|
HC N GONNORHOEAE AMPLIFICATION
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$290.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.42
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$88.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$305.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$290.93
|
| Rate for Payer: Heritage Provider Network Senior |
$84.18
|
| Rate for Payer: Heritage Provider Network Senior |
$290.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$224.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC N GONNORHOEAE AMPLIFICATION
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$85.07 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$302.68
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$318.19
|
| Rate for Payer: Heritage Provider Network Senior |
$318.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.50
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
|
|
HC NGS POST TX CD3 ENGRAFTMENT
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902026
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$143.71 |
| Max. Negotiated Rate |
$595.50 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$511.34
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$537.54
|
| Rate for Payer: Heritage Provider Network Senior |
$537.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.50
|
| Rate for Payer: Multiplan Commercial |
$595.50
|
|
|
HC NGS POST TX CD3 ENGRAFTMENT
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902026
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$143.71 |
| Max. Negotiated Rate |
$2,444.51 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$490.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,444.51
|
| Rate for Payer: Blue Shield of California Commercial |
$484.34
|
| Rate for Payer: Blue Shield of California EPN |
$387.47
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$260.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$491.49
|
| Rate for Payer: Heritage Provider Network Senior |
$491.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$378.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$349.46
|
| Rate for Payer: Multiplan Commercial |
$595.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$260.79
|
| Rate for Payer: TriValley Medical Group Senior |
$260.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$281.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$281.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Vantage Medical Group Senior |
$260.79
|
|
|
HC NGS POST TX ENGRAFTMENT
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
CPT 81267
|
| Hospital Charge Code |
903902025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$226.25 |
| Max. Negotiated Rate |
$937.50 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$805.00
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$846.25
|
| Rate for Payer: Heritage Provider Network Senior |
$846.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$226.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.50
|
| Rate for Payer: Multiplan Commercial |
$937.50
|
|
|
HC NGS POST TX ENGRAFTMENT
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
CPT 81267
|
| Hospital Charge Code |
903902025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$207.46 |
| Max. Negotiated Rate |
$5,202.87 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$772.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,202.87
|
| Rate for Payer: Blue Shield of California Commercial |
$762.50
|
| Rate for Payer: Blue Shield of California EPN |
$610.00
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$812.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$207.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$737.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$207.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$773.75
|
| Rate for Payer: Heritage Provider Network Senior |
$773.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$207.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$596.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$226.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$278.00
|
| Rate for Payer: Multiplan Commercial |
$937.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$207.46
|
| Rate for Payer: TriValley Medical Group Senior |
$207.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$224.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$224.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.21
|
| Rate for Payer: Vantage Medical Group Senior |
$207.46
|
|
|
HC NGS POST TX MYELOID ENGRAFTMENT
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$143.71 |
| Max. Negotiated Rate |
$2,444.51 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$490.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,444.51
|
| Rate for Payer: Blue Shield of California Commercial |
$484.34
|
| Rate for Payer: Blue Shield of California EPN |
$387.47
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$260.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$491.49
|
| Rate for Payer: Heritage Provider Network Senior |
$491.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$378.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$349.46
|
| Rate for Payer: Multiplan Commercial |
$595.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$260.79
|
| Rate for Payer: TriValley Medical Group Senior |
$260.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$281.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$281.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Vantage Medical Group Senior |
$260.79
|
|
|
HC NGS POST TX MYELOID ENGRAFTMENT
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$143.71 |
| Max. Negotiated Rate |
$595.50 |
| Rate for Payer: Adventist Health Commercial |
$158.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$511.34
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$537.54
|
| Rate for Payer: Heritage Provider Network Senior |
$537.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.50
|
| Rate for Payer: Multiplan Commercial |
$595.50
|
|
|
HC NGS PRE TX ENGRAFTMENT SCREEN
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
903902024
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$134.84 |
| Max. Negotiated Rate |
$558.75 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$479.78
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$504.37
|
| Rate for Payer: Heritage Provider Network Senior |
$504.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
|
|
HC NGS PRE TX ENGRAFTMENT SCREEN
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
903902024
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$134.84 |
| Max. Negotiated Rate |
$2,264.76 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$460.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$233.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,264.76
|
| Rate for Payer: Blue Shield of California Commercial |
$454.45
|
| Rate for Payer: Blue Shield of California EPN |
$363.56
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$484.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$256.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$233.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$439.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$233.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.15
|
| Rate for Payer: Heritage Provider Network Senior |
$461.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$233.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$355.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$268.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$312.31
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$233.07
|
| Rate for Payer: TriValley Medical Group Senior |
$233.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$251.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$349.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: Vantage Medical Group Senior |
$233.07
|
|
|
HC NICU TRANSPORT PER HOUR
|
Facility
|
IP
|
$2,394.00
|
|
| Hospital Charge Code |
905200001
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$433.31 |
| Max. Negotiated Rate |
$4,915.00 |
| Rate for Payer: Adventist Health Commercial |
$478.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,541.74
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$1,077.30
|
| Rate for Payer: Cash Price |
$1,077.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,620.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,620.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$433.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$598.50
|
| Rate for Payer: Multiplan Commercial |
$1,795.50
|
|
|
HC NID
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$76.64 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.64
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Heritage Provider Network Senior |
$32.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NID
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.49
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.20
|
| Rate for Payer: Heritage Provider Network Senior |
$35.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
|
|
HC NIPT
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 81507
|
| Hospital Charge Code |
910401507
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.81 |
| Max. Negotiated Rate |
$2,670.47 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$279.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,192.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$874.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$795.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,670.47
|
| Rate for Payer: Blue Shield of California Commercial |
$275.72
|
| Rate for Payer: Blue Shield of California EPN |
$220.58
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$293.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,192.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$795.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$795.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$279.79
|
| Rate for Payer: Heritage Provider Network Senior |
$279.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$795.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$215.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$914.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,065.30
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$795.00
|
| Rate for Payer: TriValley Medical Group Senior |
$795.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$858.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$858.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,192.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.50
|
| Rate for Payer: Vantage Medical Group Senior |
$795.00
|
|
|
HC NIPT
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 81507
|
| Hospital Charge Code |
910401507
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.81 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$291.09
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$306.00
|
| Rate for Payer: Heritage Provider Network Senior |
$306.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
|
|
HC NITINAL WIRES/SHORT
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.14
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.19
|
| Rate for Payer: Heritage Provider Network Senior |
$165.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
|
|
HC NITINAL WIRES/SHORT
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$150.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$183.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.05
|
| Rate for Payer: Blue Shield of California Commercial |
$148.84
|
| Rate for Payer: Blue Shield of California EPN |
$119.07
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$158.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$207.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$207.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$151.04
|
| Rate for Payer: Heritage Provider Network Senior |
$151.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$116.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$170.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$122.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$122.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.40
|
| Rate for Payer: Vantage Medical Group Senior |
$207.40
|
|
|
HC NITRIC OXIDE/HELIOX THRPY PER DAY
|
Facility
|
OP
|
$2,615.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800400
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$1,961.25 |
| Rate for Payer: Adventist Health Commercial |
$523.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,616.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,308.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1,595.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,276.12
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,699.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,542.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,618.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,618.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,247.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$473.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$1,961.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$182.04
|
| Rate for Payer: TriValley Medical Group Senior |
$165.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,307.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,307.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC NITRIC OXIDE/HELIOX THRPY PER DAY
|
Facility
|
IP
|
$2,615.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800400
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$473.31 |
| Max. Negotiated Rate |
$1,961.25 |
| Rate for Payer: Adventist Health Commercial |
$523.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,684.06
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,770.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,770.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$473.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.75
|
| Rate for Payer: Multiplan Commercial |
$1,961.25
|
|
|
HC NMIC306
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$76.64 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.64
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NMIC306
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC NMIC312
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913013
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.10
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC NMIC312
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913013
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$76.64 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.64
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NM MYCRD IMG PET RST & STRS CT
|
Facility
|
IP
|
$4,751.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
909308431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$859.93 |
| Max. Negotiated Rate |
$3,563.25 |
| Rate for Payer: Adventist Health Commercial |
$950.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,059.64
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,216.43
|
| Rate for Payer: Heritage Provider Network Senior |
$3,216.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$859.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.75
|
| Rate for Payer: Multiplan Commercial |
$3,563.25
|
|
|
HC NM MYCRD IMG PET RST & STRS CT
|
Facility
|
OP
|
$4,751.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
909308431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$859.93 |
| Max. Negotiated Rate |
$4,249.73 |
| Rate for Payer: Adventist Health Commercial |
$950.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,936.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,249.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,116.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,833.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,376.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2,898.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,318.49
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,088.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,249.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,116.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,833.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,088.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,833.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,940.87
|
| Rate for Payer: Heritage Provider Network Senior |
$2,940.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,833.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,266.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$859.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,258.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,796.42
|
| Rate for Payer: Multiplan Commercial |
$3,563.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,116.47
|
| Rate for Payer: TriValley Medical Group Senior |
$2,833.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,375.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,375.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,249.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,116.47
|
| Rate for Payer: Vantage Medical Group Senior |
$2,833.15
|
|
