|
HC THERAPEUTIC PROCEDURE ADDL 15MIN PT
|
Facility
|
IP
|
$209.00
|
|
| Hospital Charge Code |
900409031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.83 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Adventist Health Commercial |
$41.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.60
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.49
|
| Rate for Payer: Heritage Provider Network Senior |
$141.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.25
|
| Rate for Payer: Multiplan Commercial |
$156.75
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
901300059
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$111.75 |
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.96
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.87
|
| Rate for Payer: Heritage Provider Network Senior |
$100.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.25
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900400055
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$111.75 |
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.96
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.87
|
| Rate for Payer: Heritage Provider Network Senior |
$100.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.25
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900400055
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$61.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$126.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.23
|
| Rate for Payer: Heritage Provider Network Senior |
$92.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$71.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$104.30
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.65
|
| Rate for Payer: Vantage Medical Group Senior |
$126.65
|
|
|
HC THERAPEUTIC PROCEDURE GRP MCAL
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
901300059
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$61.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$126.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.23
|
| Rate for Payer: Heritage Provider Network Senior |
$92.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$71.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$104.30
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.65
|
| Rate for Payer: Vantage Medical Group Senior |
$126.65
|
|
|
HC THERAPEUTIC PROCEDURE GRP OT
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905104147
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$61.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$126.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.23
|
| Rate for Payer: Heritage Provider Network Senior |
$92.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$71.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$104.30
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.65
|
| Rate for Payer: Vantage Medical Group Senior |
$126.65
|
|
|
HC THERAPEUTIC PROCEDURE GRP OT
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905104147
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$111.75 |
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.96
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.87
|
| Rate for Payer: Heritage Provider Network Senior |
$100.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.25
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
|
|
HC THERAPEUTIC PROCEDURE GRP PT
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905103147
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$111.75 |
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.96
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.87
|
| Rate for Payer: Heritage Provider Network Senior |
$100.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.25
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
|
|
HC THERAPEUTIC PROCEDURE GRP PT
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905103147
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Cigna of CA HMO/PPO |
$96.85
|
| Rate for Payer: Adventist Health Commercial |
$61.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$126.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.23
|
| Rate for Payer: Heritage Provider Network Senior |
$92.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$71.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$104.30
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.65
|
| Rate for Payer: Vantage Medical Group Senior |
$126.65
|
|
|
HC THERAPEUTIC PROCEDURE GRP PT COMM MCARE
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900417151
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$111.75 |
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.96
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.87
|
| Rate for Payer: Heritage Provider Network Senior |
$100.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.25
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
|
|
HC THERAPEUTIC PROCEDURE GRP PT COMM MCARE
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
900417151
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$61.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$126.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.23
|
| Rate for Payer: Heritage Provider Network Senior |
$92.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$71.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$104.30
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.65
|
| Rate for Payer: Vantage Medical Group Senior |
$126.65
|
|
|
HC THERAPUTIC BRONCH SUB
|
Facility
|
IP
|
$4,756.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
900803511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$860.84 |
| Max. Negotiated Rate |
$3,567.00 |
| Rate for Payer: Adventist Health Commercial |
$951.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,062.86
|
| Rate for Payer: Cash Price |
$2,140.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,219.81
|
| Rate for Payer: Heritage Provider Network Senior |
$3,219.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$860.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,189.00
|
| Rate for Payer: Multiplan Commercial |
$3,567.00
|
|
|
HC THERAPUTIC BRONCH SUB
|
Facility
|
OP
|
$4,756.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
900803511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$503.04 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$951.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,939.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$754.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$553.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$503.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,901.16
|
| Rate for Payer: Blue Shield of California EPN |
$2,320.93
|
| Rate for Payer: Cash Price |
$2,140.20
|
| Rate for Payer: Cash Price |
$2,140.20
|
| Rate for Payer: Cash Price |
$2,140.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,091.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$754.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$553.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$503.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$503.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,943.96
|
| Rate for Payer: Heritage Provider Network Senior |
$2,943.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$503.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,268.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$860.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$578.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,189.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$674.07
|
| Rate for Payer: Multiplan Commercial |
$3,567.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$553.34
|
| Rate for Payer: TriValley Medical Group Senior |
$553.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,378.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,378.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$754.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$553.34
|
| Rate for Payer: Vantage Medical Group Senior |
$503.04
|
|
|
HC THERMAL DEST INRA BN INCL IG 1ST 2 VB LUM OR SAC
|
Facility
|
IP
|
$47,276.00
|
|
|
Service Code
|
CPT 64628
|
| Hospital Charge Code |
909050628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,556.96 |
| Max. Negotiated Rate |
$35,457.00 |
| Rate for Payer: Adventist Health Commercial |
$9,455.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30,445.74
|
| Rate for Payer: Cash Price |
$21,274.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$32,005.85
|
| Rate for Payer: Heritage Provider Network Senior |
$32,005.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,556.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,819.00
|
| Rate for Payer: Multiplan Commercial |
$35,457.00
|
|
|
HC THERMAL DEST INRA BN INCL IG 1ST 2 VB LUM OR SAC
|
Facility
|
OP
|
$47,276.00
|
|
|
Service Code
|
CPT 64628
|
| Hospital Charge Code |
909050628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,158.00 |
| Max. Negotiated Rate |
$35,457.00 |
| Rate for Payer: Adventist Health Commercial |
$9,455.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29,216.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,512.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$21,274.20
|
| Rate for Payer: Cash Price |
$21,274.20
|
| Rate for Payer: Cash Price |
$21,274.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30,729.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,163.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,512.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,365.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$16,512.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$29,263.84
|
| Rate for Payer: Heritage Provider Network Senior |
$20,310.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31,374.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,556.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,989.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,819.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,127.00
|
| Rate for Payer: Multiplan Commercial |
$35,457.00
|
| Rate for Payer: Multiplan WC |
$26,048.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$18,163.96
|
| Rate for Payer: TriValley Medical Group Senior |
$18,163.96
|
| 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 |
$24,769.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Vantage Medical Group Senior |
$16,512.69
|
|
|
HC THERMAL DEST INRA BN INCL IG EA ADDL VB LUM OR SAC
|
Facility
|
IP
|
$23,638.00
|
|
|
Service Code
|
CPT 64629
|
| Hospital Charge Code |
909050629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,278.48 |
| Max. Negotiated Rate |
$17,728.50 |
| Rate for Payer: Adventist Health Commercial |
$4,727.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,222.87
|
| Rate for Payer: Cash Price |
$10,637.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,002.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16,002.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,909.50
|
| Rate for Payer: Multiplan Commercial |
$17,728.50
|
|
|
HC THERMAL DEST INRA BN INCL IG EA ADDL VB LUM OR SAC
|
Facility
|
OP
|
$23,638.00
|
|
|
Service Code
|
CPT 64629
|
| Hospital Charge Code |
909050629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$20,092.30 |
| Rate for Payer: Adventist Health Commercial |
$4,727.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,608.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,092.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,000.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,728.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$10,637.10
|
| Rate for Payer: Cash Price |
$10,637.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,364.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,092.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,092.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,182.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,631.92
|
| Rate for Payer: Heritage Provider Network Senior |
$14,631.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11,275.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,909.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,546.60
|
| Rate for Payer: Multiplan Commercial |
$17,728.50
|
| 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 |
$20,092.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,092.30
|
| Rate for Payer: Vantage Medical Group Senior |
$20,092.30
|
|
|
HC THERMODILUTION CONGENITAL
|
Facility
|
IP
|
$3,319.00
|
|
|
Service Code
|
CPT 93561
|
| Hospital Charge Code |
906811494
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$600.74 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$663.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,137.44
|
| Rate for Payer: Cash Price |
$1,493.55
|
| Rate for Payer: Cash Price |
$1,493.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$600.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$829.75
|
| Rate for Payer: Multiplan Commercial |
$2,489.25
|
|
|
HC THERMODILUTION CONGENITAL
|
Facility
|
OP
|
$3,319.00
|
|
|
Service Code
|
CPT 93561
|
| Hospital Charge Code |
906811494
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$600.74 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$663.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,051.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,821.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,825.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,489.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,660.16
|
| 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 |
$1,493.55
|
| Rate for Payer: Cash Price |
$1,493.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,821.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,821.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,821.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,958.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,054.46
|
| Rate for Payer: Heritage Provider Network Senior |
$2,054.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,583.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$600.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$829.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,323.30
|
| Rate for Payer: Multiplan Commercial |
$2,489.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,659.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,659.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,821.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,821.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,821.15
|
|
|
HC THERMODILUTION CONGENITAL ADDL
|
Facility
|
OP
|
$1,660.00
|
|
|
Service Code
|
CPT 93562
|
| Hospital Charge Code |
906811495
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$300.46 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$332.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,025.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,411.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$913.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,245.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$830.33
|
| 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 |
$747.00
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,411.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,411.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,411.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$979.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,027.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,027.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$791.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$300.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,162.00
|
| Rate for Payer: Multiplan Commercial |
$1,245.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$830.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$830.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,411.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,411.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,411.00
|
|
|
HC THERMODILUTION CONGENITAL ADDL
|
Facility
|
IP
|
$1,660.00
|
|
|
Service Code
|
CPT 93562
|
| Hospital Charge Code |
906811495
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$300.46 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$332.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,069.04
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$300.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.00
|
| Rate for Payer: Multiplan Commercial |
$1,245.00
|
|
|
HC THIOCYANATE SERUM
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 84430
|
| Hospital Charge Code |
900910463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$314.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.46
|
| Rate for Payer: Blue Shield of California Commercial |
$93.66
|
| Rate for Payer: Blue Shield of California Commercial |
$93.66
|
| Rate for Payer: Blue Shield of California EPN |
$75.12
|
| Rate for Payer: Blue Shield of California EPN |
$75.12
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$242.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.58
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.63
|
| Rate for Payer: TriValley Medical Group Senior |
$11.63
|
| Rate for Payer: TriValley Medical Group Senior |
$11.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.79
|
| Rate for Payer: Vantage Medical Group Senior |
$11.63
|
| Rate for Payer: Vantage Medical Group Senior |
$11.63
|
|
|
HC THIOCYANATE SERUM
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 84430
|
| Hospital Charge Code |
900910463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$327.80
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.59
|
| Rate for Payer: Heritage Provider Network Senior |
$344.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
|
OP
|
$4,093.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
900200007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$740.83 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$818.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,529.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,841.85
|
| Rate for Payer: Cash Price |
$1,841.85
|
| Rate for Payer: Cash Price |
$1,841.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,660.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$806.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,533.57
|
| Rate for Payer: Heritage Provider Network Senior |
$992.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,532.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$740.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$927.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,023.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$3,069.75
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$887.50
|
| Rate for Payer: TriValley Medical Group Senior |
$887.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC THORACENTESIS ASPIRATN W GUID
|
Facility
|
IP
|
$4,093.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
900200007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$740.83 |
| Max. Negotiated Rate |
$3,069.75 |
| Rate for Payer: Adventist Health Commercial |
$818.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,635.89
|
| Rate for Payer: Cash Price |
$1,841.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,770.96
|
| Rate for Payer: Heritage Provider Network Senior |
$2,770.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$740.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,023.25
|
| Rate for Payer: Multiplan Commercial |
$3,069.75
|
|
