|
HC MATRIX 3D X-FIRM COIL
|
Facility
|
OP
|
$4,400.00
|
|
| Hospital Charge Code |
909081830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$880.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,719.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,420.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,768.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,768.80
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,024.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,740.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,740.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,816.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,037.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,037.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,200.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,200.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,200.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,080.00
|
| Rate for Payer: Multiplan Commercial |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,589.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,456.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,740.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,740.00
|
|
|
HC MAXILLOFACIAL FIXATION
|
Facility
|
IP
|
$10,460.00
|
|
|
Service Code
|
CPT 21100
|
| Hospital Charge Code |
900501456
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,893.26 |
| Max. Negotiated Rate |
$7,845.00 |
| Rate for Payer: Adventist Health Commercial |
$2,092.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,736.24
|
| Rate for Payer: Cash Price |
$4,707.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,081.42
|
| Rate for Payer: Heritage Provider Network Senior |
$7,081.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,893.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,615.00
|
| Rate for Payer: Multiplan Commercial |
$7,845.00
|
|
|
HC MAXILLOFACIAL FIXATION
|
Facility
|
OP
|
$10,460.00
|
|
|
Service Code
|
CPT 21100
|
| Hospital Charge Code |
900501456
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,893.26 |
| Max. Negotiated Rate |
$11,976.10 |
| Rate for Payer: Adventist Health Commercial |
$2,092.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,464.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,968.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,953.88
|
| Rate for Payer: Cash Price |
$4,707.00
|
| Rate for Payer: Cash Price |
$4,707.00
|
| Rate for Payer: Cash Price |
$4,707.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,799.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,613.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,081.42
|
| Rate for Payer: Heritage Provider Network Senior |
$7,081.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,989.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,893.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,755.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,615.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan Commercial |
$7,845.00
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,276.00
|
| Rate for Payer: TriValley Medical Group Senior |
$6,276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
HC MEASLES AB
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913530
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$135.24
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC MEASLES AB
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913530
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$122.35 |
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.35
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.81
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$45.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$100.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC MECHANICAL CHEST WALL OSCILL
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
900100003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$30.41 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$108.19
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.74
|
| Rate for Payer: Heritage Provider Network Senior |
$113.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
|
|
HC MECHANICAL CHEST WALL OSCILL
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
900100003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$30.41 |
| Max. Negotiated Rate |
$422.46 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$281.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.99
|
| Rate for Payer: Heritage Provider Network Senior |
$103.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$80.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
|
HC MECKELS SCAN
|
Facility
|
IP
|
$1,964.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
909301366
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$355.48 |
| Max. Negotiated Rate |
$1,473.00 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,264.82
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,329.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,329.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$355.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.00
|
| Rate for Payer: Multiplan Commercial |
$1,473.00
|
|
|
HC MECKELS SCAN
|
Facility
|
OP
|
$1,964.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
909301366
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$355.48 |
| Max. Negotiated Rate |
$1,473.00 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,213.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$982.39
|
| Rate for Payer: Blue Shield of California Commercial |
$641.23
|
| Rate for Payer: Blue Shield of California EPN |
$515.66
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,276.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,276.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,215.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,215.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$936.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$355.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,473.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$982.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$982.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC MEDCOMP TEMP DIALYSIS CATH
|
Facility
|
IP
|
$441.60
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
909081724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$88.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$284.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$177.52
|
| Rate for Payer: Blue Shield of California EPN |
$177.52
|
| Rate for Payer: Cash Price |
$198.72
|
| Rate for Payer: Cash Price |
$198.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$203.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.46
|
| Rate for Payer: Heritage Provider Network Senior |
$204.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$220.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$220.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$220.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.40
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$146.21
|
|
|
HC MEDCOMP TEMP DIALYSIS CATH
|
Facility
|
OP
|
$441.60
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
909081724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$88.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$272.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$331.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$177.52
|
| Rate for Payer: Blue Shield of California EPN |
$177.52
|
| Rate for Payer: Cash Price |
$198.72
|
| Rate for Payer: Cash Price |
$198.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$203.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$375.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.46
|
| Rate for Payer: Heritage Provider Network Senior |
$204.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$220.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$220.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$220.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$309.12
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$146.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$375.36
|
| Rate for Payer: Vantage Medical Group Senior |
$375.36
|
|
|
HC MEMORY CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9168
|
| Hospital Charge Code |
900018133
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9168
|
| Hospital Charge Code |
900018233
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9168
|
| Hospital Charge Code |
900018233
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MEMORY CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9168
|
| Hospital Charge Code |
900018433
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MEMORY CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9168
|
| Hospital Charge Code |
900018433
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9168
|
| Hospital Charge Code |
900018133
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MEMORY D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9170
|
| Hospital Charge Code |
900018435
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MEMORY D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9170
|
| Hospital Charge Code |
900018435
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9170
|
| Hospital Charge Code |
900018135
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MEMORY D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9170
|
| Hospital Charge Code |
900018235
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MEMORY D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9170
|
| Hospital Charge Code |
900018135
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9170
|
| Hospital Charge Code |
900018235
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9169
|
| Hospital Charge Code |
900018134
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9169
|
| Hospital Charge Code |
900018234
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
