|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
IP
|
$5,844.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,057.76 |
| Max. Negotiated Rate |
$4,383.00 |
| Rate for Payer: Adventist Health Commercial |
$1,168.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,763.54
|
| Rate for Payer: Cash Price |
$2,629.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,956.39
|
| Rate for Payer: Heritage Provider Network Senior |
$3,956.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,057.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,461.00
|
| Rate for Payer: Multiplan Commercial |
$4,383.00
|
|
|
HC NERVE BLOCK INJ-CERVICAL PLEXU
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 64413
|
| Hospital Charge Code |
900501738
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.69 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$575.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$792.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$512.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$699.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$442.70
|
| Rate for Payer: Blue Shield of California EPN |
$352.30
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$605.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$792.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$792.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$792.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$630.96
|
| Rate for Payer: Heritage Provider Network Senior |
$630.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$444.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$652.40
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$559.20
|
| Rate for Payer: TriValley Medical Group Senior |
$559.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$792.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$792.20
|
| Rate for Payer: Vantage Medical Group Senior |
$792.20
|
|
|
HC NERVE BLOCK INJ-CERVICAL PLEXU
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 64413
|
| Hospital Charge Code |
900501738
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.69 |
| Max. Negotiated Rate |
$699.00 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$600.21
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$630.96
|
| Rate for Payer: Heritage Provider Network Senior |
$630.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
|
|
HC NERVE TEASING
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 88362
|
| Hospital Charge Code |
903800042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$95.39 |
| Max. Negotiated Rate |
$1,554.36 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Adventist Health Commercial |
$68.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$325.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.27
|
| Rate for Payer: Blue Shield of California Commercial |
$709.58
|
| Rate for Payer: Blue Shield of California Commercial |
$709.58
|
| Rate for Payer: Blue Shield of California EPN |
$570.62
|
| Rate for Payer: Blue Shield of California EPN |
$570.62
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$222.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$342.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$222.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,036.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,036.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.21
|
| Rate for Payer: Heritage Provider Network Senior |
$211.70
|
| Rate for Payer: Heritage Provider Network Senior |
$326.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$163.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$251.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Multiplan Commercial |
$256.50
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,036.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,036.24
|
| Rate for Payer: TriValley Medical Group Senior |
$1,036.24
|
| Rate for Payer: TriValley Medical Group Senior |
$1,036.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$722.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$722.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$722.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$722.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
|
|
HC NERVE TEASING
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 88362
|
| Hospital Charge Code |
903800042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$95.39 |
| Max. Negotiated Rate |
$395.25 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$339.39
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$356.78
|
| Rate for Payer: Heritage Provider Network Senior |
$356.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.75
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN
|
Facility
|
OP
|
$1,023.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
905601804
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Adventist Health Commercial |
$419.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$632.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| 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 |
$460.35
|
| Rate for Payer: Cash Price |
$460.35
|
| Rate for Payer: Cash Price |
$460.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$664.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$277.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.24
|
| Rate for Payer: Heritage Provider Network Senior |
$633.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$487.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$767.25
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN
|
Facility
|
IP
|
$1,023.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
905601804
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$185.16 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Adventist Health Commercial |
$204.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$658.81
|
| Rate for Payer: Cash Price |
$460.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$692.57
|
| Rate for Payer: Heritage Provider Network Senior |
$692.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.75
|
| Rate for Payer: Multiplan Commercial |
$767.25
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN MCAL
|
Facility
|
OP
|
$1,023.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
907000032
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Adventist Health Commercial |
$419.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$632.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| 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 |
$460.35
|
| Rate for Payer: Cash Price |
$460.35
|
| Rate for Payer: Cash Price |
$460.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$664.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$277.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.24
|
| Rate for Payer: Heritage Provider Network Senior |
$633.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$487.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$767.25
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN MCAL
|
Facility
|
IP
|
$1,023.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
907000032
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$185.16 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Adventist Health Commercial |
$204.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$658.81
|
| Rate for Payer: Cash Price |
$460.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$692.57
|
| Rate for Payer: Heritage Provider Network Senior |
$692.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.75
|
| Rate for Payer: Multiplan Commercial |
$767.25
|
|
|
HC NEUROINTERVENTIONAL CATH J&J
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.03
|
| Rate for Payer: Blue Shield of California Commercial |
$84.18
|
| Rate for Payer: Blue Shield of California EPN |
$67.34
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.42
|
| Rate for Payer: Heritage Provider Network Senior |
$85.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$65.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.30
|
| Rate for Payer: Vantage Medical Group Senior |
$117.30
|
|
|
HC NEUROINTERVENTIONAL CATH J&J
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.87
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
|
OP
|
$4,924.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$891.24 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$984.80
|
| Rate for Payer: Adventist Health Commercial |
$933.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,883.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,043.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,215.80
|
| Rate for Payer: Cash Price |
$2,099.70
|
| Rate for Payer: Cash Price |
$2,099.70
|
| Rate for Payer: Cash Price |
$2,215.80
|
| Rate for Payer: Cash Price |
$2,099.70
|
| Rate for Payer: Cash Price |
$2,215.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,032.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,200.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,799.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,954.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,888.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,047.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,161.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,161.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$891.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$844.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,166.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$3,499.50
|
| Rate for Payer: Multiplan Commercial |
$3,693.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,251.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,251.34
|
| Rate for Payer: TriValley Medical Group Senior |
$1,251.34
|
| Rate for Payer: TriValley Medical Group Senior |
$1,251.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
|
OP
|
$4,924.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$984.80
|
| Rate for Payer: Adventist Health Commercial |
$933.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,883.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,043.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,215.80
|
| Rate for Payer: Cash Price |
$2,099.70
|
| Rate for Payer: Cash Price |
$2,215.80
|
| Rate for Payer: Cash Price |
$2,099.70
|
| Rate for Payer: Cash Price |
$2,215.80
|
| Rate for Payer: Cash Price |
$2,099.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,032.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,200.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,799.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,954.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,047.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,888.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,225.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,348.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$891.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$844.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,166.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$3,693.00
|
| Rate for Payer: Multiplan Commercial |
$3,499.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
|
IP
|
$4,924.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$891.24 |
| Max. Negotiated Rate |
$3,693.00 |
| Rate for Payer: Adventist Health Commercial |
$984.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,171.06
|
| Rate for Payer: Cash Price |
$2,215.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,333.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,333.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$891.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.00
|
| Rate for Payer: Multiplan Commercial |
$3,693.00
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
|
IP
|
$4,924.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$891.24 |
| Max. Negotiated Rate |
$3,693.00 |
| Rate for Payer: Adventist Health Commercial |
$984.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,171.06
|
| Rate for Payer: Cash Price |
$2,215.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,333.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,333.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$891.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.00
|
| Rate for Payer: Multiplan Commercial |
$3,693.00
|
|
|
HC NEUROMUSC RE-ED 15 MIN OT
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905104141
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| 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 |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.56
|
| Rate for Payer: Heritage Provider Network Senior |
$83.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| 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 |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC NEUROMUSC RE-ED 15 MIN OT
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905104141
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.94
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.39
|
| Rate for Payer: Heritage Provider Network Senior |
$91.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
|
|
HC NEUROMUSC RE ED 15MIN PT
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905103141
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.94
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.39
|
| Rate for Payer: Heritage Provider Network Senior |
$91.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
|
|
HC NEUROMUSC RE ED 15MIN PT
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
905103141
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| 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 |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.56
|
| Rate for Payer: Heritage Provider Network Senior |
$83.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| 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 |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC NEUROMUSC RE-ED 15 MIN PT
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
900417112
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.94
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.39
|
| Rate for Payer: Heritage Provider Network Senior |
$91.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
|
|
HC NEUROMUSC RE-ED 15 MIN PT
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
900417112
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| 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 |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.56
|
| Rate for Payer: Heritage Provider Network Senior |
$83.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| 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 |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.14
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.54
|
| Rate for Payer: Blue Shield of California Commercial |
$94.66
|
| Rate for Payer: Blue Shield of California EPN |
$76.12
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.23
|
| Rate for Payer: TriValley Medical Group Senior |
$171.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$92.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$92.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC NEWBORN SCREENING PANEL
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT S3620
|
| Hospital Charge Code |
903100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.99 |
| Max. Negotiated Rate |
$197.20 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$143.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.05
|
| Rate for Payer: Blue Shield of California Commercial |
$141.52
|
| Rate for Payer: Blue Shield of California EPN |
$113.22
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$150.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.61
|
| Rate for Payer: Heritage Provider Network Senior |
$143.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$110.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$162.40
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$116.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$116.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.20
|
| Rate for Payer: Vantage Medical Group Senior |
$197.20
|
|
|
HC NEWBORN SCREENING PANEL
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT S3620
|
| Hospital Charge Code |
903100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.99 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.41
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.06
|
| Rate for Payer: Heritage Provider Network Senior |
$157.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
|
