|
HC RECOVERY LEVEL IV FIRST HOUR
|
Facility
|
IP
|
$2,692.00
|
|
| Hospital Charge Code |
907201707
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$487.25 |
| Max. Negotiated Rate |
$2,019.00 |
| Rate for Payer: Adventist Health Commercial |
$538.40
|
| Rate for Payer: Cash Price |
$1,480.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,822.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,822.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$487.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.00
|
| Rate for Payer: Multiplan Commercial |
$2,019.00
|
|
|
HC RECOVERY LEVL I EA ADDL 30 MIN
|
Facility
|
IP
|
$716.00
|
|
| Hospital Charge Code |
907201702
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$537.00 |
| Rate for Payer: Adventist Health Commercial |
$143.20
|
| Rate for Payer: Cash Price |
$393.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.73
|
| Rate for Payer: Heritage Provider Network Senior |
$484.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.00
|
| Rate for Payer: Multiplan Commercial |
$537.00
|
|
|
HC RECOVERY LEVL I EA ADDL 30 MIN
|
Facility
|
OP
|
$716.00
|
|
| Hospital Charge Code |
907201702
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$608.60 |
| Rate for Payer: Adventist Health Commercial |
$143.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$382.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$491.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$608.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$393.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$537.00
|
| Rate for Payer: Blue Shield of California Commercial |
$436.76
|
| Rate for Payer: Blue Shield of California EPN |
$349.41
|
| Rate for Payer: Cash Price |
$393.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$465.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$608.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$608.60
|
| Rate for Payer: Dignity Health Senior |
$608.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$465.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$443.20
|
| Rate for Payer: Heritage Provider Network Senior |
$443.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$341.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$501.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$501.20
|
| Rate for Payer: Multiplan Commercial |
$537.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$358.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$608.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$608.60
|
| Rate for Payer: Vantage Medical Group Senior |
$608.60
|
|
|
HC RECOVERY LEVL II EA ADDL 30 MIN
|
Facility
|
OP
|
$907.00
|
|
| Hospital Charge Code |
907201704
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$164.17 |
| Max. Negotiated Rate |
$770.95 |
| Rate for Payer: Adventist Health Commercial |
$181.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$484.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$623.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$770.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$498.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$680.25
|
| Rate for Payer: Blue Shield of California Commercial |
$553.27
|
| Rate for Payer: Blue Shield of California EPN |
$442.62
|
| Rate for Payer: Cash Price |
$498.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$589.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$770.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$770.95
|
| Rate for Payer: Dignity Health Senior |
$770.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$589.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$561.43
|
| Rate for Payer: Heritage Provider Network Senior |
$561.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$432.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$634.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$634.90
|
| Rate for Payer: Multiplan Commercial |
$680.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$453.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$453.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$770.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$770.95
|
| Rate for Payer: Vantage Medical Group Senior |
$770.95
|
|
|
HC RECOVERY LEVL II EA ADDL 30 MIN
|
Facility
|
IP
|
$907.00
|
|
| Hospital Charge Code |
907201704
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$164.17 |
| Max. Negotiated Rate |
$680.25 |
| Rate for Payer: Adventist Health Commercial |
$181.40
|
| Rate for Payer: Cash Price |
$498.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$614.04
|
| Rate for Payer: Heritage Provider Network Senior |
$614.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.75
|
| Rate for Payer: Multiplan Commercial |
$680.25
|
|
|
HC RECOVERY LEVL IV EA ADDL 30 MIN
|
Facility
|
IP
|
$1,507.00
|
|
| Hospital Charge Code |
907201708
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$272.77 |
| Max. Negotiated Rate |
$1,130.25 |
| Rate for Payer: Adventist Health Commercial |
$301.40
|
| Rate for Payer: Cash Price |
$828.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,020.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1,020.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.75
|
| Rate for Payer: Multiplan Commercial |
$1,130.25
|
|
|
HC RECOVERY LEVL IV EA ADDL 30 MIN
|
Facility
|
OP
|
$1,507.00
|
|
| Hospital Charge Code |
907201708
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$272.77 |
| Max. Negotiated Rate |
$1,280.95 |
| Rate for Payer: Adventist Health Commercial |
$301.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$805.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,035.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,280.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$828.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,130.25
|
| Rate for Payer: Blue Shield of California Commercial |
$919.27
|
| Rate for Payer: Blue Shield of California EPN |
$735.42
|
| Rate for Payer: Cash Price |
$828.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$979.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,280.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,280.95
|
| Rate for Payer: Dignity Health Senior |
$1,280.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$979.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$932.83
|
| Rate for Payer: Heritage Provider Network Senior |
$932.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$718.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,054.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,054.90
|
| Rate for Payer: Multiplan Commercial |
$1,130.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$753.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$753.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,280.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,280.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,280.95
|
|
|
HC RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 91120
|
| Hospital Charge Code |
906791120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$143.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| 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 |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$174.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Senior |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$395.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.89
|
| Rate for Payer: Heritage Provider Network Senior |
$486.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$127.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$455.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$498.53
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| 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 |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 91120
|
| Hospital Charge Code |
906791120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.44
|
| Rate for Payer: Heritage Provider Network Senior |
$181.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
|
|
HC RED CELL MASS
|
Facility
|
IP
|
$1,802.00
|
|
|
Service Code
|
CPT 78122
|
| Hospital Charge Code |
909301332
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$326.16 |
| Max. Negotiated Rate |
$1,351.50 |
| Rate for Payer: Adventist Health Commercial |
$360.40
|
| Rate for Payer: Cash Price |
$991.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,219.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1,219.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.50
|
| Rate for Payer: Multiplan Commercial |
$1,351.50
|
|
|
HC RED CELL MASS
|
Facility
|
OP
|
$1,802.00
|
|
|
Service Code
|
CPT 78122
|
| Hospital Charge Code |
909301332
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$143.08 |
| Max. Negotiated Rate |
$1,351.50 |
| Rate for Payer: Adventist Health Commercial |
$360.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$963.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,237.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Blue Shield of California Commercial |
$967.87
|
| Rate for Payer: Blue Shield of California EPN |
$778.33
|
| Rate for Payer: Cash Price |
$991.10
|
| Rate for Payer: Cash Price |
$991.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,171.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Senior |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,171.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$683.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,115.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1,115.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$859.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$786.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$861.75
|
| Rate for Payer: Multiplan Commercial |
$1,351.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$752.32
|
| Rate for Payer: TriValley Medical Group Senior |
$683.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$901.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$901.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC RED CELL SUR/HEP SEQ
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
CPT 78140
|
| Hospital Charge Code |
909301336
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$795.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,022.26
|
| 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 |
$828.24
|
| Rate for Payer: Blue Shield of California EPN |
$666.04
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$967.20
|
| 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 |
$967.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$921.07
|
| Rate for Payer: Heritage Provider Network Senior |
$921.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$709.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$269.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.00
|
| 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 |
$1,116.00
|
| 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 |
$744.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$744.00
|
| 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 RED CELL SUR/HEP SEQ
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT 78140
|
| Hospital Charge Code |
909301336
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$269.33 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,007.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,007.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$269.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.00
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
|
|
HC RED CELL SURVIVAL
|
Facility
|
IP
|
$1,358.00
|
|
|
Service Code
|
CPT 78130
|
| Hospital Charge Code |
909301334
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$245.80 |
| Max. Negotiated Rate |
$1,018.50 |
| Rate for Payer: Adventist Health Commercial |
$271.60
|
| Rate for Payer: Cash Price |
$746.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$919.37
|
| Rate for Payer: Heritage Provider Network Senior |
$919.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.50
|
| Rate for Payer: Multiplan Commercial |
$1,018.50
|
|
|
HC RED CELL SURVIVAL
|
Facility
|
OP
|
$1,358.00
|
|
|
Service Code
|
CPT 78130
|
| Hospital Charge Code |
909301334
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$1,018.50 |
| Rate for Payer: Adventist Health Commercial |
$271.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$725.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$932.95
|
| 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 |
$597.94
|
| Rate for Payer: Blue Shield of California EPN |
$480.84
|
| Rate for Payer: Cash Price |
$746.90
|
| Rate for Payer: Cash Price |
$746.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$882.70
|
| 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 |
$882.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$840.60
|
| Rate for Payer: Heritage Provider Network Senior |
$840.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$647.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.50
|
| 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 |
$1,018.50
|
| 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 |
$679.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$679.00
|
| 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 RED CELL SURV - SEQ
|
Facility
|
IP
|
$1,358.00
|
|
|
Service Code
|
CPT 78135
|
| Hospital Charge Code |
909301335
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$245.80 |
| Max. Negotiated Rate |
$1,018.50 |
| Rate for Payer: Adventist Health Commercial |
$271.60
|
| Rate for Payer: Cash Price |
$746.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$919.37
|
| Rate for Payer: Heritage Provider Network Senior |
$919.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.50
|
| Rate for Payer: Multiplan Commercial |
$1,018.50
|
|
|
HC RED CELL SURV - SEQ
|
Facility
|
OP
|
$1,358.00
|
|
|
Service Code
|
CPT 78135
|
| Hospital Charge Code |
909301335
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$245.80 |
| Max. Negotiated Rate |
$1,154.30 |
| Rate for Payer: Adventist Health Commercial |
$271.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$725.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$932.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,154.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$746.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,018.50
|
| Rate for Payer: Blue Shield of California Commercial |
$828.38
|
| Rate for Payer: Blue Shield of California EPN |
$662.70
|
| Rate for Payer: Cash Price |
$746.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$882.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,154.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,154.30
|
| Rate for Payer: Dignity Health Senior |
$1,154.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$882.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$840.60
|
| Rate for Payer: Heritage Provider Network Senior |
$840.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$647.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$950.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$950.60
|
| Rate for Payer: Multiplan Commercial |
$1,018.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$679.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$679.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,154.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,154.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,154.30
|
|
|
HC RED OF PROCIDENTIA UND ANESTH
|
Facility
|
OP
|
$1,404.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
900501155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$964.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$912.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Senior |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,158.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$950.51
|
| Rate for Payer: Heritage Provider Network Senior |
$950.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$669.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,332.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,459.61
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$505.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$464.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC RED OF PROCIDENTIA UND ANESTH
|
Facility
|
IP
|
$1,404.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
900501155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$254.12 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$950.51
|
| Rate for Payer: Heritage Provider Network Senior |
$950.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
|
|
HC REDUCING SUBSTANCE
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
900910318
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.90
|
| Rate for Payer: Heritage Provider Network Senior |
$58.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
|
|
HC REDUCING SUBSTANCE
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
900910318
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.73
|
| Rate for Payer: Blue Shield of California Commercial |
$17.45
|
| Rate for Payer: Blue Shield of California EPN |
$14.00
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.39
|
| Rate for Payer: Dignity Health Senior |
$2.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.85
|
| Rate for Payer: Heritage Provider Network Senior |
$53.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.73
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.17
|
| Rate for Payer: TriValley Medical Group Senior |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2.17
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$267.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$918.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$735.35
|
| Rate for Payer: Cash Price |
$735.35
|
| Rate for Payer: Cash Price |
$735.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$869.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Senior |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,033.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$905.15
|
| Rate for Payer: Heritage Provider Network Senior |
$905.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$637.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,338.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,562.18
|
| Rate for Payer: Multiplan Commercial |
$1,002.75
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$481.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$442.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$1,002.75 |
| Rate for Payer: Adventist Health Commercial |
$267.40
|
| Rate for Payer: Cash Price |
$735.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$905.15
|
| Rate for Payer: Heritage Provider Network Senior |
$905.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.25
|
| Rate for Payer: Multiplan Commercial |
$1,002.75
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
|
OP
|
$892.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.33 |
| Max. Negotiated Rate |
$669.00 |
| Rate for Payer: Adventist Health Commercial |
$178.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$476.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$612.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$575.72
|
| Rate for Payer: Blue Shield of California Commercial |
$541.39
|
| Rate for Payer: Blue Shield of California EPN |
$435.37
|
| Rate for Payer: Cash Price |
$490.60
|
| Rate for Payer: Cash Price |
$490.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$579.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$552.15
|
| Rate for Payer: Heritage Provider Network Senior |
$552.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$425.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$669.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$226.19
|
| Rate for Payer: TriValley Medical Group Senior |
$226.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
|
IP
|
$892.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.45 |
| Max. Negotiated Rate |
$669.00 |
| Rate for Payer: Adventist Health Commercial |
$178.40
|
| Rate for Payer: Cash Price |
$490.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$603.88
|
| Rate for Payer: Heritage Provider Network Senior |
$603.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.00
|
| Rate for Payer: Multiplan Commercial |
$669.00
|
|
