
|
|
|
HC SD RECOVERY ADDL 30 MIN
|
Facility
|
OP
|
$664.00
|
|
| Hospital Charge Code |
907201508
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$120.18 |
| Max. Negotiated Rate |
$564.40 |
| Rate for Payer: Adventist Health Commercial |
$132.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$354.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$456.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$564.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$365.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.34
|
| Rate for Payer: Blue Shield of California EPN |
$389.77
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$431.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$564.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$564.40
|
| Rate for Payer: Dignity Health Senior |
$564.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$431.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$411.02
|
| Rate for Payer: Heritage Provider Network Senior |
$411.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$320.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.00
|
| Rate for Payer: Multiplan Commercial |
$498.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$564.40
|
| Rate for Payer: Vantage Medical Group Senior |
$564.40
|
|
|
HC SD RECOVERY ADDL 30 MIN
|
Facility
|
IP
|
$664.00
|
|
| Hospital Charge Code |
907201508
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$120.18 |
| Max. Negotiated Rate |
$498.00 |
| Rate for Payer: Adventist Health Commercial |
$132.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$456.17
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$449.53
|
| Rate for Payer: Heritage Provider Network Senior |
$449.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.00
|
| Rate for Payer: Multiplan Commercial |
$498.00
|
|
|
HC SD RECOVERY LEVEL IV FIRST HR
|
Facility
|
OP
|
$1,536.00
|
|
| Hospital Charge Code |
906500107
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$278.02 |
| Max. Negotiated Rate |
$1,305.60 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$820.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,055.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$844.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,152.00
|
| Rate for Payer: Blue Shield of California Commercial |
$953.86
|
| Rate for Payer: Blue Shield of California EPN |
$901.63
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$998.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,305.60
|
| Rate for Payer: Dignity Health Senior |
$1,305.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$998.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$950.78
|
| Rate for Payer: Heritage Provider Network Senior |
$950.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$740.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,305.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,305.60
|
|
|
HC SD RECOVERY LEVEL IV FIRST HR
|
Facility
|
IP
|
$1,536.00
|
|
| Hospital Charge Code |
906500107
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$278.02 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,055.23
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,039.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,039.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
IP
|
$14,344.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
909081845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,596.26 |
| Max. Negotiated Rate |
$10,758.00 |
| Rate for Payer: Adventist Health Commercial |
$2,868.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,854.33
|
| Rate for Payer: Cash Price |
$6,454.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,710.89
|
| Rate for Payer: Heritage Provider Network Senior |
$9,710.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,596.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,586.00
|
| Rate for Payer: Multiplan Commercial |
$10,758.00
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
IP
|
$12,452.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
906820199
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,253.81 |
| Max. Negotiated Rate |
$9,339.00 |
| Rate for Payer: Adventist Health Commercial |
$2,490.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,554.52
|
| Rate for Payer: Cash Price |
$5,603.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,430.00
|
| Rate for Payer: Heritage Provider Network Senior |
$8,430.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,253.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,113.00
|
| Rate for Payer: Multiplan Commercial |
$9,339.00
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
OP
|
$12,452.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
906820199
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$556.39 |
| Max. Negotiated Rate |
$10,584.20 |
| Rate for Payer: Adventist Health Commercial |
$2,490.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,554.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,584.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,848.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,339.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$5,603.40
|
| Rate for Payer: Cash Price |
$5,603.40
|
| Rate for Payer: Cash Price |
$5,603.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,093.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,584.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,584.20
|
| Rate for Payer: Dignity Health Senior |
$10,584.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,707.79
|
| Rate for Payer: Heritage Provider Network Senior |
$7,707.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,001.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,253.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,113.00
|
| Rate for Payer: Multiplan Commercial |
$9,339.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,584.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10,584.20
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
OP
|
$14,344.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
909081845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$556.39 |
| Max. Negotiated Rate |
$12,192.40 |
| Rate for Payer: Adventist Health Commercial |
$2,868.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,854.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,192.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,889.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,758.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$6,454.80
|
| Rate for Payer: Cash Price |
$6,454.80
|
| Rate for Payer: Cash Price |
$6,454.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,323.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,192.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,192.40
|
| Rate for Payer: Dignity Health Senior |
$12,192.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,878.94
|
| Rate for Payer: Heritage Provider Network Senior |
$8,878.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,913.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,596.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,586.00
|
| Rate for Payer: Multiplan Commercial |
$10,758.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,192.40
|
| Rate for Payer: Vantage Medical Group Senior |
$12,192.40
|
|
