|
HC XRAY SKULL RADIOGRAPH LTD
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
908801144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$504.75 |
| Rate for Payer: Adventist Health Commercial |
$134.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$415.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.88
|
| Rate for Payer: Blue Shield of California Commercial |
$131.04
|
| Rate for Payer: Blue Shield of California EPN |
$105.38
|
| Rate for Payer: Cash Price |
$302.85
|
| Rate for Payer: Cash Price |
$302.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$437.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$416.59
|
| Rate for Payer: Heritage Provider Network Senior |
$416.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$321.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$504.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XRAY SKULL RADIOGRAPH LTD
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
908801144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.81 |
| Max. Negotiated Rate |
$504.75 |
| Rate for Payer: Adventist Health Commercial |
$134.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$433.41
|
| Rate for Payer: Cash Price |
$302.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$455.62
|
| Rate for Payer: Heritage Provider Network Senior |
$455.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.25
|
| Rate for Payer: Multiplan Commercial |
$504.75
|
|
|
HC XR RIBS UNI & PA CHEST
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
950463101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$278.25 |
| Rate for Payer: Adventist Health Commercial |
$74.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$229.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.88
|
| Rate for Payer: Blue Shield of California Commercial |
$141.12
|
| Rate for Payer: Blue Shield of California EPN |
$113.48
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$241.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$229.65
|
| Rate for Payer: Heritage Provider Network Senior |
$229.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$176.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$278.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XR RIBS UNI & PA CHEST
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
950463101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$278.25 |
| Rate for Payer: Adventist Health Commercial |
$74.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$238.92
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$251.17
|
| Rate for Payer: Heritage Provider Network Senior |
$251.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.75
|
| Rate for Payer: Multiplan Commercial |
$278.25
|
|
|
HC XR RIBS W PA CXR
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
950463102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$278.25 |
| Rate for Payer: Adventist Health Commercial |
$74.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$238.92
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$251.17
|
| Rate for Payer: Heritage Provider Network Senior |
$251.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.75
|
| Rate for Payer: Multiplan Commercial |
$278.25
|
|
|
HC XR RIBS W PA CXR
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
950463102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$278.25 |
| Rate for Payer: Adventist Health Commercial |
$74.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$229.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.22
|
| Rate for Payer: Blue Shield of California Commercial |
$188.45
|
| Rate for Payer: Blue Shield of California EPN |
$151.54
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$241.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$229.65
|
| Rate for Payer: Heritage Provider Network Senior |
$229.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$176.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$278.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC XR TEMP MANDIBULAR BILAT
|
Facility
|
IP
|
$1,044.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
909020170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$188.96 |
| Max. Negotiated Rate |
$783.00 |
| Rate for Payer: Adventist Health Commercial |
$208.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$672.34
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$706.79
|
| Rate for Payer: Heritage Provider Network Senior |
$706.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.00
|
| Rate for Payer: Multiplan Commercial |
$783.00
|
|
|
HC XR TEMP MANDIBULAR BILAT
|
Facility
|
OP
|
$1,044.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
909020170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$783.00 |
| Rate for Payer: Adventist Health Commercial |
$208.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$645.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.99
|
| Rate for Payer: Blue Shield of California Commercial |
$178.94
|
| Rate for Payer: Blue Shield of California EPN |
$143.90
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$678.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$615.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$646.24
|
| Rate for Payer: Heritage Provider Network Senior |
$646.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$497.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$783.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC XYLOSE TOLERANCE BLD
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 84620
|
| Hospital Charge Code |
900910321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$112.44 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.44
|
| Rate for Payer: Blue Shield of California Commercial |
$95.33
|
| Rate for Payer: Blue Shield of California Commercial |
$95.33
|
| Rate for Payer: Blue Shield of California EPN |
$76.46
|
| Rate for Payer: Blue Shield of California EPN |
$76.46
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$152.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.91
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.05
|
| Rate for Payer: Heritage Provider Network Senior |
$145.47
|
| Rate for Payer: Heritage Provider Network Senior |
$34.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$112.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.30
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.91
|
| Rate for Payer: TriValley Medical Group Senior |
$12.91
|
| Rate for Payer: TriValley Medical Group Senior |
$12.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.91
|
| Rate for Payer: Vantage Medical Group Senior |
$12.91
|
|
|
HC XYLOSE TOLERANCE BLD
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 84620
|
| Hospital Charge Code |
900910321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.53 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$151.34
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.09
|
| Rate for Payer: Heritage Provider Network Senior |
$159.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.75
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
|
|
HC Y90 MICROSPHERES
|
Facility
|
IP
|
$28,943.00
|
|
|
Service Code
|
CPT C2616
|
| Hospital Charge Code |
909301347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,788.60 |
| Max. Negotiated Rate |
$21,707.25 |
| Rate for Payer: Adventist Health Commercial |
$5,788.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,639.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,635.09
|
| Rate for Payer: Blue Shield of California EPN |
$11,635.09
|
| Rate for Payer: Cash Price |
$13,024.35
|
| Rate for Payer: Cash Price |
$13,024.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,313.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,629.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,400.61
|
| Rate for Payer: Heritage Provider Network Senior |
$13,400.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,471.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,471.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,471.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,235.75
|
| Rate for Payer: Multiplan Commercial |
$21,707.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,457.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,583.03
|
|
|
HC Y90 MICROSPHERES
|
Facility
|
OP
|
$28,943.00
|
|
|
Service Code
|
CPT C2616
|
| Hospital Charge Code |
909301347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,788.60 |
| Max. Negotiated Rate |
$33,557.88 |
| Rate for Payer: Adventist Health Commercial |
$5,788.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,886.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,557.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,609.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,371.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,635.09
|
| Rate for Payer: Blue Shield of California EPN |
$11,635.09
|
| Rate for Payer: Cash Price |
$13,024.35
|
| Rate for Payer: Cash Price |
$13,024.35
|
| Rate for Payer: Cash Price |
$13,024.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,313.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,557.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,609.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,371.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,523.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,371.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,400.61
|
| Rate for Payer: Heritage Provider Network Senior |
$13,400.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,371.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,471.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,471.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,471.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,235.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29,978.37
|
| Rate for Payer: Multiplan Commercial |
$21,707.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,609.11
|
| Rate for Payer: TriValley Medical Group Senior |
$22,371.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,457.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,583.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,557.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,609.11
|
| Rate for Payer: Vantage Medical Group Senior |
$22,371.92
|
|
|
HC Y-90 ZEVALIN UP TO 40 MCI
|
Facility
|
OP
|
$107,795.00
|
|
|
Service Code
|
CPT A9543
|
| Hospital Charge Code |
909301343
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$19,510.90 |
| Max. Negotiated Rate |
$134,724.69 |
| Rate for Payer: Adventist Health Commercial |
$21,559.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66,617.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71,030.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62,507.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62,507.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134,724.69
|
| Rate for Payer: Blue Shield of California Commercial |
$65,754.95
|
| Rate for Payer: Blue Shield of California EPN |
$52,603.96
|
| Rate for Payer: Cash Price |
$48,507.75
|
| Rate for Payer: Cash Price |
$48,507.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70,066.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71,030.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$62,507.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62,507.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68,988.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$56,824.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$66,725.10
|
| Rate for Payer: Heritage Provider Network Senior |
$66,725.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,824.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$51,418.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,510.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65,348.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26,948.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$76,144.90
|
| Rate for Payer: Multiplan Commercial |
$80,846.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$62,507.00
|
| Rate for Payer: TriValley Medical Group Senior |
$56,824.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38,946.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$35,690.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71,030.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62,507.00
|
| Rate for Payer: Vantage Medical Group Senior |
$62,507.00
|
|
|
HC Y-90 ZEVALIN UP TO 40 MCI
|
Facility
|
IP
|
$107,795.00
|
|
|
Service Code
|
CPT A9543
|
| Hospital Charge Code |
909301343
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$19,510.90 |
| Max. Negotiated Rate |
$80,846.25 |
| Rate for Payer: Adventist Health Commercial |
$21,559.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69,419.98
|
| Rate for Payer: Cash Price |
$48,507.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$58,209.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$72,977.21
|
| Rate for Payer: Heritage Provider Network Senior |
$72,977.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,510.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26,948.75
|
| Rate for Payer: Multiplan Commercial |
$80,846.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38,946.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$35,690.92
|
|
|
HC ZELANTE CATHETER
|
Facility
|
OP
|
$8,798.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909001757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,759.60 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$1,759.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,437.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,478.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,838.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,598.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,536.80
|
| Rate for Payer: Blue Shield of California EPN |
$3,536.80
|
| Rate for Payer: Cash Price |
$3,959.10
|
| Rate for Payer: Cash Price |
$3,959.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,047.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,478.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,478.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,478.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,630.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,073.47
|
| Rate for Payer: Heritage Provider Network Senior |
$4,073.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,399.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,399.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,399.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,199.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,158.60
|
| Rate for Payer: Multiplan Commercial |
$6,598.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,178.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,913.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,478.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,478.30
|
| Rate for Payer: Vantage Medical Group Senior |
$7,478.30
|
|
|
HC ZELANTE CATHETER
|
Facility
|
IP
|
$8,798.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909001757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,759.60 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$1,759.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,665.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,536.80
|
| Rate for Payer: Blue Shield of California EPN |
$3,536.80
|
| Rate for Payer: Cash Price |
$3,959.10
|
| Rate for Payer: Cash Price |
$3,959.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,047.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,750.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,073.47
|
| Rate for Payer: Heritage Provider Network Senior |
$4,073.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,399.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,399.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,399.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,199.50
|
| Rate for Payer: Multiplan Commercial |
$6,598.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,178.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,913.02
|
|
|
HEADACHES WITH MCC
|
Facility
|
IP
|
$17,913.54
|
|
|
Service Code
|
MSDRG 102
|
| Min. Negotiated Rate |
$13,368.31 |
| Max. Negotiated Rate |
$17,913.54 |
| Rate for Payer: EPIC Health Plan Medicare |
$13,368.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,368.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,373.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,913.54
|
|
|
HEADACHES WITHOUT MCC
|
Facility
|
IP
|
$13,543.39
|
|
|
Service Code
|
MSDRG 103
|
| Min. Negotiated Rate |
$10,107.01 |
| Max. Negotiated Rate |
$13,543.39 |
| Rate for Payer: EPIC Health Plan Medicare |
$10,107.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,107.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,623.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,543.39
|
|
|
HEART FAILURE AND SHOCK WITH CC
|
Facility
|
IP
|
$13,738.39
|
|
|
Service Code
|
MSDRG 292
|
| Min. Negotiated Rate |
$10,252.53 |
| Max. Negotiated Rate |
$13,738.39 |
| Rate for Payer: EPIC Health Plan Medicare |
$10,252.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,252.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,790.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,738.39
|
|
|
HEART FAILURE AND SHOCK WITH MCC
|
Facility
|
IP
|
$20,414.94
|
|
|
Service Code
|
MSDRG 291
|
| Min. Negotiated Rate |
$15,235.03 |
| Max. Negotiated Rate |
$20,414.94 |
| Rate for Payer: EPIC Health Plan Medicare |
$15,235.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,235.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,520.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,414.94
|
|
|
HEART FAILURE AND SHOCK WITHOUT CC/MCC
|
Facility
|
IP
|
$9,392.78
|
|
|
Service Code
|
MSDRG 293
|
| Min. Negotiated Rate |
$7,009.54 |
| Max. Negotiated Rate |
$9,392.78 |
| Rate for Payer: EPIC Health Plan Medicare |
$7,009.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,009.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,060.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,392.78
|
|
|
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC
|
Facility
|
IP
|
$431,021.67
|
|
|
Service Code
|
MSDRG 001
|
| Min. Negotiated Rate |
$321,657.96 |
| Max. Negotiated Rate |
$431,021.67 |
| Rate for Payer: EPIC Health Plan Medicare |
$321,657.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321,657.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$369,906.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$431,021.67
|
|
|
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC
|
Facility
|
IP
|
$174,706.64
|
|
|
Service Code
|
MSDRG 002
|
| Min. Negotiated Rate |
$130,378.09 |
| Max. Negotiated Rate |
$174,706.64 |
| Rate for Payer: EPIC Health Plan Medicare |
$130,378.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130,378.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$149,934.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$174,706.64
|
|
|
HEMIARTHROPLASTY, HIP, PARTIAL (EG, FEMORAL STEM PROSTHESIS, BIPOLAR ARTHROPLASTY)
|
Facility
|
OP
|
$24,769.03
|
|
|
Service Code
|
CPT 27125
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$24,769.03 |
| 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 |
$9,728.00
|
| 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: 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16,512.69
|
| 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 |
$9,944.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,989.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,127.00
|
| 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
|
|
|
HEMIN 350 MG INTRAVENOUS POWDER FOR SOLUTION [218818]
|
Facility
|
IP
|
$13,712.59
|
|
|
Service Code
|
HCPCS J1640
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,481.98 |
| Max. Negotiated Rate |
$10,284.44 |
| Rate for Payer: Adventist Health Commercial |
$2,742.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,830.91
|
| Rate for Payer: Cash Price |
$6,170.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,307.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,404.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,348.93
|
| Rate for Payer: Heritage Provider Network Senior |
$6,348.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,481.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,428.15
|
| Rate for Payer: Multiplan Commercial |
$10,284.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,954.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,540.24
|
|
