|
HC PULM STRESS TEST SIMPLE
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
900801020
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$917.70
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$964.73
|
| Rate for Payer: Heritage Provider Network Senior |
$964.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.25
|
| Rate for Payer: Multiplan Commercial |
$1,068.75
|
|
|
HC PULSE OXIMETRY-CONTINUOUS OVER
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
900800103
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$76.58 |
| Max. Negotiated Rate |
$366.75 |
| Rate for Payer: Adventist Health Commercial |
$97.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$302.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$244.60
|
| Rate for Payer: Blue Shield of California Commercial |
$95.23
|
| Rate for Payer: Blue Shield of California EPN |
$76.58
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$317.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.51
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$302.69
|
| Rate for Payer: Heritage Provider Network Senior |
$302.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$233.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$366.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$182.04
|
| Rate for Payer: TriValley Medical Group Senior |
$165.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$244.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$244.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC PULSE OXIMETRY-CONTINUOUS OVER
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
900800103
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$88.51 |
| Max. Negotiated Rate |
$366.75 |
| Rate for Payer: Adventist Health Commercial |
$97.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$314.92
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$331.05
|
| Rate for Payer: Heritage Provider Network Senior |
$331.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.25
|
| Rate for Payer: Multiplan Commercial |
$366.75
|
|
|
HC PULSE OXIMETRY MULT DETER
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
900800106
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$373.15 |
| Rate for Payer: Adventist Health Commercial |
$87.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$271.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$329.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.59
|
| Rate for Payer: Blue Shield of California Commercial |
$22.80
|
| Rate for Payer: Blue Shield of California EPN |
$18.34
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$285.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$373.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$373.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$271.74
|
| Rate for Payer: Heritage Provider Network Senior |
$271.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$209.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$307.30
|
| Rate for Payer: Multiplan Commercial |
$329.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$219.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$219.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$373.15
|
| Rate for Payer: Vantage Medical Group Senior |
$373.15
|
|
|
HC PULSE OXIMETRY MULT DETER
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
900800106
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$79.46 |
| Max. Negotiated Rate |
$329.25 |
| Rate for Payer: Adventist Health Commercial |
$87.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$282.72
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$297.20
|
| Rate for Payer: Heritage Provider Network Senior |
$297.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.75
|
| Rate for Payer: Multiplan Commercial |
$329.25
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.54
|
| Rate for Payer: Blue Shield of California Commercial |
$10.99
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.94
|
| Rate for Payer: Heritage Provider Network Senior |
$121.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$93.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$137.90
|
| Rate for Payer: Multiplan Commercial |
$147.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$98.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$98.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.45
|
| Rate for Payer: Vantage Medical Group Senior |
$167.45
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$93.58
|
| Rate for Payer: Blue Shield of California EPN |
$74.47
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.37
|
| Rate for Payer: Heritage Provider Network Senior |
$133.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$93.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$137.90
|
| Rate for Payer: Multiplan Commercial |
$147.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$118.20
|
| Rate for Payer: TriValley Medical Group Senior |
$118.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.45
|
| Rate for Payer: Vantage Medical Group Senior |
$167.45
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$147.75 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.87
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.37
|
| Rate for Payer: Heritage Provider Network Senior |
$133.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Multiplan Commercial |
$147.75
|
|
|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$147.75 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.87
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.37
|
| Rate for Payer: Heritage Provider Network Senior |
$133.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.25
|
| Rate for Payer: Multiplan Commercial |
$147.75
|
|
|
HC PUNCH BX SKIN EA SEP/ADD LSN
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
900511105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$165.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.27
|
| Rate for Payer: Heritage Provider Network Senior |
$165.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$127.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$186.90
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| 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 |
$226.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC PUNCH BX SKIN EA SEP/ADD LSN
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
900511105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$200.25 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.95
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.76
|
| Rate for Payer: Heritage Provider Network Senior |
$180.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
|
|
HC PUNCH BX SKIN SINGLE LESION
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
900511104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.29 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Adventist Health Commercial |
$106.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$342.61
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$360.16
|
| Rate for Payer: Heritage Provider Network Senior |
$360.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$399.00
|
|
|
HC PUNCH BX SKIN SINGLE LESION
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
900511104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$106.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$328.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$345.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.31
|
| Rate for Payer: Heritage Provider Network Senior |
$643.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$993.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$399.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$575.13
|
| Rate for Payer: TriValley Medical Group Senior |
$575.13
|
| 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 |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$391.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$301.15
|
| Rate for Payer: Blue Shield of California EPN |
$239.65
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$302.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$380.40
|
| Rate for Payer: TriValley Medical Group Senior |
$380.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$391.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.45
|
| Rate for Payer: Heritage Provider Network Senior |
$643.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$993.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$575.13
|
| Rate for Payer: TriValley Medical Group Senior |
$575.13
|
| 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 |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$355.67 |
| Max. Negotiated Rate |
$1,473.75 |
| Rate for Payer: Adventist Health Commercial |
$393.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,265.46
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,330.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,330.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$355.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.25
|
| Rate for Payer: Multiplan Commercial |
$1,473.75
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$355.67 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$393.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,214.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,277.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,179.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,216.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,724.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$355.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$1,473.75
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$998.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$355.67 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$393.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,214.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$933.38
|
| Rate for Payer: Blue Shield of California EPN |
$742.77
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,277.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,330.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,330.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$937.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$355.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$1,473.75
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,179.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,179.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$355.67 |
| Max. Negotiated Rate |
$1,473.75 |
| Rate for Payer: Adventist Health Commercial |
$393.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,265.46
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,330.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,330.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$355.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.25
|
| Rate for Payer: Multiplan Commercial |
$1,473.75
|
|
|
HC PVA PARTICLES
|
Facility
|
IP
|
$1,127.00
|
|
| Hospital Charge Code |
909081806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$225.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$725.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$453.05
|
| Rate for Payer: Blue Shield of California EPN |
$453.05
|
| Rate for Payer: Cash Price |
$507.15
|
| Rate for Payer: Cash Price |
$507.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$518.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$608.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$521.80
|
| Rate for Payer: Heritage Provider Network Senior |
$521.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$563.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$563.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$563.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.75
|
| Rate for Payer: Multiplan Commercial |
$845.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$407.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$373.15
|
|
|
HC PVA PARTICLES
|
Facility
|
OP
|
$1,127.00
|
|
| Hospital Charge Code |
909081806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$225.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$696.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$957.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$619.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$845.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$453.05
|
| Rate for Payer: Blue Shield of California EPN |
$453.05
|
| Rate for Payer: Cash Price |
$507.15
|
| Rate for Payer: Cash Price |
$507.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$518.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$957.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$957.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$957.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$721.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$521.80
|
| Rate for Payer: Heritage Provider Network Senior |
$521.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$563.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$563.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$563.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$788.90
|
| Rate for Payer: Multiplan Commercial |
$845.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$407.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$373.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$957.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$957.95
|
| Rate for Payer: Vantage Medical Group Senior |
$957.95
|
|
|
HC PYRUVATE
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$103.11 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.11
|
| Rate for Payer: Blue Shield of California Commercial |
$87.38
|
| Rate for Payer: Blue Shield of California Commercial |
$87.38
|
| Rate for Payer: Blue Shield of California EPN |
$70.09
|
| Rate for Payer: Blue Shield of California EPN |
$70.09
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.57
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$31.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$52.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.48
|
| Rate for Payer: TriValley Medical Group Senior |
$14.48
|
| Rate for Payer: TriValley Medical Group Senior |
$14.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
|
|
HC PYRUVATE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.84
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
