|
HC TRT SWALLOW ORAL FUNC FEEDING MCARE COMM
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
901300802
|
|
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 TARS BONE FX;W/MANIPUL, EA
|
Facility
|
IP
|
$1,291.00
|
|
|
Service Code
|
CPT 28455
|
| Hospital Charge Code |
900501247
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.67 |
| Max. Negotiated Rate |
$968.25 |
| Rate for Payer: Adventist Health Commercial |
$258.20
|
| Rate for Payer: Cash Price |
$710.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.01
|
| Rate for Payer: Heritage Provider Network Senior |
$874.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.75
|
| Rate for Payer: Multiplan Commercial |
$968.25
|
|
|
HC TRT TARS BONE FX;W/MANIPUL, EA
|
Facility
|
OP
|
$1,291.00
|
|
|
Service Code
|
CPT 28455
|
| Hospital Charge Code |
900501247
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$258.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$886.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$710.05
|
| Rate for Payer: Cash Price |
$710.05
|
| Rate for Payer: Cash Price |
$710.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$839.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Senior |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,033.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.01
|
| Rate for Payer: Heritage Provider Network Senior |
$874.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$615.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,338.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,562.18
|
| Rate for Payer: Multiplan Commercial |
$968.25
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$464.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$427.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC TRUE CUT SOFT TISSUE
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
909001070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| Rate for Payer: Blue Shield of California Commercial |
$48.19
|
| Rate for Payer: Blue Shield of California EPN |
$38.55
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Senior |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$39.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$39.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC TRUE CUT SOFT TISSUE
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
909001070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
|
HC TRUFILL N-BCA
|
Facility
|
OP
|
$6,235.00
|
|
| Hospital Charge Code |
909081833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,128.54 |
| Max. Negotiated Rate |
$5,299.75 |
| Rate for Payer: Adventist Health Commercial |
$1,247.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,332.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,283.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,299.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,429.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,676.25
|
| Rate for Payer: Blue Shield of California Commercial |
$3,803.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,042.68
|
| Rate for Payer: Cash Price |
$3,429.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,052.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,299.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,299.75
|
| Rate for Payer: Dignity Health Senior |
$5,299.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,052.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,859.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3,859.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,974.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,128.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,558.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,364.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,364.50
|
| Rate for Payer: Multiplan Commercial |
$4,676.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,117.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,117.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,299.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,299.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,299.75
|
|
|
HC TRUFILL N-BCA
|
Facility
|
IP
|
$6,235.00
|
|
| Hospital Charge Code |
909081833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,128.54 |
| Max. Negotiated Rate |
$4,676.25 |
| Rate for Payer: Adventist Health Commercial |
$1,247.00
|
| Rate for Payer: Cash Price |
$3,429.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,221.10
|
| Rate for Payer: Heritage Provider Network Senior |
$4,221.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,128.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,558.75
|
| Rate for Payer: Multiplan Commercial |
$4,676.25
|
|
|
HC TRYPSIN STOOL
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT 84488
|
| Hospital Charge Code |
900910231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$336.75 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$239.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$308.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.63
|
| Rate for Payer: Blue Shield of California Commercial |
$58.75
|
| Rate for Payer: Blue Shield of California EPN |
$47.12
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.03
|
| Rate for Payer: Dignity Health Senior |
$7.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$277.93
|
| Rate for Payer: Heritage Provider Network Senior |
$277.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$214.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.30
|
| Rate for Payer: TriValley Medical Group Senior |
$7.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.03
|
| Rate for Payer: Vantage Medical Group Senior |
$7.30
|
|
|
HC TRYPSIN STOOL
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 84488
|
| Hospital Charge Code |
900910231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.27 |
| Max. Negotiated Rate |
$336.75 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$303.97
|
| Rate for Payer: Heritage Provider Network Senior |
$303.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.25
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
|
|
HC TSH (THYROTROPIN)
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
900910829
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$228.75 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$163.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$209.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.41
|
| Rate for Payer: Blue Shield of California Commercial |
$135.19
|
| Rate for Payer: Blue Shield of California EPN |
$108.43
|
| Rate for Payer: Cash Price |
$167.75
|
| Rate for Payer: Cash Price |
$167.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$198.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.48
|
| Rate for Payer: Dignity Health Senior |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.79
|
| Rate for Payer: Heritage Provider Network Senior |
$188.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.17
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Vantage Medical Group Senior |
$16.80
|
|
|
HC TSH (THYROTROPIN)
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
900910829
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$228.75 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Cash Price |
$167.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$206.49
|
| Rate for Payer: Heritage Provider Network Senior |
$206.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.25
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
|
|
HC TTE W OR W/O FOL W/CON,DOPPLER
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT C8929
|
| Hospital Charge Code |
900200256
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$236.93 |
| Max. Negotiated Rate |
$981.75 |
| Rate for Payer: Adventist Health Commercial |
$261.80
|
| Rate for Payer: Cash Price |
$719.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$886.19
|
| Rate for Payer: Heritage Provider Network Senior |
$886.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.25
|
| Rate for Payer: Multiplan Commercial |
$981.75
|
|
|
HC TTE W OR W/O FOL W/CON,DOPPLER
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT C8929
|
| Hospital Charge Code |
900200256
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$236.93 |
| Max. Negotiated Rate |
$1,505.78 |
| Rate for Payer: Adventist Health Commercial |
$261.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$699.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$899.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Blue Shield of California Commercial |
$798.49
|
| Rate for Payer: Blue Shield of California EPN |
$638.79
|
| Rate for Payer: Cash Price |
$719.95
|
| Rate for Payer: Cash Price |
$719.95
|
| Rate for Payer: Cash Price |
$719.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$850.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Senior |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,003.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$810.27
|
| Rate for Payer: Heritage Provider Network Senior |
$810.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$624.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,154.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,264.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,264.85
|
| Rate for Payer: Multiplan Commercial |
$981.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,104.23
|
| Rate for Payer: TriValley Medical Group Senior |
$1,003.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$313.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$264.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC TTE W WO CONTR ECG
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT C8930
|
| Hospital Charge Code |
900200257
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$236.93 |
| Max. Negotiated Rate |
$981.75 |
| Rate for Payer: Adventist Health Commercial |
$261.80
|
| Rate for Payer: Cash Price |
$719.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$886.19
|
| Rate for Payer: Heritage Provider Network Senior |
$886.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.25
|
| Rate for Payer: Multiplan Commercial |
$981.75
|
|
|
HC TTE W WO CONTR ECG
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT C8930
|
| Hospital Charge Code |
900200257
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$236.93 |
| Max. Negotiated Rate |
$1,505.78 |
| Rate for Payer: Adventist Health Commercial |
$261.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$699.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$899.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Blue Shield of California Commercial |
$798.49
|
| Rate for Payer: Blue Shield of California EPN |
$638.79
|
| Rate for Payer: Cash Price |
$719.95
|
| Rate for Payer: Cash Price |
$719.95
|
| Rate for Payer: Cash Price |
$719.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$850.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Senior |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,003.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$810.27
|
| Rate for Payer: Heritage Provider Network Senior |
$810.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$624.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,154.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,264.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,264.85
|
| Rate for Payer: Multiplan Commercial |
$981.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,104.23
|
| Rate for Payer: TriValley Medical Group Senior |
$1,003.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$313.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$264.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC TTG IGA
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
|
|
HC TTG IGA
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$213.58 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.58
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC TTG IGG
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913670
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$213.58 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.58
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC TTG IGG
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913670
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
|
|
HC T-TUBE CHOLANGIOGRAM INJ
|
Facility
|
IP
|
$1,358.00
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
909000191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$245.80 |
| Max. Negotiated Rate |
$1,018.50 |
| Rate for Payer: Adventist Health Commercial |
$271.60
|
| Rate for Payer: Cash Price |
$746.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$919.37
|
| Rate for Payer: Heritage Provider Network Senior |
$919.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.50
|
| Rate for Payer: Multiplan Commercial |
$1,018.50
|
|
|
HC T-TUBE CHOLANGIOGRAM INJ
|
Facility
|
OP
|
$1,358.00
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
909000191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$271.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$932.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,484.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$746.90
|
| Rate for Payer: Cash Price |
$746.90
|
| Rate for Payer: Cash Price |
$746.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$882.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,932.42
|
| Rate for Payer: Dignity Health Senior |
$4,484.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,484.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$840.60
|
| Rate for Payer: Heritage Provider Network Senior |
$5,515.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$552.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,519.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,156.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,649.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,649.87
|
| Rate for Payer: Multiplan Commercial |
$1,018.50
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,932.42
|
| Rate for Payer: TriValley Medical Group Senior |
$4,932.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4,484.02
|
|
|
HC TUBE BIVONA AIR CUFF PEDS
|
Facility
|
OP
|
$738.00
|
|
| Hospital Charge Code |
900800708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.58 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$394.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$507.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.50
|
| Rate for Payer: Blue Shield of California Commercial |
$450.18
|
| Rate for Payer: Blue Shield of California EPN |
$360.14
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$479.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$627.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$627.30
|
| Rate for Payer: Dignity Health Senior |
$627.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$479.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.82
|
| Rate for Payer: Heritage Provider Network Senior |
$456.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$352.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$516.60
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$369.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
|
HC TUBE BIVONA AIR CUFF PEDS
|
Facility
|
IP
|
$738.00
|
|
| Hospital Charge Code |
900800708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.58 |
| Max. Negotiated Rate |
$553.50 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.63
|
| Rate for Payer: Heritage Provider Network Senior |
$499.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.50
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
|
|
HC TUBE CHECK (ABSCESS/CYST)
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
909000212
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$769.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$616.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$840.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$728.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$952.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$952.00
|
| Rate for Payer: Dignity Health Senior |
$952.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.28
|
| Rate for Payer: Heritage Provider Network Senior |
$693.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$534.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$784.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$784.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$952.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$952.00
|
| Rate for Payer: Vantage Medical Group Senior |
$952.00
|
|
|
HC TUBE CHECK (ABSCESS/CYST)
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
909000212
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$202.72 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Adventist Health Commercial |
$224.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$758.24
|
| Rate for Payer: Heritage Provider Network Senior |
$758.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
|
