|
HC BLLN ANGIOPLASTY, PULM, INIT
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 92997
|
| Hospital Charge Code |
906820075
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,771.83 |
| Max. Negotiated Rate |
$11,485.50 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,771.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
|
|
HC BLLN DILATION URETERAL STRCTR
|
Facility
|
OP
|
$4,886.00
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
909050706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$977.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,356.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,153.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,687.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,664.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,175.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,153.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,153.10
|
| Rate for Payer: Dignity Health Senior |
$4,153.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,024.43
|
| Rate for Payer: Heritage Provider Network Senior |
$3,024.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,091.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,355.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.50
|
| Rate for Payer: Multiplan Commercial |
$3,664.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,153.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,153.10
|
|
|
HC BLLN DILATION URETERAL STRCTR
|
Facility
|
IP
|
$4,886.00
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
909050706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$884.37 |
| Max. Negotiated Rate |
$3,664.50 |
| Rate for Payer: Adventist Health Commercial |
$977.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,356.68
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,307.82
|
| Rate for Payer: Heritage Provider Network Senior |
$3,307.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.50
|
| Rate for Payer: Multiplan Commercial |
$3,664.50
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
901200031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$167.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.67
|
| Rate for Payer: Heritage Provider Network Senior |
$174.67
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$124.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$93.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$86.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
901200031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.25
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.67
|
| Rate for Payer: Heritage Provider Network Senior |
$174.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
901200031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.25
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.67
|
| Rate for Payer: Heritage Provider Network Senior |
$174.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
|
|
HC BLOOD DRAW FOR VAD
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
901200031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.20
|
| Rate for Payer: Blue Shield of California Commercial |
$160.22
|
| Rate for Payer: Blue Shield of California EPN |
$151.45
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$167.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.70
|
| Rate for Payer: Heritage Provider Network Senior |
$159.70
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$159.60
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC BLOOD DRAW LT 3YRS FEM/JUGULAR
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
900501687
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.90
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.13
|
| Rate for Payer: Heritage Provider Network Senior |
$52.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
|
|
HC BLOOD DRAW LT 3YRS FEM/JUGULAR
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
900501687
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.45
|
| Rate for Payer: Dignity Health Senior |
$65.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.13
|
| Rate for Payer: Heritage Provider Network Senior |
$52.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Vantage Medical Group Senior |
$65.45
|
|
|
HC BLOOD GAS AND COOXIMETRY
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
900801109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$1,065.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$82.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$975.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$118.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.32
|
| Rate for Payer: Blue Shield of California Commercial |
$221.64
|
| Rate for Payer: Blue Shield of California EPN |
$173.27
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$923.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.65
|
| Rate for Payer: Dignity Health Senior |
$78.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$78.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$878.98
|
| Rate for Payer: Heritage Provider Network Senior |
$878.98
|
| Rate for Payer: Humana Medicare |
$78.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$78.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$149.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.25
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$78.77
|
| Rate for Payer: TriValley Medical Group Senior |
$78.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$85.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$85.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$118.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.65
|
| Rate for Payer: Vantage Medical Group Senior |
$78.77
|
|
|
HC BLOOD GAS AND COOXIMETRY
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
900801109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$257.02 |
| Max. Negotiated Rate |
$1,065.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$975.54
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$961.34
|
| Rate for Payer: Heritage Provider Network Senior |
$961.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
|
|
HC BLOOD GAS CHLORIDE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
900801121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC BLOOD GAS CHLORIDE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
900801121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.83
|
| Rate for Payer: Blue Shield of California Commercial |
$35.89
|
| Rate for Payer: Blue Shield of California EPN |
$28.06
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.06
|
| Rate for Payer: Dignity Health Senior |
$4.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Humana Medicare |
$4.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.60
|
| Rate for Payer: TriValley Medical Group Senior |
$4.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.06
|
| Rate for Payer: Vantage Medical Group Senior |
$4.60
|
|
|
HC BLOOD GAS POTASSIUM
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900801122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.83
|
| Rate for Payer: Blue Shield of California Commercial |
$35.89
|
| Rate for Payer: Blue Shield of California EPN |
$28.06
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: Dignity Health Senior |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Humana Medicare |
$4.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.76
|
| Rate for Payer: TriValley Medical Group Senior |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC BLOOD GAS POTASSIUM
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900801122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC BLOOD GAS SODIUM
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900801123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC BLOOD GAS SODIUM
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900801123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.12
|
| Rate for Payer: Blue Shield of California Commercial |
$37.56
|
| Rate for Payer: Blue Shield of California EPN |
$29.37
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: Dignity Health Senior |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.81
|
| Rate for Payer: TriValley Medical Group Senior |
$4.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC BLOOD OCCULT FECES
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
900911638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.81
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.59
|
| Rate for Payer: Heritage Provider Network Senior |
$82.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.50
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
|
|
HC BLOOD OCCULT FECES
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
900911638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$124.21 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.02
|
| Rate for Payer: Blue Shield of California Commercial |
$124.21
|
| Rate for Payer: Blue Shield of California EPN |
$97.10
|
| 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 |
$23.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.51
|
| Rate for Payer: Dignity Health Senior |
$15.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Humana Medicare |
$15.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.06
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.92
|
| Rate for Payer: TriValley Medical Group Senior |
$15.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.51
|
| Rate for Payer: Vantage Medical Group Senior |
$15.92
|
|
|
HC BLOOD PH PCO2 P02 (POC)
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
900912112
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$170.25 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.95
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$153.68
|
| Rate for Payer: Heritage Provider Network Senior |
$153.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.75
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
|
|
HC BLOOD PH PCO2 P02 (POC)
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
900912112
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$170.25 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.95
|
| Rate for Payer: Blue Shield of California Commercial |
$151.15
|
| Rate for Payer: Blue Shield of California EPN |
$118.16
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$147.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.68
|
| Rate for Payer: Dignity Health Senior |
$26.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.51
|
| Rate for Payer: Heritage Provider Network Senior |
$140.51
|
| Rate for Payer: Humana Medicare |
$26.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.85
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.07
|
| Rate for Payer: TriValley Medical Group Senior |
$26.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.68
|
| Rate for Payer: Vantage Medical Group Senior |
$26.07
|
|
|
HC BLOOD/PLASMA VOLUME
|
Facility
|
OP
|
$1,951.00
|
|
|
Service Code
|
CPT 78111
|
| Hospital Charge Code |
909301331
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$81.76 |
| Max. Negotiated Rate |
$3,370.88 |
| Rate for Payer: Adventist Health Commercial |
$390.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$170.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,340.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Blue Shield of California Commercial |
$527.56
|
| Rate for Payer: Blue Shield of California EPN |
$300.01
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,268.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: Dignity Health Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,268.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,774.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,207.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,207.67
|
| Rate for Payer: Humana Medicare |
$1,774.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,370.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,093.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,235.43
|
| Rate for Payer: Multiplan Commercial |
$1,463.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,951.56
|
| Rate for Payer: TriValley Medical Group Senior |
$1,774.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC BLOOD/PLASMA VOLUME
|
Facility
|
IP
|
$1,951.00
|
|
|
Service Code
|
CPT 78111
|
| Hospital Charge Code |
909301331
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$353.13 |
| Max. Negotiated Rate |
$1,463.25 |
| Rate for Payer: Adventist Health Commercial |
$390.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,340.34
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,320.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,320.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.75
|
| Rate for Payer: Multiplan Commercial |
$1,463.25
|
|
|
HC BODY PLETHYSMOGRAPHY
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
900801003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$75.02 |
| Max. Negotiated Rate |
$745.12 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$99.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$447.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Blue Shield of California Commercial |
$238.13
|
| Rate for Payer: Blue Shield of California EPN |
$135.42
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$423.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$423.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$403.59
|
| Rate for Payer: Heritage Provider Network Senior |
$403.59
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$745.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$431.39
|
| Rate for Payer: TriValley Medical Group Senior |
$392.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC BODY PLETHYSMOGRAPHY
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
900801003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$118.01 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$447.92
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$441.40
|
| Rate for Payer: Heritage Provider Network Senior |
$441.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.00
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
|
