|
HC VENT TUBE
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
909081809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.10
|
| Rate for Payer: Heritage Provider Network Senior |
$203.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
|
|
HC VERTEBRAL UNI
|
Facility
|
IP
|
$17,590.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
909020149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,183.79 |
| Max. Negotiated Rate |
$13,192.50 |
| Rate for Payer: Adventist Health Commercial |
$3,518.00
|
| Rate for Payer: Cash Price |
$9,674.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,908.43
|
| Rate for Payer: Heritage Provider Network Senior |
$11,908.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,183.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,397.50
|
| Rate for Payer: Multiplan Commercial |
$13,192.50
|
|
|
HC VERTEBRAL UNI
|
Facility
|
OP
|
$17,095.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
906820224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$3,419.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,744.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$9,402.25
|
| Rate for Payer: Cash Price |
$9,402.25
|
| Rate for Payer: Cash Price |
$9,402.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,111.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Senior |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,868.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,581.81
|
| Rate for Payer: Heritage Provider Network Senior |
$8,448.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$455.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,050.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,094.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,273.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,654.28
|
| Rate for Payer: Multiplan Commercial |
$12,821.25
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,555.33
|
| Rate for Payer: TriValley Medical Group Senior |
$7,555.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC VERTEBRAL UNI
|
Facility
|
OP
|
$17,590.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
909020149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$3,518.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,084.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$9,674.50
|
| Rate for Payer: Cash Price |
$9,674.50
|
| Rate for Payer: Cash Price |
$9,674.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,433.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Senior |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,868.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,888.21
|
| Rate for Payer: Heritage Provider Network Senior |
$8,448.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$455.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,050.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,183.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,397.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,654.28
|
| Rate for Payer: Multiplan Commercial |
$13,192.50
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,555.33
|
| Rate for Payer: TriValley Medical Group Senior |
$7,555.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC VERTEBRAL UNI
|
Facility
|
IP
|
$17,095.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
906820224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,094.20 |
| Max. Negotiated Rate |
$12,821.25 |
| Rate for Payer: Adventist Health Commercial |
$3,419.00
|
| Rate for Payer: Cash Price |
$9,402.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,573.32
|
| Rate for Payer: Heritage Provider Network Senior |
$11,573.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,094.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,273.75
|
| Rate for Payer: Multiplan Commercial |
$12,821.25
|
|
|
HC VERTEBROPLASTY ADDL INJECT
|
Facility
|
OP
|
$12,258.00
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
909022512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,829.24 |
| Rate for Payer: Adventist Health Commercial |
$2,451.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,421.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,419.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,741.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,193.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$6,741.90
|
| Rate for Payer: Cash Price |
$6,741.90
|
| Rate for Payer: Cash Price |
$6,741.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,967.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,419.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,419.30
|
| Rate for Payer: Dignity Health Senior |
$10,419.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,587.70
|
| Rate for Payer: Heritage Provider Network Senior |
$7,587.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$294.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,847.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,218.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,064.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,580.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,580.60
|
| Rate for Payer: Multiplan Commercial |
$9,193.50
|
| 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 |
$10,419.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,419.30
|
| Rate for Payer: Vantage Medical Group Senior |
$10,419.30
|
|
|
HC VERTEBROPLASTY ADDL INJECT
|
Facility
|
IP
|
$12,258.00
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
909022512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,218.70 |
| Max. Negotiated Rate |
$9,193.50 |
| Rate for Payer: Adventist Health Commercial |
$2,451.60
|
| Rate for Payer: Cash Price |
$6,741.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,298.67
|
| Rate for Payer: Heritage Provider Network Senior |
$8,298.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,218.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,064.50
|
| Rate for Payer: Multiplan Commercial |
$9,193.50
|
|
|
HC VESTIBULE OF MOUTH
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
900501785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$316.93 |
| Max. Negotiated Rate |
$1,313.25 |
| Rate for Payer: Adventist Health Commercial |
$350.20
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,185.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,185.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.75
|
| Rate for Payer: Multiplan Commercial |
$1,313.25
|
|
|
HC VESTIBULE OF MOUTH
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
900501785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$350.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,202.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,138.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Senior |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$647.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,185.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,185.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$835.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$744.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$815.28
|
| Rate for Payer: Multiplan Commercial |
$1,313.25
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$630.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$579.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC VITAL CAPACITY TOTAL
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
900800430
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$263.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$338.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Blue Shield of California Commercial |
$92.35
|
| Rate for Payer: Blue Shield of California EPN |
$74.27
|
| Rate for Payer: Cash Price |
$271.15
|
| Rate for Payer: Cash Price |
$271.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$320.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.17
|
| Rate for Payer: Heritage Provider Network Senior |
$305.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$235.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$218.68
|
| Rate for Payer: TriValley Medical Group Senior |
$198.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$246.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$246.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC VITAL CAPACITY TOTAL
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
900800430
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Cash Price |
$271.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.76
|
| Rate for Payer: Heritage Provider Network Senior |
$333.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.25
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
|
|
HC VITAMIN B12
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
900910830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC VITAMIN B12
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
900910830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.62
|
| Rate for Payer: Blue Shield of California Commercial |
$121.31
|
| Rate for Payer: Blue Shield of California EPN |
$97.30
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.59
|
| Rate for Payer: Dignity Health Senior |
$15.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.08
|
| Rate for Payer: TriValley Medical Group Senior |
$15.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Vantage Medical Group Senior |
$15.08
|
|
|
HC VITAMIN D TOTAL
|
Facility
|
OP
|
$302.27
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$270.25 |
| Rate for Payer: Adventist Health Commercial |
$60.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$161.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$207.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.25
|
| Rate for Payer: Blue Shield of California Commercial |
$238.23
|
| Rate for Payer: Blue Shield of California EPN |
$191.08
|
| Rate for Payer: Cash Price |
$166.25
|
| Rate for Payer: Cash Price |
$166.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$196.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.56
|
| Rate for Payer: Dignity Health Senior |
$29.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.11
|
| Rate for Payer: Heritage Provider Network Senior |
$187.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$144.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.30
|
| Rate for Payer: Multiplan Commercial |
$226.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.60
|
| Rate for Payer: TriValley Medical Group Senior |
$29.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Vantage Medical Group Senior |
$29.60
|
|
|
HC VITAMIN D TOTAL
|
Facility
|
IP
|
$302.27
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.71 |
| Max. Negotiated Rate |
$226.70 |
| Rate for Payer: Adventist Health Commercial |
$60.45
|
| Rate for Payer: Cash Price |
$166.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.64
|
| Rate for Payer: Heritage Provider Network Senior |
$204.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.57
|
| Rate for Payer: Multiplan Commercial |
$226.70
|
|
|
HC VNUS ABLATION CATHETER
|
Facility
|
IP
|
$1,740.00
|
|
|
Service Code
|
CPT C1888
|
| Hospital Charge Code |
909080043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$348.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$835.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$699.48
|
| Rate for Payer: Blue Shield of California EPN |
$699.48
|
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$800.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$939.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$805.62
|
| Rate for Payer: Heritage Provider Network Senior |
$805.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$870.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$870.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$870.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.00
|
| Rate for Payer: Multiplan Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$628.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$576.11
|
|
|
HC VNUS ABLATION CATHETER
|
Facility
|
OP
|
$1,740.00
|
|
|
Service Code
|
CPT C1888
|
| Hospital Charge Code |
909080043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$348.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$835.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,195.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,479.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$957.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,305.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$699.48
|
| Rate for Payer: Blue Shield of California EPN |
$699.48
|
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$800.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,479.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,479.00
|
| Rate for Payer: Dignity Health Senior |
$1,479.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,113.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$805.62
|
| Rate for Payer: Heritage Provider Network Senior |
$805.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$870.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$870.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$870.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,218.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,218.00
|
| Rate for Payer: Multiplan Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$628.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$576.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,479.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,479.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,479.00
|
|
|
HC VOICE CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9171
|
| Hospital Charge Code |
900018236
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC VOICE CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9171
|
| Hospital Charge Code |
900018136
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC VOICE CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9171
|
| Hospital Charge Code |
900018136
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC VOICE CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9171
|
| Hospital Charge Code |
900018436
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC VOICE CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9171
|
| Hospital Charge Code |
900018236
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC VOICE CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9171
|
| Hospital Charge Code |
900018436
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC VOICE D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9173
|
| Hospital Charge Code |
900018138
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC VOICE D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9173
|
| Hospital Charge Code |
900018138
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
