|
HC TERUMO TR BAND COMPRESSOR
|
Facility
|
OP
|
$319.00
|
|
| Hospital Charge Code |
906812391
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$271.15 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$271.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$239.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.56
|
| Rate for Payer: Blue Shield of California Commercial |
$194.59
|
| Rate for Payer: Blue Shield of California EPN |
$155.67
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$207.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$271.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$271.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.46
|
| Rate for Payer: Heritage Provider Network Senior |
$197.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$152.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$223.30
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$159.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$271.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.15
|
| Rate for Payer: Vantage Medical Group Senior |
$271.15
|
|
|
HC TESTICULAR SCAN
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
909301429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$191.32 |
| Max. Negotiated Rate |
$792.75 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$680.71
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$715.59
|
| Rate for Payer: Heritage Provider Network Senior |
$715.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.25
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
|
|
HC TESTICULAR SCAN
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
909301429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$191.32 |
| Max. Negotiated Rate |
$792.75 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$653.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.71
|
| Rate for Payer: Blue Shield of California Commercial |
$672.96
|
| Rate for Payer: Blue Shield of California EPN |
$541.17
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$687.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$654.28
|
| Rate for Payer: Heritage Provider Network Senior |
$654.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$504.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$528.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$528.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC TESTOSTERONE TOTAL
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.56
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.48
|
| Rate for Payer: Heritage Provider Network Senior |
$162.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
|
|
HC TESTOSTERONE TOTAL
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$245.08 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.08
|
| Rate for Payer: Blue Shield of California Commercial |
$207.82
|
| Rate for Payer: Blue Shield of California Commercial |
$207.82
|
| Rate for Payer: Blue Shield of California EPN |
$166.69
|
| Rate for Payer: Blue Shield of California EPN |
$166.69
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$156.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.56
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$148.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$114.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.59
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.81
|
| Rate for Payer: TriValley Medical Group Senior |
$25.81
|
| Rate for Payer: TriValley Medical Group Senior |
$25.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC TEST URINE VOLUME
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
900910797
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.69
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.05
|
| Rate for Payer: Heritage Provider Network Senior |
$69.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
|
|
HC TEST URINE VOLUME
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
900910797
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$24.16 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.16
|
| Rate for Payer: Blue Shield of California Commercial |
$24.13
|
| Rate for Payer: Blue Shield of California Commercial |
$24.13
|
| Rate for Payer: Blue Shield of California EPN |
$19.36
|
| Rate for Payer: Blue Shield of California EPN |
$19.36
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Senior |
$63.14
|
| Rate for Payer: Heritage Provider Network Senior |
$16.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$48.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.64
|
| Rate for Payer: TriValley Medical Group Senior |
$3.64
|
| Rate for Payer: TriValley Medical Group Senior |
$3.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3.64
|
| Rate for Payer: Vantage Medical Group Senior |
$3.64
|
|
|
HC TETRACYCLINE E TEST
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912444
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$23.16 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.41
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$65.00
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$50.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC TETRACYCLINE E TEST
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912444
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.62
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.08
|
| Rate for Payer: Heritage Provider Network Senior |
$71.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
|
|
HC THAWING COMPONENT
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
900904700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.23 |
| Max. Negotiated Rate |
$328.68 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.46
|
| Rate for Payer: Blue Shield of California Commercial |
$52.51
|
| Rate for Payer: Blue Shield of California EPN |
$42.23
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$195.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.32
|
| Rate for Payer: Heritage Provider Network Senior |
$186.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$143.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC THAWING COMPONENT
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
900904700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$225.75 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.84
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.78
|
| Rate for Payer: Heritage Provider Network Senior |
$203.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.25
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
|
|
HC THEOPHYLLINE
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
900910457
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.36
|
| Rate for Payer: Blue Shield of California Commercial |
$113.88
|
| Rate for Payer: Blue Shield of California Commercial |
$113.88
|
| Rate for Payer: Blue Shield of California EPN |
$91.34
|
| Rate for Payer: Blue Shield of California EPN |
$91.34
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.95
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.14
|
| Rate for Payer: TriValley Medical Group Senior |
$14.14
|
| Rate for Payer: TriValley Medical Group Senior |
$14.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Vantage Medical Group Senior |
$14.14
|
| Rate for Payer: Vantage Medical Group Senior |
$14.14
|
|
|
HC THEOPHYLLINE
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
900910457
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.80
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC THERAPEUTIC ACTIVITY 15 MIN MCAL
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
901300061
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.16
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC THERAPEUTIC ACTIVITY 15 MIN MCAL
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
901300061
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| 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 |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC THERAPEUTIC ACTIVITY 15MIN MCAL
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
900400073
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| 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 |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC THERAPEUTIC ACTIVITY 15MIN MCAL
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
900400073
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.16
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC THERAPEUTIC ACTIVITY 15 MIN OT
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
905104224
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| 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 |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC THERAPEUTIC ACTIVITY 15 MIN OT
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
905104224
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.16
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC THERAPEUTIC ACTIVITY 15 MIN PT
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
905103224
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.16
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC THERAPEUTIC ACTIVITY 15 MIN PT
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
905103224
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| 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 |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC THERAPEUTIC ACTIVITY 15 MIN PT COMM MCARE
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
900419055
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.16
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC THERAPEUTIC ACTIVITY 15 MIN PT COMM MCARE
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
900419055
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| 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 |
$119.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119.00
|
|
|
HC THERAPEUTIC ASPIR BRONCH INITL
|
Facility
|
IP
|
$3,578.00
|
|
|
Service Code
|
CPT 31645
|
| Hospital Charge Code |
900803510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$647.62 |
| Max. Negotiated Rate |
$2,683.50 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,304.23
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,422.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,422.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$647.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.50
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
|
|
HC THERAPEUTIC ASPIR BRONCH INITL
|
Facility
|
OP
|
$3,578.00
|
|
|
Service Code
|
CPT 31645
|
| Hospital Charge Code |
900803510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$647.62 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,211.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,182.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,746.06
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,325.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,289.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,214.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2,214.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,706.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$647.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,518.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2,518.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,789.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,789.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
