|
HC SENSITIVITY MIC
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900911558
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.92 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$219.84
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.64
|
| Rate for Payer: Heritage Provider Network Senior |
$216.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
|
|
HC SENSITIVITY STREP MIC
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912413
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$72.35 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.35
|
| Rate for Payer: Blue Shield of California Commercial |
$67.53
|
| Rate for Payer: Blue Shield of California EPN |
$52.79
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Senior |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Humana Medicare |
$8.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.90
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.65
|
| Rate for Payer: TriValley Medical Group Senior |
$8.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC SENSITIVITY STREP MIC
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912413
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.92 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$219.84
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.64
|
| Rate for Payer: Heritage Provider Network Senior |
$216.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
|
|
HC SENSORY INTEGRAT TECH 15 MIN MCAL
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
901300064
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.15 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$182.74
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.08
|
| Rate for Payer: Heritage Provider Network Senior |
$180.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.50
|
| Rate for Payer: Multiplan Commercial |
$199.50
|
|
|
HC SENSORY INTEGRAT TECH 15 MIN MCAL
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
900400062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.15 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$182.74
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.08
|
| Rate for Payer: Heritage Provider Network Senior |
$180.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.50
|
| Rate for Payer: Multiplan Commercial |
$199.50
|
|
|
HC SENSORY INTEGRAT TECH 15 MIN MCAL
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
901300064
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$182.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$172.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.10
|
| Rate for Payer: Dignity Health Senior |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$164.65
|
| Rate for Payer: Heritage Provider Network Senior |
$164.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.50
|
| Rate for Payer: Multiplan Commercial |
$199.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.10
|
| Rate for Payer: Vantage Medical Group Senior |
$226.10
|
|
|
HC SENSORY INTEGRAT TECH 15 MIN MCAL
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
900400062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$182.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$172.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.10
|
| Rate for Payer: Dignity Health Senior |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$164.65
|
| Rate for Payer: Heritage Provider Network Senior |
$164.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.50
|
| Rate for Payer: Multiplan Commercial |
$199.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.10
|
| Rate for Payer: Vantage Medical Group Senior |
$226.10
|
|
|
HC SENSORY INTEGRAT TECH 15 MIN OT
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
905104522
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.90
|
| Rate for Payer: Dignity Health Senior |
$147.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.71
|
| Rate for Payer: Heritage Provider Network Senior |
$107.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.90
|
| Rate for Payer: Vantage Medical Group Senior |
$147.90
|
|
|
HC SENSORY INTEGRAT TECH 15 MIN OT
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
905104522
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.54
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.80
|
| Rate for Payer: Heritage Provider Network Senior |
$117.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
|
|
HC SENSORY INTEGRAT TECH 15 MIN PT
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
905103501
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.90
|
| Rate for Payer: Dignity Health Senior |
$147.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.71
|
| Rate for Payer: Heritage Provider Network Senior |
$107.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.90
|
| Rate for Payer: Vantage Medical Group Senior |
$147.90
|
|
|
HC SENSORY INTEGRAT TECH 15 MIN PT
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
905103501
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.54
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.80
|
| Rate for Payer: Heritage Provider Network Senior |
$117.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
|
|
HC SENSORY TEST ENDOSCOP SWALLOW
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 92616
|
| Hospital Charge Code |
905601752
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$59.37 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$225.34
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$222.06
|
| Rate for Payer: Heritage Provider Network Senior |
$222.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
|
|
HC SENSORY TEST ENDOSCOP SWALLOW
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 92616
|
| Hospital Charge Code |
905601752
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$59.37 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$228.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$225.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$278.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$213.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$278.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$278.80
|
| Rate for Payer: Dignity Health Senior |
$278.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.03
|
| Rate for Payer: Heritage Provider Network Senior |
$203.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$278.80
|
| Rate for Payer: Vantage Medical Group Senior |
$278.80
|
|
|
HC SENSORY TEST ENDOSCOP SWALLOW MCAL
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 92616
|
| Hospital Charge Code |
907000034
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$59.37 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$225.34
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$222.06
|
| Rate for Payer: Heritage Provider Network Senior |
$222.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
|
|
HC SENSORY TEST ENDOSCOP SWALLOW MCAL
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 92616
|
| Hospital Charge Code |
907000034
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$59.37 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$228.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$225.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$278.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$213.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$278.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$278.80
|
| Rate for Payer: Dignity Health Senior |
$278.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.03
|
| Rate for Payer: Heritage Provider Network Senior |
$203.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$278.80
|
| Rate for Payer: Vantage Medical Group Senior |
$278.80
|
|
|
HC SEO ADD MOB ELEV PROX
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
CPT L3970
|
| Hospital Charge Code |
901309115
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$112.94 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Adventist Health Commercial |
$124.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$333.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$428.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$530.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$343.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$468.00
|
| Rate for Payer: Blue Shield of California Commercial |
$387.50
|
| Rate for Payer: Blue Shield of California EPN |
$366.29
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$405.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$530.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$530.40
|
| Rate for Payer: Dignity Health Senior |
$530.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$399.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$386.26
|
| Rate for Payer: Heritage Provider Network Senior |
$386.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$300.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$530.40
|
| Rate for Payer: Vantage Medical Group Senior |
$530.40
|
|
|
HC SEO ADD MOB ELEV PROX
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
CPT L3970
|
| Hospital Charge Code |
901309115
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$112.94 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$124.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$428.69
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$422.45
|
| Rate for Payer: Heritage Provider Network Senior |
$422.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
|
|
HC SEO ADD MOB ROCKER ARM W/BAL C
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT L3972
|
| Hospital Charge Code |
901309116
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$100.27 |
| Max. Negotiated Rate |
$415.50 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$380.60
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.06
|
| Rate for Payer: Heritage Provider Network Senior |
$375.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.50
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
|
|
HC SEO ADD MOB ROCKER ARM W/BAL C
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
CPT L3972
|
| Hospital Charge Code |
901309116
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$100.27 |
| Max. Negotiated Rate |
$470.90 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$296.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$380.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$470.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$304.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$415.50
|
| Rate for Payer: Blue Shield of California Commercial |
$344.03
|
| Rate for Payer: Blue Shield of California EPN |
$325.20
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$360.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.90
|
| Rate for Payer: Dignity Health Senior |
$470.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$342.93
|
| Rate for Payer: Heritage Provider Network Senior |
$342.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$267.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.50
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$470.90
|
| Rate for Payer: Vantage Medical Group Senior |
$470.90
|
|
|
HC SHAVING SKIN LESION .5CM OR LT
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
900501338
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$87.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$227.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.09
|
| Rate for Payer: Heritage Provider Network Senior |
$224.09
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$159.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$110.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC SHAVING SKIN LESION .5CM OR LT
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
900501338
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$227.40
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.09
|
| Rate for Payer: Heritage Provider Network Senior |
$224.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
|
|
HC SHEATH NEEDLE (COOK)
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$129.75 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.12
|
| Rate for Payer: Heritage Provider Network Senior |
$117.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.25
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
|
|
HC SHEATH NEEDLE (COOK)
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$147.05 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.75
|
| Rate for Payer: Blue Shield of California Commercial |
$107.43
|
| Rate for Payer: Blue Shield of California EPN |
$101.55
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$112.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.05
|
| Rate for Payer: Dignity Health Senior |
$147.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.09
|
| Rate for Payer: Heritage Provider Network Senior |
$107.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.25
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.05
|
| Rate for Payer: Vantage Medical Group Senior |
$147.05
|
|
|
HC SHEATH SET/11CM (COOK)
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Blue Shield of California Commercial |
$74.52
|
| Rate for Payer: Blue Shield of California EPN |
$70.44
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Senior |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC SHEATH SET/11CM (COOK)
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
