|
HC TRLUML BLLN ANGIO INIT VEIN
|
Facility
|
OP
|
$24,242.00
|
|
|
Service Code
|
CPT 37248
|
| Hospital Charge Code |
906820286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,189.95 |
| Max. Negotiated Rate |
$18,181.50 |
| Rate for Payer: Adventist Health Commercial |
$4,848.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,654.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$13,333.10
|
| Rate for Payer: Cash Price |
$13,333.10
|
| Rate for Payer: Cash Price |
$13,333.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,757.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Senior |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,005.80
|
| Rate for Payer: Heritage Provider Network Senior |
$8,910.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,189.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,764.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,387.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,331.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,060.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,127.88
|
| Rate for Payer: Multiplan Commercial |
$18,181.50
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,968.78
|
| Rate for Payer: TriValley Medical Group Senior |
$7,968.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC TRLUML BLLN ANGIO INIT VEIN
|
Facility
|
IP
|
$15,645.00
|
|
|
Service Code
|
CPT 37248
|
| Hospital Charge Code |
909037248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,831.74 |
| Max. Negotiated Rate |
$11,733.75 |
| Rate for Payer: Adventist Health Commercial |
$3,129.00
|
| Rate for Payer: Cash Price |
$8,604.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,591.67
|
| Rate for Payer: Heritage Provider Network Senior |
$10,591.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,831.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,911.25
|
| Rate for Payer: Multiplan Commercial |
$11,733.75
|
|
|
HC TRMNT SPEECH/LANG/DYSPHAGIA GRP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 92508
|
| Hospital Charge Code |
905601501
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$184.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$240.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$309.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$382.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$247.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$292.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$382.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$382.50
|
| Rate for Payer: Dignity Health Senior |
$382.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.55
|
| Rate for Payer: Heritage Provider Network Senior |
$278.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$214.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.00
|
| Rate for Payer: Multiplan Commercial |
$337.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| 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 |
$382.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$382.50
|
| Rate for Payer: Vantage Medical Group Senior |
$382.50
|
|
|
HC TRMNT SPEECH/LANG/DYSPHAGIA GRP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 92508
|
| Hospital Charge Code |
905601501
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Adventist Health Commercial |
$90.00
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$304.65
|
| Rate for Payer: Heritage Provider Network Senior |
$304.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.50
|
| Rate for Payer: Multiplan Commercial |
$337.50
|
|
|
HC TRMNT SPEECH/LANG/DYSPHAGIA GRP MCAL
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT X4302
|
| Hospital Charge Code |
907000038
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Cash Price |
$75.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.75
|
| Rate for Payer: Heritage Provider Network Senior |
$92.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.25
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
|
|
HC TRMNT SPEECH/LANG/DYSPHAGIA GRP MCAL
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT X4302
|
| Hospital Charge Code |
907000038
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$56.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$75.35
|
| Rate for Payer: Cash Price |
$75.35
|
| Rate for Payer: Cash Price |
$75.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: Dignity Health Senior |
$116.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.80
|
| Rate for Payer: Heritage Provider Network Senior |
$84.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$65.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| 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 |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC TRMNT SPEECH/LANG/VOICE INDIV MCAL
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000041
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$48.15 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$288.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$370.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$351.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Senior |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$351.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.26
|
| Rate for Payer: Heritage Provider Network Senior |
$334.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$257.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| 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 |
$459.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
HC TRMNT SPEECH/LANG/VOICE INDIV MCAL
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000041
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$97.74 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$365.58
|
| Rate for Payer: Heritage Provider Network Senior |
$365.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
|
|
HC TROPONIN - I
|
Facility
|
OP
|
$1,014.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900910994
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Adventist Health Commercial |
$202.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$541.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$696.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.19
|
| Rate for Payer: Blue Shield of California Commercial |
$79.20
|
| Rate for Payer: Blue Shield of California EPN |
$63.52
|
| Rate for Payer: Cash Price |
$557.70
|
| Rate for Payer: Cash Price |
$557.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$659.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.72
|
| Rate for Payer: Dignity Health Senior |
$12.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$627.67
|
| Rate for Payer: Heritage Provider Network Senior |
$627.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$483.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.71
|
| Rate for Payer: Multiplan Commercial |
$760.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.47
|
| Rate for Payer: TriValley Medical Group Senior |
$12.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Vantage Medical Group Senior |
$12.47
|
|
|
HC TROPONIN - I
|
Facility
|
IP
|
$1,014.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900910994
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$183.53 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Adventist Health Commercial |
$202.80
|
| Rate for Payer: Cash Price |
$557.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$686.48
|
| Rate for Payer: Heritage Provider Network Senior |
$686.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.50
|
| Rate for Payer: Multiplan Commercial |
$760.50
|
|
|
HC TROPONIN-T
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900912119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.25
|
| Rate for Payer: Heritage Provider Network Senior |
$213.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
|
|
HC TROPONIN-T
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
900912119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.19
|
| Rate for Payer: Blue Shield of California Commercial |
$79.20
|
| Rate for Payer: Blue Shield of California EPN |
$63.52
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.72
|
| Rate for Payer: Dignity Health Senior |
$12.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.99
|
| Rate for Payer: Heritage Provider Network Senior |
$194.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.71
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.47
|
| Rate for Payer: TriValley Medical Group Senior |
$12.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.72
|
| Rate for Payer: Vantage Medical Group Senior |
$12.47
|
|
|
HC TRSNCATH INS/REPL LEADLESS PCR
|
Facility
|
IP
|
$48,374.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
906811498
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,755.69 |
| Max. Negotiated Rate |
$36,280.50 |
| Rate for Payer: Adventist Health Commercial |
$9,674.80
|
| Rate for Payer: Cash Price |
$26,605.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$32,749.20
|
| Rate for Payer: Heritage Provider Network Senior |
$32,749.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,755.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,093.50
|
| Rate for Payer: Multiplan Commercial |
$36,280.50
|
|
|
HC TRSNCATH INS/REPL LEADLESS PCR
|
Facility
|
OP
|
$48,374.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
906811498
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$46,040.46 |
| Rate for Payer: Adventist Health Commercial |
$9,674.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,232.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| 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 |
$26,605.70
|
| Rate for Payer: Cash Price |
$26,605.70
|
| Rate for Payer: Cash Price |
$26,605.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31,443.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Senior |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,231.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$29,943.51
|
| Rate for Payer: Heritage Provider Network Senior |
$29,805.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$676.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,040.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,755.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,866.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,093.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,532.09
|
| Rate for Payer: Multiplan Commercial |
$36,280.50
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,655.00
|
| Rate for Payer: TriValley Medical Group Senior |
$26,655.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,939.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC TRSNCATH INS/REPL LEADLESS PCR
|
Facility
|
OP
|
$53,844.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
906820022
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$46,040.46 |
| Rate for Payer: Adventist Health Commercial |
$10,768.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,990.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| 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 |
$29,614.20
|
| Rate for Payer: Cash Price |
$29,614.20
|
| Rate for Payer: Cash Price |
$29,614.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34,998.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Senior |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,231.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$33,329.44
|
| Rate for Payer: Heritage Provider Network Senior |
$29,805.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$676.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,040.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,745.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,866.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,461.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,532.09
|
| Rate for Payer: Multiplan Commercial |
$40,383.00
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,655.00
|
| Rate for Payer: TriValley Medical Group Senior |
$26,655.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,939.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC TRSNCATH INS/REPL LEADLESS PCR
|
Facility
|
IP
|
$53,844.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
906820022
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,745.76 |
| Max. Negotiated Rate |
$40,383.00 |
| Rate for Payer: Adventist Health Commercial |
$10,768.80
|
| Rate for Payer: Cash Price |
$29,614.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,452.39
|
| Rate for Payer: Heritage Provider Network Senior |
$36,452.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,745.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,461.00
|
| Rate for Payer: Multiplan Commercial |
$40,383.00
|
|
|
HC TRT SPEECH/LANG/VOICE INDIV
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907001401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$97.74 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$365.58
|
| Rate for Payer: Heritage Provider Network Senior |
$365.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
|
|
HC TRT SPEECH/LANG/VOICE INDIV
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907001401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$48.15 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$288.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$370.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$351.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Senior |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$351.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.26
|
| Rate for Payer: Heritage Provider Network Senior |
$334.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$257.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| 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 |
$459.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
905601801
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$54.79 |
| Max. Negotiated Rate |
$404.60 |
| Rate for Payer: Adventist Health Commercial |
$195.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$254.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$327.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$404.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$261.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$357.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$309.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$404.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$404.60
|
| Rate for Payer: Dignity Health Senior |
$404.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.64
|
| Rate for Payer: Heritage Provider Network Senior |
$294.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$227.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.20
|
| Rate for Payer: Multiplan Commercial |
$357.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| 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 |
$404.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$404.60
|
| Rate for Payer: Vantage Medical Group Senior |
$404.60
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
905601801
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$86.16 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Adventist Health Commercial |
$95.20
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$322.25
|
| Rate for Payer: Heritage Provider Network Senior |
$322.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$357.00
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
907000039
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$86.16 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Adventist Health Commercial |
$95.20
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$322.25
|
| Rate for Payer: Heritage Provider Network Senior |
$322.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$357.00
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$54.79 |
| Max. Negotiated Rate |
$404.60 |
| Rate for Payer: Adventist Health Commercial |
$195.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$254.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$327.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$404.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$261.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$357.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$309.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$404.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$404.60
|
| Rate for Payer: Dignity Health Senior |
$404.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.64
|
| Rate for Payer: Heritage Provider Network Senior |
$294.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$227.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.20
|
| Rate for Payer: Multiplan Commercial |
$357.00
|
| 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 |
$404.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$404.60
|
| Rate for Payer: Vantage Medical Group Senior |
$404.60
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
907000039
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$54.79 |
| Max. Negotiated Rate |
$404.60 |
| Rate for Payer: Adventist Health Commercial |
$195.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$254.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$327.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$404.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$261.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$357.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$309.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$404.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$404.60
|
| Rate for Payer: Dignity Health Senior |
$404.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.64
|
| Rate for Payer: Heritage Provider Network Senior |
$294.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$227.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.20
|
| Rate for Payer: Multiplan Commercial |
$357.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| 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 |
$404.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$404.60
|
| Rate for Payer: Vantage Medical Group Senior |
$404.60
|
|
|
HC TRT SWALLOW/ORAL FUNC FEEDING MCAL
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$86.16 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Adventist Health Commercial |
$95.20
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$322.25
|
| Rate for Payer: Heritage Provider Network Senior |
$322.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$357.00
|
|
|
HC TRT SWALLOW ORAL FUNC FEEDING MCARE COMM
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300802
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$86.16 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Adventist Health Commercial |
$95.20
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$322.25
|
| Rate for Payer: Heritage Provider Network Senior |
$322.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$357.00
|
|
