|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]
|
Facility
|
IP
|
$1.92
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Senior |
$0.89
|
| Rate for Payer: Heritage Provider Network Senior |
$0.49
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.64
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.77
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.06
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.11
|
| Rate for Payer: Dignity Health Senior |
$6.11
|
| Rate for Payer: Dignity Health Senior |
$0.90
|
| Rate for Payer: Dignity Health Senior |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$0.49
|
| Rate for Payer: Heritage Provider Network Senior |
$0.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.42
|
| Rate for Payer: TriValley Medical Group Senior |
$0.42
|
| Rate for Payer: TriValley Medical Group Senior |
$2.88
|
| Rate for Payer: TriValley Medical Group Senior |
$0.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6.11
|
| Rate for Payer: Vantage Medical Group Senior |
$1.63
|
|
|
HB COVID-19 RNA
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.90
|
| Rate for Payer: Heritage Provider Network Senior |
$102.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
|
|
HB COVID-19 RNA
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$329.38 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$329.38
|
| Rate for Payer: Blue Shield of California Commercial |
$92.72
|
| Rate for Payer: Blue Shield of California EPN |
$74.18
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$98.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Senior |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.09
|
| Rate for Payer: Heritage Provider Network Senior |
$94.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$72.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.65
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Senior |
$51.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC 25 CH VITAMIN D2 D3
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$270.25 |
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$84.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$108.55
|
| 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 |
$86.90
|
| Rate for Payer: Cash Price |
$86.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.70
|
| 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 |
$102.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.80
|
| Rate for Payer: Heritage Provider Network Senior |
$97.80
|
| 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 |
$75.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.50
|
| 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 |
$118.50
|
| 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 25 CH VITAMIN D2 D3
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Cash Price |
$86.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.97
|
| Rate for Payer: Heritage Provider Network Senior |
$106.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.50
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
OP
|
$2,583.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
906820201
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$467.52 |
| Max. Negotiated Rate |
$2,195.55 |
| Rate for Payer: Adventist Health Commercial |
$516.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,774.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,195.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,420.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,937.25
|
| Rate for Payer: Blue Shield of California Commercial |
$737.66
|
| Rate for Payer: Blue Shield of California EPN |
$593.20
|
| Rate for Payer: Cash Price |
$1,420.65
|
| Rate for Payer: Cash Price |
$1,420.65
|
| Rate for Payer: Cash Price |
$1,420.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,678.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,195.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.55
|
| Rate for Payer: Dignity Health Senior |
$2,195.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,678.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,598.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,598.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,232.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$645.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,808.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,808.10
|
| Rate for Payer: Multiplan Commercial |
$1,937.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,291.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,195.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,195.55
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
IP
|
$2,583.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
906820201
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$467.52 |
| Max. Negotiated Rate |
$1,937.25 |
| Rate for Payer: Adventist Health Commercial |
$516.60
|
| Rate for Payer: Cash Price |
$1,420.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,748.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,748.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$645.75
|
| Rate for Payer: Multiplan Commercial |
$1,937.25
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201370
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$112.58 |
| Max. Negotiated Rate |
$466.50 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$421.09
|
| Rate for Payer: Heritage Provider Network Senior |
$421.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.50
|
| Rate for Payer: Multiplan Commercial |
$466.50
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201370
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$112.58 |
| Max. Negotiated Rate |
$1,024.00 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$427.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$342.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$466.50
|
| Rate for Payer: Blue Shield of California Commercial |
$737.66
|
| Rate for Payer: Blue Shield of California EPN |
$593.20
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$404.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$528.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.70
|
| Rate for Payer: Dignity Health Senior |
$528.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$385.02
|
| Rate for Payer: Heritage Provider Network Senior |
$385.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$296.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$435.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$435.40
|
| Rate for Payer: Multiplan Commercial |
$466.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$311.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$311.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.70
|
| Rate for Payer: Vantage Medical Group Senior |
$528.70
|
|
|
HC 3-PHASE BONE SCAN
|
Facility
|
OP
|
$2,846.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
909301372
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$212.38 |
| Max. Negotiated Rate |
$2,134.50 |
| Rate for Payer: Adventist Health Commercial |
$569.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,521.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,955.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,005.70
|
| Rate for Payer: Blue Shield of California EPN |
$808.75
|
| Rate for Payer: Cash Price |
$1,565.30
|
| Rate for Payer: Cash Price |
$1,565.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,849.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,849.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,761.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,761.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$212.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,357.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$711.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$2,134.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,423.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,423.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC 3-PHASE BONE SCAN
|
Facility
|
IP
|
$2,846.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
909301372
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$515.13 |
| Max. Negotiated Rate |
$2,134.50 |
| Rate for Payer: Adventist Health Commercial |
$569.20
|
| Rate for Payer: Cash Price |
$1,565.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,926.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,926.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$711.50
|
| Rate for Payer: Multiplan Commercial |
$2,134.50
|
|
|
HC 59 FE CHLORIDE
|
Facility
|
IP
|
$1,217.00
|
|
|
Service Code
|
CPT A4641
|
| Hospital Charge Code |
909301497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$220.28 |
| Max. Negotiated Rate |
$912.75 |
| Rate for Payer: Adventist Health Commercial |
$243.40
|
| Rate for Payer: Cash Price |
$669.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$559.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$563.47
|
| Rate for Payer: Heritage Provider Network Senior |
$563.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.25
|
| Rate for Payer: Multiplan Commercial |
$912.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$439.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$402.95
|
|
|
HC 59 FE CHLORIDE
|
Facility
|
OP
|
$1,217.00
|
|
|
Service Code
|
CPT A4641
|
| Hospital Charge Code |
909301497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$220.28 |
| Max. Negotiated Rate |
$1,034.45 |
| Rate for Payer: Adventist Health Commercial |
$243.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,034.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$669.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$912.75
|
| Rate for Payer: Blue Shield of California Commercial |
$742.37
|
| Rate for Payer: Blue Shield of California EPN |
$593.90
|
| Rate for Payer: Cash Price |
$669.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$559.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,034.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,034.45
|
| Rate for Payer: Dignity Health Senior |
$1,034.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$778.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$563.47
|
| Rate for Payer: Heritage Provider Network Senior |
$563.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$580.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$851.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$851.90
|
| Rate for Payer: Multiplan Commercial |
$912.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$486.80
|
| Rate for Payer: TriValley Medical Group Senior |
$486.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$439.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$402.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,034.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,034.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,034.45
|
|
|
HC 5-HIAA BY HPLC
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900910535
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.76
|
| Rate for Payer: Blue Shield of California Commercial |
$103.74
|
| Rate for Payer: Blue Shield of California EPN |
$83.21
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Senior |
$12.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.25
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.90
|
| Rate for Payer: TriValley Medical Group Senior |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC 5-HIAA BY HPLC
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900910535
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.43
|
| Rate for Payer: Heritage Provider Network Senior |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
|
|
HC 5-HYDROXYINDOLACETIC ACID URINE 24 HOURS
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900912191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.76
|
| Rate for Payer: Blue Shield of California Commercial |
$103.74
|
| Rate for Payer: Blue Shield of California EPN |
$83.21
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Senior |
$12.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.25
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.90
|
| Rate for Payer: TriValley Medical Group Senior |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC 5-HYDROXYINDOLACETIC ACID URINE 24 HOURS
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900912191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.43
|
| Rate for Payer: Heritage Provider Network Senior |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
|
|
HC 5-HYDROXYINDOLACETIC ACID URINE RANDOM
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900912190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.43
|
| Rate for Payer: Heritage Provider Network Senior |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
|
|
HC 5-HYDROXYINDOLACETIC ACID URINE RANDOM
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900912190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.76
|
| Rate for Payer: Blue Shield of California Commercial |
$103.74
|
| Rate for Payer: Blue Shield of California EPN |
$83.21
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Senior |
$12.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.25
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.90
|
| Rate for Payer: TriValley Medical Group Senior |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC ABCESS CATH EXCHANGE
|
Facility
|
IP
|
$1,995.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909001859
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$361.10 |
| Max. Negotiated Rate |
$1,496.25 |
| Rate for Payer: Adventist Health Commercial |
$399.00
|
| Rate for Payer: Cash Price |
$1,097.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,350.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,350.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.75
|
| Rate for Payer: Multiplan Commercial |
$1,496.25
|
|
|
HC ABCESS CATH EXCHANGE
|
Facility
|
OP
|
$1,995.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909001859
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.32 |
| Max. Negotiated Rate |
$1,695.75 |
| Rate for Payer: Adventist Health Commercial |
$399.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,370.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,695.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,097.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,496.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$818.20
|
| Rate for Payer: Blue Shield of California Commercial |
$664.90
|
| Rate for Payer: Blue Shield of California EPN |
$534.69
|
| Rate for Payer: Cash Price |
$1,097.25
|
| Rate for Payer: Cash Price |
$1,097.25
|
| Rate for Payer: Cash Price |
$1,097.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,296.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,695.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,695.75
|
| Rate for Payer: Dignity Health Senior |
$1,695.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,296.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,234.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,234.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$169.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$951.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,396.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,396.50
|
| Rate for Payer: Multiplan Commercial |
$1,496.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$997.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$997.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,695.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,695.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,695.75
|
|
|
HC ABDOMEN KUB SUPINE
|
Facility
|
OP
|
$539.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
909001702
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.85 |
| Max. Negotiated Rate |
$404.25 |
| Rate for Payer: Adventist Health Commercial |
$107.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$288.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$370.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.78
|
| Rate for Payer: Blue Shield of California Commercial |
$102.43
|
| Rate for Payer: Blue Shield of California EPN |
$82.37
|
| Rate for Payer: Cash Price |
$296.45
|
| Rate for Payer: Cash Price |
$296.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$350.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.64
|
| Rate for Payer: Heritage Provider Network Senior |
$333.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$257.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$404.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$99.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC ABDOMEN KUB SUPINE
|
Facility
|
IP
|
$539.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
909001702
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.56 |
| Max. Negotiated Rate |
$404.25 |
| Rate for Payer: Adventist Health Commercial |
$107.80
|
| Rate for Payer: Cash Price |
$296.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$364.90
|
| Rate for Payer: Heritage Provider Network Senior |
$364.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.75
|
| Rate for Payer: Multiplan Commercial |
$404.25
|
|
|
HC ABDOMEN/RETROPERIT PERC BIO
|
Facility
|
IP
|
$3,449.00
|
|
|
Service Code
|
CPT 49180
|
| Hospital Charge Code |
909000161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$624.27 |
| Max. Negotiated Rate |
$2,586.75 |
| Rate for Payer: Adventist Health Commercial |
$689.80
|
| Rate for Payer: Cash Price |
$1,896.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,334.97
|
| Rate for Payer: Heritage Provider Network Senior |
$2,334.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$862.25
|
| Rate for Payer: Multiplan Commercial |
$2,586.75
|
|
