|
HC ADM SARSCOV2 PF PEDS (6MS-4YRS)BOOSTER 3MCG/0.2ML TRS-SUCR 3
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 0173A
|
| Hospital Charge Code |
949001356
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.92
|
| Rate for Payer: Heritage Provider Network Senior |
$81.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
|
|
HC ADM SARSCOV2 PF PEDS (6MS-4YRS)BOOSTER 3MCG/0.2ML TRS-SUCR 3
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 0173A
|
| Hospital Charge Code |
949001356
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.75
|
| Rate for Payer: Blue Shield of California Commercial |
$73.81
|
| Rate for Payer: Blue Shield of California EPN |
$59.05
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.85
|
| Rate for Payer: Dignity Health Senior |
$102.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.90
|
| Rate for Payer: Heritage Provider Network Senior |
$74.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.70
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Vantage Medical Group Senior |
$102.85
|
|
|
HC ADM SARSCOV2 VACCINE SINGLE DOSE IM
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
949001358
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.25
|
| Rate for Payer: Blue Shield of California Commercial |
$73.81
|
| Rate for Payer: Blue Shield of California EPN |
$59.05
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.04
|
| Rate for Payer: Dignity Health Senior |
$52.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$52.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.90
|
| Rate for Payer: Heritage Provider Network Senior |
$74.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$64.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$52.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.48
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$58.04
|
| Rate for Payer: TriValley Medical Group Senior |
$52.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.04
|
| Rate for Payer: Vantage Medical Group Senior |
$52.76
|
|
|
HC ADM SARSCOV2 VACCINE SINGLE DOSE IM
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
949001358
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.92
|
| Rate for Payer: Heritage Provider Network Senior |
$81.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
|
|
HC ADRENAL SCAN
|
Facility
|
IP
|
$2,998.00
|
|
|
Service Code
|
CPT 78075
|
| Hospital Charge Code |
909301425
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$542.64 |
| Max. Negotiated Rate |
$2,248.50 |
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Cash Price |
$1,648.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,029.65
|
| Rate for Payer: Heritage Provider Network Senior |
$2,029.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$749.50
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
|
|
HC ADRENAL SCAN
|
Facility
|
OP
|
$2,998.00
|
|
|
Service Code
|
CPT 78075
|
| Hospital Charge Code |
909301425
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$352.87 |
| Max. Negotiated Rate |
$2,488.11 |
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,602.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,059.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,142.78
|
| Rate for Payer: Blue Shield of California EPN |
$918.99
|
| Rate for Payer: Cash Price |
$1,648.90
|
| Rate for Payer: Cash Price |
$1,648.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,948.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Senior |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,948.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,658.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,855.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$352.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,430.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,907.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$749.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,090.01
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,824.61
|
| Rate for Payer: TriValley Medical Group Senior |
$1,658.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,499.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,499.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC AERO INHAL MDI/DPI INITIAL
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800330
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.59
|
| Rate for Payer: Heritage Provider Network Senior |
$344.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
|
|
HC AERO INHAL MDI/DPI INITIAL
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800330
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$387.64 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$272.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| 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 |
$279.95
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Senior |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$242.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$325.62
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC AERO INHAL MDI/DPI SUB
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800331
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$387.64 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$272.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| 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 |
$279.95
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Senior |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$242.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$325.62
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC AERO INHAL MDI/DPI SUB
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800331
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.59
|
| Rate for Payer: Heritage Provider Network Senior |
$344.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
|
|
HC AERO INHAL PENTAMIDINE TX
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
900800300
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$66.06 |
| Max. Negotiated Rate |
$273.75 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Cash Price |
$200.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.10
|
| Rate for Payer: Heritage Provider Network Senior |
$247.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.25
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
|
|
HC AERO INHAL PENTAMIDINE TX
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
900800300
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$66.06 |
| Max. Negotiated Rate |
$387.64 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$195.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$250.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| 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 |
$200.75
|
| Rate for Payer: Cash Price |
$200.75
|
| Rate for Payer: Cash Price |
$200.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$237.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Senior |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.94
|
| Rate for Payer: Heritage Provider Network Senior |
$225.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$139.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$174.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$325.62
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC AERO INHAL SPUTUM IND INITIAL
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$387.64 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$180.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$231.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| 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 |
$185.35
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$219.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Senior |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.60
|
| Rate for Payer: Heritage Provider Network Senior |
$208.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$160.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$325.62
|
| Rate for Payer: Multiplan Commercial |
$252.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC AERO INHAL SPUTUM IND INITIAL
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$252.75 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$228.15
|
| Rate for Payer: Heritage Provider Network Senior |
$228.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.25
|
| Rate for Payer: Multiplan Commercial |
$252.75
|
|
|
HC AERO INHAL SPUTUM IND SUB
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$387.64 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$180.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$231.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| 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 |
$185.35
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$219.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Senior |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.60
|
| Rate for Payer: Heritage Provider Network Senior |
$208.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$160.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$325.62
|
| Rate for Payer: Multiplan Commercial |
$252.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC AERO INHAL SPUTUM IND SUB
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$252.75 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$228.15
|
| Rate for Payer: Heritage Provider Network Senior |
$228.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.25
|
| Rate for Payer: Multiplan Commercial |
$252.75
|
|
|
HC AERO INHAL SVN INITIAL
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800310
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$387.64 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$272.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| 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 |
$279.95
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Senior |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$242.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$325.62
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC AERO INHAL SVN INITIAL
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800310
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.59
|
| Rate for Payer: Heritage Provider Network Senior |
$344.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
|
|
HC AERO INHAL SVN SUB
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800311
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.59
|
| Rate for Payer: Heritage Provider Network Senior |
$344.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
|
|
HC AERO INHAL SVN SUB
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800311
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$387.64 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$272.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| 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 |
$279.95
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Senior |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$242.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$325.62
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC AFB FLUOROCHROME STAIN CONCEN
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911546
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
|
HC AFB FLUOROCHROME STAIN CONCEN
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911546
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.05
|
| Rate for Payer: Blue Shield of California Commercial |
$43.20
|
| Rate for Payer: Blue Shield of California EPN |
$34.65
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Senior |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.42
|
| Rate for Payer: Heritage Provider Network Senior |
$85.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$65.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.79
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Senior |
$5.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC AFB FLUOROCHROME STAIN DIRECT
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911545
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
|
HC AFB FLUOROCHROME STAIN DIRECT
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911545
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.05
|
| Rate for Payer: Blue Shield of California Commercial |
$43.20
|
| Rate for Payer: Blue Shield of California EPN |
$34.65
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Senior |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.42
|
| Rate for Payer: Heritage Provider Network Senior |
$85.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$65.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.79
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Senior |
$5.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC AFB ZIEHL-NEELSEN STAIN
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911544
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
