|
HC PLUG DECANNULATION 8.0
|
Facility
|
IP
|
$38.62
|
|
| Hospital Charge Code |
900800860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$28.96 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.87
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.15
|
| Rate for Payer: Heritage Provider Network Senior |
$26.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.65
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
|
|
HC PLUG DECANNULATION 8.0
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
900800860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.32
|
| Rate for Payer: Blue Shield of California Commercial |
$23.56
|
| Rate for Payer: Blue Shield of California EPN |
$18.85
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.91
|
| Rate for Payer: Heritage Provider Network Senior |
$23.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.03
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
HC PLUG SHILEY DISP DECANNULATION
|
Facility
|
OP
|
$30.99
|
|
| Hospital Charge Code |
900800857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$26.34 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.50
|
| Rate for Payer: Blue Shield of California Commercial |
$18.90
|
| Rate for Payer: Blue Shield of California EPN |
$15.12
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.18
|
| Rate for Payer: Heritage Provider Network Senior |
$19.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.69
|
| Rate for Payer: Multiplan Commercial |
$23.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.34
|
| Rate for Payer: Vantage Medical Group Senior |
$26.34
|
|
|
HC PLUG SHILEY DISP DECANNULATION
|
Facility
|
IP
|
$30.99
|
|
| Hospital Charge Code |
900800857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$23.24 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.96
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.98
|
| Rate for Payer: Heritage Provider Network Senior |
$20.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$23.24
|
|
|
HC PMIC110
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900913007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.67
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.58
|
| Rate for Payer: Heritage Provider Network Senior |
$59.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
|
|
HC PMIC110
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900913007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$82.08 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.08
|
| Rate for Payer: Blue Shield of California Commercial |
$69.58
|
| Rate for Payer: Blue Shield of California EPN |
$55.81
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.47
|
| Rate for Payer: Heritage Provider Network Senior |
$54.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.65
|
| Rate for Payer: TriValley Medical Group Senior |
$8.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC PNEUMOCYSTIS STAIN
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911625
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$40.53 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.53
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.47
|
| Rate for Payer: Heritage Provider Network Senior |
$113.90
|
| Rate for Payer: Heritage Provider Network Senior |
$28.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$87.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC PNEUMOCYSTIS STAIN
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911625
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.50
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.57
|
| Rate for Payer: Heritage Provider Network Senior |
$124.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
|
|
HC PNEUMOTHORAX SET (COOK)
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$479.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$299.49
|
| Rate for Payer: Blue Shield of California EPN |
$299.49
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$342.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.94
|
| Rate for Payer: Heritage Provider Network Senior |
$344.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$372.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$372.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$372.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$269.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$246.67
|
|
|
HC PNEUMOTHORAX SET (COOK)
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$13,770.00 |
| 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 |
$633.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$299.49
|
| Rate for Payer: Blue Shield of California EPN |
$299.49
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$342.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.94
|
| Rate for Payer: Heritage Provider Network Senior |
$344.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$372.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$372.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$372.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$521.50
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$269.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$246.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC POL D 5 (PAPER WASP), IGE
|
Facility
|
OP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Commercial |
$3.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.45
|
| Rate for Payer: Heritage Provider Network Senior |
$10.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC POL D 5 (PAPER WASP), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.91
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.52
|
| Rate for Payer: Heritage Provider Network Senior |
$12.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
|
|
HC POLYS MICRO EXAM
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900910045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$40.53 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.53
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.47
|
| Rate for Payer: Heritage Provider Network Senior |
$105.23
|
| Rate for Payer: Heritage Provider Network Senior |
$28.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$81.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC POLYS MICRO EXAM
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900910045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.48
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.09
|
| Rate for Payer: Heritage Provider Network Senior |
$115.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.50
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
|
|
HC POOL EXERCISE EA ADDL 15 MIN PT
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$118.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$188.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$179.51
|
| Rate for Payer: Heritage Provider Network Senior |
$179.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$138.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| 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 |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC POOL EXERCISE EA ADDL 15 MIN PT
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$217.50 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.76
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$196.33
|
| Rate for Payer: Heritage Provider Network Senior |
$196.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.50
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
|
|
HC POOL EXERCISE INIT 30 MIN PT
|
Facility
|
IP
|
$433.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400412
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.37 |
| Max. Negotiated Rate |
$324.75 |
| Rate for Payer: Adventist Health Commercial |
$86.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$278.85
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$293.14
|
| Rate for Payer: Heritage Provider Network Senior |
$293.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.25
|
| Rate for Payer: Multiplan Commercial |
$324.75
|
|
|
HC POOL EXERCISE INIT 30 MIN PT
|
Facility
|
OP
|
$433.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400412
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.37 |
| Max. Negotiated Rate |
$368.05 |
| Rate for Payer: Adventist Health Commercial |
$177.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$267.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$368.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$238.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$324.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$281.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$368.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$368.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.03
|
| Rate for Payer: Heritage Provider Network Senior |
$268.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$206.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$303.10
|
| Rate for Payer: Multiplan Commercial |
$324.75
|
| 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 |
$368.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.05
|
| Rate for Payer: Vantage Medical Group Senior |
$368.05
|
|
|
HC POOLING COMPONENTS
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.92 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.08
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.64
|
| Rate for Payer: Heritage Provider Network Senior |
$216.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
|
|
HC POOLING COMPONENTS
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.62 |
| Max. Negotiated Rate |
$328.68 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.86
|
| Rate for Payer: Blue Shield of California Commercial |
$66.67
|
| Rate for Payer: Blue Shield of California EPN |
$53.62
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$208.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$198.08
|
| Rate for Payer: Heritage Provider Network Senior |
$198.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$152.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC POOL THRPY W/EXERCISE ADD 15 M
|
Facility
|
OP
|
$235.00
|
|
| Hospital Charge Code |
905103312
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.53 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$96.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$176.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$152.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.47
|
| Rate for Payer: Heritage Provider Network Senior |
$145.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$112.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$164.50
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| 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 |
$199.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.75
|
| Rate for Payer: Vantage Medical Group Senior |
$199.75
|
|
|
HC POOL THRPY W/EXERCISE ADD 15 M
|
Facility
|
IP
|
$235.00
|
|
| Hospital Charge Code |
905103312
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.53 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$151.34
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.09
|
| Rate for Payer: Heritage Provider Network Senior |
$159.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.75
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
|
|
HC POOL THRPY W EXERCISE ADD 15 MIN MCAL
|
Facility
|
OP
|
$236.00
|
|
| Hospital Charge Code |
900419081
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.72 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$96.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$200.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$153.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$200.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$146.08
|
| Rate for Payer: Heritage Provider Network Senior |
$146.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$112.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$165.20
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
| 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 |
$200.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$200.60
|
| Rate for Payer: Vantage Medical Group Senior |
$200.60
|
|
|
HC POOL THRPY W EXERCISE ADD 15 MIN MCAL
|
Facility
|
IP
|
$236.00
|
|
| Hospital Charge Code |
900419081
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.72 |
| Max. Negotiated Rate |
$177.00 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$151.98
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.77
|
| Rate for Payer: Heritage Provider Network Senior |
$159.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.00
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
|
|
HC POOL THRPY W/EXERCISE INTL 30
|
Facility
|
IP
|
$288.00
|
|
| Hospital Charge Code |
905103311
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.47
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.98
|
| Rate for Payer: Heritage Provider Network Senior |
$194.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
|
