|
HC PT SINGLE MOD ONE AREA EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
900419012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$42.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.40
|
| Rate for Payer: Dignity Health Senior |
$88.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.38
|
| Rate for Payer: Heritage Provider Network Senior |
$64.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.40
|
| Rate for Payer: Vantage Medical Group Senior |
$88.40
|
|
|
HC PT SINGLE MOD ONE AREA EA ADDL 15 MIN MCAL
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
900419012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.41
|
| Rate for Payer: Heritage Provider Network Senior |
$70.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
|
|
HC PT SINGLE PROC EA ADDL 15 MIN
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
905103303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$42.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.40
|
| Rate for Payer: Dignity Health Senior |
$88.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.38
|
| Rate for Payer: Heritage Provider Network Senior |
$64.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.40
|
| Rate for Payer: Vantage Medical Group Senior |
$88.40
|
|
|
HC PT SINGLE PROC EA ADDL 15 MIN
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
905103303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.41
|
| Rate for Payer: Heritage Provider Network Senior |
$70.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
|
|
HC PT SINGLE PROC EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
900419021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$42.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.40
|
| Rate for Payer: Dignity Health Senior |
$88.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.38
|
| Rate for Payer: Heritage Provider Network Senior |
$64.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.40
|
| Rate for Payer: Vantage Medical Group Senior |
$88.40
|
|
|
HC PT SINGLE PROC EA ADDL 15 MIN MCAL
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
900419021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.41
|
| Rate for Payer: Heritage Provider Network Senior |
$70.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
|
|
HC PT SINGLE PROC INITIAL 30 MIN
|
Facility
|
IP
|
$195.00
|
|
| Hospital Charge Code |
905103302
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.01
|
| Rate for Payer: Heritage Provider Network Senior |
$132.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
|
|
HC PT SINGLE PROC INITIAL 30 MIN
|
Facility
|
OP
|
$195.00
|
|
| Hospital Charge Code |
905103302
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$79.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$104.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.75
|
| Rate for Payer: Dignity Health Senior |
$165.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.70
|
| Rate for Payer: Heritage Provider Network Senior |
$120.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| 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 |
$165.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.75
|
| Rate for Payer: Vantage Medical Group Senior |
$165.75
|
|
|
HC PT SINGLE PROC INITIAL 30 MIN MCAL
|
Facility
|
IP
|
$195.00
|
|
| Hospital Charge Code |
900419020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.01
|
| Rate for Payer: Heritage Provider Network Senior |
$132.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
|
|
HC PT SINGLE PROC INITIAL 30 MIN MCAL
|
Facility
|
OP
|
$195.00
|
|
| Hospital Charge Code |
900419020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$79.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$104.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.75
|
| Rate for Payer: Dignity Health Senior |
$165.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.70
|
| Rate for Payer: Heritage Provider Network Senior |
$120.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| 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 |
$165.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.75
|
| Rate for Payer: Vantage Medical Group Senior |
$165.75
|
|
|
HC PT SUBSTITUTION
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
900910105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.04 |
| Max. Negotiated Rate |
$132.75 |
| Rate for Payer: Adventist Health Commercial |
$35.40
|
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.83
|
| Rate for Payer: Heritage Provider Network Senior |
$119.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.25
|
| Rate for Payer: Multiplan Commercial |
$132.75
|
|
|
HC PT SUBSTITUTION
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
900910105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$132.75 |
| Rate for Payer: Adventist Health Commercial |
$35.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$94.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.96
|
| Rate for Payer: Blue Shield of California Commercial |
$31.74
|
| Rate for Payer: Blue Shield of California EPN |
$25.46
|
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.33
|
| Rate for Payer: Dignity Health Senior |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.56
|
| Rate for Payer: Heritage Provider Network Senior |
$109.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$84.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.96
|
| Rate for Payer: Multiplan Commercial |
$132.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.94
|
| Rate for Payer: TriValley Medical Group Senior |
$3.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Vantage Medical Group Senior |
$3.94
|
|
|
HC PTT
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.82
|
| Rate for Payer: Blue Shield of California Commercial |
$48.27
|
| Rate for Payer: Blue Shield of California EPN |
$38.72
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Senior |
$6.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.90
|
| Rate for Payer: Heritage Provider Network Senior |
$113.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$87.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.57
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Senior |
$6.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC PTT
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.57
|
| Rate for Payer: Heritage Provider Network Senior |
$124.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
|
|
HC PTT SUBSTITUTION
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910106
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.07
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.90
|
| Rate for Payer: Heritage Provider Network Senior |
$113.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$87.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC PTT SUBSTITUTION
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910106
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.57
|
| Rate for Payer: Heritage Provider Network Senior |
$124.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906811417
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$357.48 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$395.00
|
| Rate for Payer: Cash Price |
$1,086.25
|
| Rate for Payer: Cash Price |
$1,086.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$493.75
|
| Rate for Payer: Multiplan Commercial |
$1,481.25
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906811417
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$150.98 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$395.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,356.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,678.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,086.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,481.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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: Cash Price |
$1,086.25
|
| Rate for Payer: Cash Price |
$1,086.25
|
| Rate for Payer: Cash Price |
$1,086.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,678.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,678.75
|
| Rate for Payer: Dignity Health Senior |
$1,678.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,283.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,222.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,222.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$150.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$942.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$493.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,382.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,382.50
|
| Rate for Payer: Multiplan Commercial |
$1,481.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,678.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,678.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,678.75
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
OP
|
$2,323.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906820074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$150.98 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$464.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,595.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,974.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,277.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,742.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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: Cash Price |
$1,277.65
|
| Rate for Payer: Cash Price |
$1,277.65
|
| Rate for Payer: Cash Price |
$1,277.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,974.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,974.55
|
| Rate for Payer: Dignity Health Senior |
$1,974.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,509.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,437.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1,437.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$150.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,108.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$420.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,626.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,626.10
|
| Rate for Payer: Multiplan Commercial |
$1,742.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,974.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,974.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,974.55
|
|
|
HC PULMONARY ARTERIAL ANGIO
|
Facility
|
IP
|
$2,323.00
|
|
|
Service Code
|
CPT 93568
|
| Hospital Charge Code |
906820074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$420.46 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$464.60
|
| Rate for Payer: Cash Price |
$1,277.65
|
| Rate for Payer: Cash Price |
$1,277.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$420.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.75
|
| Rate for Payer: Multiplan Commercial |
$1,742.25
|
|
|
HC PULMONARY EXERCISE THERAPY GRP
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT G0239
|
| Hospital Charge Code |
900201804
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$49.87 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$438.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$563.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$500.20
|
| Rate for Payer: Blue Shield of California EPN |
$400.16
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$533.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Senior |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$533.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$49.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.58
|
| Rate for Payer: Heritage Provider Network Senior |
$507.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$391.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.84
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| 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 |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC PULMONARY EXERCISE THERAPY GRP
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT G0239
|
| Hospital Charge Code |
900201804
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
|
|
HC PULM PERFUSION SCAN
|
Facility
|
IP
|
$1,925.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
909301400
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$348.43 |
| Max. Negotiated Rate |
$1,443.75 |
| Rate for Payer: Adventist Health Commercial |
$385.00
|
| Rate for Payer: Cash Price |
$1,058.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,303.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,303.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$481.25
|
| Rate for Payer: Multiplan Commercial |
$1,443.75
|
|
|
HC PULM PERFUSION SCAN
|
Facility
|
OP
|
$1,925.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
909301400
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$1,443.75 |
| Rate for Payer: Adventist Health Commercial |
$385.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,028.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,322.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$720.86
|
| Rate for Payer: Blue Shield of California EPN |
$579.69
|
| Rate for Payer: Cash Price |
$1,058.75
|
| Rate for Payer: Cash Price |
$1,058.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,251.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,251.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,191.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,191.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$918.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$481.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$1,443.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$962.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$962.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC PULM PERF & VENT/VQ
|
Facility
|
IP
|
$2,376.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
909301403
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$430.06 |
| Max. Negotiated Rate |
$1,782.00 |
| Rate for Payer: Adventist Health Commercial |
$475.20
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,608.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,608.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$594.00
|
| Rate for Payer: Multiplan Commercial |
$1,782.00
|
|
