|
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 |
$62.10
|
| 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 AIRWAY BRONCH STENT SUB
|
Facility
|
IP
|
$3,088.00
|
|
|
Service Code
|
CPT 31637
|
| Hospital Charge Code |
900803518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$558.93 |
| Max. Negotiated Rate |
$2,316.00 |
| Rate for Payer: Adventist Health Commercial |
$617.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,090.58
|
| Rate for Payer: Heritage Provider Network Senior |
$2,090.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.00
|
| Rate for Payer: Multiplan Commercial |
$2,316.00
|
|
|
HC AIRWAY BRONCH STENT SUB
|
Facility
|
OP
|
$3,088.00
|
|
|
Service Code
|
CPT 31637
|
| Hospital Charge Code |
900803518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$617.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,121.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,624.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,698.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,316.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,883.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,506.94
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,007.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,624.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,624.80
|
| Rate for Payer: Dignity Health Senior |
$2,624.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,911.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,911.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,472.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,161.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,161.60
|
| Rate for Payer: Multiplan Commercial |
$2,316.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,544.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,544.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,624.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,624.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,624.80
|
|
|
HC AIRWAY DIALATN BRONCH STNT INT
|
Facility
|
OP
|
$7,345.00
|
|
|
Service Code
|
CPT 31636
|
| Hospital Charge Code |
900803517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$13,193.53 |
| Rate for Payer: Adventist Health Commercial |
$1,469.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,046.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,795.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,480.45
|
| Rate for Payer: Blue Shield of California EPN |
$3,584.36
|
| Rate for Payer: Cash Price |
$3,305.25
|
| Rate for Payer: Cash Price |
$3,305.25
|
| Rate for Payer: Cash Price |
$3,305.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,774.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,675.26
|
| Rate for Payer: Dignity Health Senior |
$8,795.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,795.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,546.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4,546.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,795.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,503.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,329.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,115.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,836.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,082.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,082.57
|
| Rate for Payer: Multiplan Commercial |
$5,508.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,675.26
|
| Rate for Payer: TriValley Medical Group Senior |
$9,675.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,672.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,672.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8,795.69
|
|
|
HC AIRWAY DIALATN BRONCH STNT INT
|
Facility
|
IP
|
$7,345.00
|
|
|
Service Code
|
CPT 31636
|
| Hospital Charge Code |
900803517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,329.44 |
| Max. Negotiated Rate |
$5,508.75 |
| Rate for Payer: Adventist Health Commercial |
$1,469.00
|
| Rate for Payer: Cash Price |
$3,305.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,972.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4,972.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,329.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,836.25
|
| Rate for Payer: Multiplan Commercial |
$5,508.75
|
|
|
HC AIRWAY DILATION WO STENT
|
Facility
|
IP
|
$11,767.00
|
|
|
Service Code
|
CPT 31630
|
| Hospital Charge Code |
900803450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,129.83 |
| Max. Negotiated Rate |
$8,825.25 |
| Rate for Payer: Adventist Health Commercial |
$2,353.40
|
| Rate for Payer: Cash Price |
$5,295.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,966.26
|
| Rate for Payer: Heritage Provider Network Senior |
$7,966.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,129.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,941.75
|
| Rate for Payer: Multiplan Commercial |
$8,825.25
|
|
|
HC AIRWAY DILATION WO STENT
|
Facility
|
OP
|
$11,767.00
|
|
|
Service Code
|
CPT 31630
|
| Hospital Charge Code |
900803450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,353.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,083.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,153.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,684.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$5,295.15
|
| Rate for Payer: Cash Price |
$5,295.15
|
| Rate for Payer: Cash Price |
$5,295.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,648.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,153.10
|
| Rate for Payer: Dignity Health Senior |
$4,684.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,684.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,283.77
|
| Rate for Payer: Heritage Provider Network Senior |
$5,762.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$361.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,684.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,900.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,129.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,387.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,941.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,902.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,902.65
|
| Rate for Payer: Multiplan Commercial |
$8,825.25
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,153.10
|
| Rate for Payer: TriValley Medical Group Senior |
$5,153.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,153.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,684.64
|
|
|
HC AIRWAY DILATION W STENT
|
Facility
|
OP
|
$7,554.00
|
|
|
Service Code
|
CPT 31631
|
| Hospital Charge Code |
900803451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$16,711.81 |
| Rate for Payer: Adventist Health Commercial |
$1,510.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,189.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,795.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,399.30
|
| Rate for Payer: Cash Price |
$3,399.30
|
| Rate for Payer: Cash Price |
$3,399.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,910.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,675.26
|
| Rate for Payer: Dignity Health Senior |
$8,795.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,795.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,675.93
|
| Rate for Payer: Heritage Provider Network Senior |
$10,818.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$313.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,795.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,711.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,367.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,115.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,888.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,082.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,082.57
|
| Rate for Payer: Multiplan Commercial |
$5,665.50
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,675.26
|
| Rate for Payer: TriValley Medical Group Senior |
$9,675.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8,795.69
|
|
|
HC AIRWAY DILATION W STENT
|
Facility
|
IP
|
$7,554.00
|
|
|
Service Code
|
CPT 31631
|
| Hospital Charge Code |
900803451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,367.27 |
| Max. Negotiated Rate |
$5,665.50 |
| Rate for Payer: Adventist Health Commercial |
$1,510.80
|
| Rate for Payer: Cash Price |
$3,399.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,114.06
|
| Rate for Payer: Heritage Provider Network Senior |
$5,114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,367.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,888.50
|
| Rate for Payer: Multiplan Commercial |
$5,665.50
|
|
|
HC AIRWAY TRACH/BRONCH REVIS STNT
|
Facility
|
IP
|
$7,527.00
|
|
|
Service Code
|
CPT 31638
|
| Hospital Charge Code |
900803519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,362.39 |
| Max. Negotiated Rate |
$5,645.25 |
| Rate for Payer: Adventist Health Commercial |
$1,505.40
|
| Rate for Payer: Cash Price |
$3,387.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,095.78
|
| Rate for Payer: Heritage Provider Network Senior |
$5,095.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,362.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.75
|
| Rate for Payer: Multiplan Commercial |
$5,645.25
|
|
|
HC AIRWAY TRACH/BRONCH REVIS STNT
|
Facility
|
OP
|
$7,527.00
|
|
|
Service Code
|
CPT 31638
|
| Hospital Charge Code |
900803519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$13,193.53 |
| Rate for Payer: Adventist Health Commercial |
$1,505.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,171.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,795.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,591.47
|
| Rate for Payer: Blue Shield of California EPN |
$3,673.18
|
| Rate for Payer: Cash Price |
$3,387.15
|
| Rate for Payer: Cash Price |
$3,387.15
|
| Rate for Payer: Cash Price |
$3,387.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,892.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,675.26
|
| Rate for Payer: Dignity Health Senior |
$8,795.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,795.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,659.21
|
| Rate for Payer: Heritage Provider Network Senior |
$4,659.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$256.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,795.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,590.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,362.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,115.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,082.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,082.57
|
| Rate for Payer: Multiplan Commercial |
$5,645.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,675.26
|
| Rate for Payer: TriValley Medical Group Senior |
$9,675.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,763.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,763.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8,795.69
|
|
|
HC ALBUMIN
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900910220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC ALBUMIN
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900910220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.24
|
| Rate for Payer: Blue Shield of California Commercial |
$39.86
|
| Rate for Payer: Blue Shield of California EPN |
$31.97
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.45
|
| Rate for Payer: Dignity Health Senior |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.95
|
| Rate for Payer: TriValley Medical Group Senior |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
|
|
HC ALBUMIN BODY FLUID
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900910715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.96
|
| Rate for Payer: Heritage Provider Network Senior |
$18.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
|
|
HC ALBUMIN BODY FLUID
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900910715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$47.20 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.20
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Senior |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.71
|
| Rate for Payer: Heritage Provider Network Senior |
$16.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.78
|
| Rate for Payer: TriValley Medical Group Senior |
$7.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
|
|
HC ALCOHOL ETHANOL (SERUM/URINE)
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910322
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.04 |
| Max. Negotiated Rate |
$377.25 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$340.53
|
| Rate for Payer: Heritage Provider Network Senior |
$340.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.75
|
| Rate for Payer: Multiplan Commercial |
$377.25
|
|
|
HC ALCOHOL ETHANOL (SERUM/URINE)
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910322
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$94.65 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.65
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.60
|
| Rate for Payer: Dignity Health Senior |
$47.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.66
|
| Rate for Payer: Heritage Provider Network Senior |
$34.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.60
|
| Rate for Payer: Vantage Medical Group Senior |
$47.60
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
|
IP
|
$1,498.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$271.14 |
| Max. Negotiated Rate |
$1,123.50 |
| Rate for Payer: Adventist Health Commercial |
$299.60
|
| Rate for Payer: Cash Price |
$674.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,014.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1,014.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.50
|
| Rate for Payer: Multiplan Commercial |
$1,123.50
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
|
OP
|
$1,498.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$299.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,029.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$674.10
|
| Rate for Payer: Cash Price |
$674.10
|
| Rate for Payer: Cash Price |
$674.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$973.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Senior |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$973.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$379.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,014.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1,014.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$714.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.57
|
| Rate for Payer: Multiplan Commercial |
$1,123.50
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$538.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$495.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
|
IP
|
$1,498.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$271.14 |
| Max. Negotiated Rate |
$1,123.50 |
| Rate for Payer: Adventist Health Commercial |
$299.60
|
| Rate for Payer: Cash Price |
$674.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,014.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1,014.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.50
|
| Rate for Payer: Multiplan Commercial |
$1,123.50
|
|
|
HC ALCOHOL INJECTION INTO ORBIT
|
Facility
|
OP
|
$1,498.00
|
|
|
Service Code
|
CPT 67505
|
| Hospital Charge Code |
900567505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$299.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,029.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$674.10
|
| Rate for Payer: Cash Price |
$674.10
|
| Rate for Payer: Cash Price |
$674.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$973.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Senior |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$898.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$379.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$927.26
|
| Rate for Payer: Heritage Provider Network Senior |
$467.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$195.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$721.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.57
|
| Rate for Payer: Multiplan Commercial |
$1,123.50
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$417.80
|
| Rate for Payer: TriValley Medical Group Senior |
$417.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC ALCOHOL URINE
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900912192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$94.65 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.65
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.35
|
| Rate for Payer: Dignity Health Senior |
$43.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.57
|
| Rate for Payer: Heritage Provider Network Senior |
$31.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.70
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.35
|
| Rate for Payer: Vantage Medical Group Senior |
$43.35
|
|
|
HC ALCOHOL URINE
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900912192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.11 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Adventist Health Commercial |
$85.20
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$288.40
|
| Rate for Payer: Heritage Provider Network Senior |
$288.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.50
|
| Rate for Payer: Multiplan Commercial |
$319.50
|
|
|
HC ALELRGEN CUCUMBER IGE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913581
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.32 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.32
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC ALELRGEN CUCUMBER IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913581
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
|
