|
HC ABLATION SPINE OTHER
|
Facility
|
OP
|
$1,129.00
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
909022899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$225.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$697.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$564.73
|
| 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 |
$508.05
|
| Rate for Payer: Cash Price |
$508.05
|
| Rate for Payer: Cash Price |
$508.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$733.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$698.85
|
| Rate for Payer: Heritage Provider Network Senior |
$390.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$602.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$204.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$846.75
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$348.99
|
| Rate for Payer: TriValley Medical Group Senior |
$348.99
|
| 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 |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC ABLAT LUM/SAC NERVE SNGL LEVEL
|
Facility
|
OP
|
$7,192.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909000262
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.75 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,444.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,674.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,315.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,511.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,451.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,089.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,771.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,301.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,888.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,762.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,762.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC ABLAT LUM/SAC NERVE SNGL LEVEL
|
Facility
|
IP
|
$7,192.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909000262
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.75 |
| Max. Negotiated Rate |
$5,394.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,631.65
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,868.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4,868.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,301.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
|
|
HC ABL IE GT 1 TMR PER ORGN INC IG
|
Facility
|
OP
|
$43,984.00
|
|
|
Service Code
|
CPT 0600T
|
| Hospital Charge Code |
909000600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$32,988.00 |
| Rate for Payer: Adventist Health Commercial |
$8,796.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27,182.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,671.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$19,792.80
|
| Rate for Payer: Cash Price |
$19,792.80
|
| Rate for Payer: Cash Price |
$19,792.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28,589.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,038.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,671.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,671.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$27,226.10
|
| Rate for Payer: Heritage Provider Network Senior |
$16,816.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,671.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25,976.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,961.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,722.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,996.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,320.13
|
| Rate for Payer: Multiplan Commercial |
$32,988.00
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,038.91
|
| Rate for Payer: TriValley Medical Group Senior |
$15,038.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13,671.74
|
|
|
HC ABL IE GT 1 TMR PER ORGN INC IG
|
Facility
|
IP
|
$43,984.00
|
|
|
Service Code
|
CPT 0600T
|
| Hospital Charge Code |
909000600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,961.10 |
| Max. Negotiated Rate |
$32,988.00 |
| Rate for Payer: Adventist Health Commercial |
$8,796.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,325.70
|
| Rate for Payer: Cash Price |
$19,792.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$29,777.17
|
| Rate for Payer: Heritage Provider Network Senior |
$29,777.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,961.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,996.00
|
| Rate for Payer: Multiplan Commercial |
$32,988.00
|
|
|
HC ABL IE GT 1 TMR PR ORG INC FL US
|
Facility
|
OP
|
$43,984.00
|
|
|
Service Code
|
CPT 0601T
|
| Hospital Charge Code |
909000601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$32,988.00 |
| Rate for Payer: Adventist Health Commercial |
$8,796.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27,182.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,671.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$19,792.80
|
| Rate for Payer: Cash Price |
$19,792.80
|
| Rate for Payer: Cash Price |
$19,792.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28,589.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,038.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,671.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,671.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$27,226.10
|
| Rate for Payer: Heritage Provider Network Senior |
$16,816.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,671.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25,976.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,961.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,722.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,996.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,320.13
|
| Rate for Payer: Multiplan Commercial |
$32,988.00
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,038.91
|
| Rate for Payer: TriValley Medical Group Senior |
$15,038.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13,671.74
|
|
|
HC ABL IE GT 1 TMR PR ORG INC FL US
|
Facility
|
IP
|
$43,984.00
|
|
|
Service Code
|
CPT 0601T
|
| Hospital Charge Code |
909000601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,961.10 |
| Max. Negotiated Rate |
$32,988.00 |
| Rate for Payer: Adventist Health Commercial |
$8,796.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,325.70
|
| Rate for Payer: Cash Price |
$19,792.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$29,777.17
|
| Rate for Payer: Heritage Provider Network Senior |
$29,777.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,961.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,996.00
|
| Rate for Payer: Multiplan Commercial |
$32,988.00
|
|
|
HC ABO BLOOD GROUP
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$189.75 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$156.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.32
|
| Rate for Payer: Blue Shield of California Commercial |
$24.02
|
| Rate for Payer: Blue Shield of California EPN |
$19.27
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$164.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$156.61
|
| Rate for Payer: Heritage Provider Network Senior |
$156.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$120.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.99
|
| Rate for Payer: TriValley Medical Group Senior |
$2.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
HC ABO BLOOD GROUP
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$189.75 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$162.93
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.28
|
| Rate for Payer: Heritage Provider Network Senior |
$171.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.25
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
|
|
HC ABO UNIT CONFIRMATION
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904524
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$189.75 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$162.93
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.28
|
| Rate for Payer: Heritage Provider Network Senior |
$171.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.25
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
|
|
HC ABO UNIT CONFIRMATION
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904524
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$156.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.19
|
| Rate for Payer: Blue Shield of California Commercial |
$154.33
|
| Rate for Payer: Blue Shield of California EPN |
$123.46
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$164.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$156.61
|
| Rate for Payer: Heritage Provider Network Senior |
$156.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$120.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.29
|
| Rate for Payer: TriValley Medical Group Senior |
$2.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
HC ACETAMINOPHEN (TYLENOL)
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
900911302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$107.37 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Adventist Health Commercial |
$109.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$339.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.64
|
| Rate for Payer: Blue Shield of California Commercial |
$107.37
|
| Rate for Payer: Blue Shield of California Commercial |
$107.37
|
| Rate for Payer: Blue Shield of California EPN |
$86.12
|
| Rate for Payer: Blue Shield of California EPN |
$86.12
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$356.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.91
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$339.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$339.83
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$261.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$411.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC ACETAMINOPHEN (TYLENOL)
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
900911302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.37 |
| Max. Negotiated Rate |
$411.75 |
| Rate for Payer: Adventist Health Commercial |
$109.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$353.56
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$371.67
|
| Rate for Payer: Heritage Provider Network Senior |
$371.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.25
|
| Rate for Payer: Multiplan Commercial |
$411.75
|
|
|
HC ACETOACETATE, SEMIQUANTITATIVE
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910466
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.14
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.19
|
| Rate for Payer: Heritage Provider Network Senior |
$165.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
|
|
HC ACETOACETATE, SEMIQUANTITATIVE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910466
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$77.15 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$150.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.15
|
| Rate for Payer: Blue Shield of California Commercial |
$65.78
|
| Rate for Payer: Blue Shield of California Commercial |
$65.78
|
| Rate for Payer: Blue Shield of California EPN |
$52.76
|
| Rate for Payer: Blue Shield of California EPN |
$52.76
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$158.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.17
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$151.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.38
|
| Rate for Payer: Heritage Provider Network Senior |
$151.04
|
| Rate for Payer: Heritage Provider Network Senior |
$25.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$116.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.95
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.17
|
| Rate for Payer: TriValley Medical Group Senior |
$8.17
|
| Rate for Payer: TriValley Medical Group Senior |
$8.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Vantage Medical Group Senior |
$8.17
|
| Rate for Payer: Vantage Medical Group Senior |
$8.17
|
|
|
HC ACETYLCHOLINESTERASE STAIN
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.08 |
| Max. Negotiated Rate |
$1,554.36 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$652.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$320.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.08
|
| Rate for Payer: Blue Shield of California Commercial |
$338.21
|
| Rate for Payer: Blue Shield of California Commercial |
$338.21
|
| Rate for Payer: Blue Shield of California EPN |
$271.98
|
| Rate for Payer: Blue Shield of California EPN |
$271.98
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$686.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$337.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,036.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,036.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$653.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$321.26
|
| Rate for Payer: Heritage Provider Network Senior |
$653.66
|
| Rate for Payer: Heritage Provider Network Senior |
$321.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$503.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$247.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,036.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,036.24
|
| Rate for Payer: TriValley Medical Group Senior |
$1,036.24
|
| Rate for Payer: TriValley Medical Group Senior |
$1,036.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$722.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$722.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$722.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$722.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
|
|
HC ACETYLCHOLINESTERASE STAIN
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$191.14 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$680.06
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$714.91
|
| Rate for Payer: Heritage Provider Network Senior |
$714.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
|
|
HC ACID FAST CONCENTRATION
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900911551
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$63.41 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.41
|
| Rate for Payer: Blue Shield of California Commercial |
$53.74
|
| Rate for Payer: Blue Shield of California Commercial |
$53.74
|
| Rate for Payer: Blue Shield of California EPN |
$43.10
|
| Rate for Payer: Blue Shield of California EPN |
$43.10
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$90.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Senior |
$86.04
|
| Rate for Payer: Heritage Provider Network Senior |
$16.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.68
|
| Rate for Payer: TriValley Medical Group Senior |
$6.68
|
| Rate for Payer: TriValley Medical Group Senior |
$6.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
HC ACID FAST CONCENTRATION
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900911551
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$104.25 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$89.52
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.10
|
| Rate for Payer: Heritage Provider Network Senior |
$94.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.75
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
|
|
HC ACID HEMOGLOBIN CONFIRMATION
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900913569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.30
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.77
|
| Rate for Payer: Heritage Provider Network Senior |
$50.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
|
|
HC ACID HEMOGLOBIN CONFIRMATION
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900913569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$103.81 |
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.81
|
| Rate for Payer: Blue Shield of California Commercial |
$103.62
|
| Rate for Payer: Blue Shield of California Commercial |
$103.62
|
| Rate for Payer: Blue Shield of California EPN |
$83.11
|
| Rate for Payer: Blue Shield of California EPN |
$83.11
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.42
|
| Rate for Payer: Heritage Provider Network Senior |
$36.52
|
| Rate for Payer: Heritage Provider Network Senior |
$46.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.87
|
| Rate for Payer: TriValley Medical Group Senior |
$12.87
|
| Rate for Payer: TriValley Medical Group Senior |
$12.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC A.C. JOINTS
|
Facility
|
OP
|
$617.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
909001501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$462.75 |
| Rate for Payer: Adventist Health Commercial |
$123.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.05
|
| Rate for Payer: Blue Shield of California Commercial |
$141.12
|
| Rate for Payer: Blue Shield of California EPN |
$113.48
|
| Rate for Payer: Cash Price |
$277.65
|
| Rate for Payer: Cash Price |
$277.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$401.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$381.92
|
| Rate for Payer: Heritage Provider Network Senior |
$381.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$294.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$462.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC A.C. JOINTS
|
Facility
|
IP
|
$617.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
909001501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.68 |
| Max. Negotiated Rate |
$462.75 |
| Rate for Payer: Adventist Health Commercial |
$123.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$397.35
|
| Rate for Payer: Cash Price |
$277.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$417.71
|
| Rate for Payer: Heritage Provider Network Senior |
$417.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.25
|
| Rate for Payer: Multiplan Commercial |
$462.75
|
|
|
HC ACTH
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
900912120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$366.72 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$366.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$366.72
|
| Rate for Payer: Blue Shield of California Commercial |
$310.87
|
| Rate for Payer: Blue Shield of California Commercial |
$310.87
|
| Rate for Payer: Blue Shield of California EPN |
$249.34
|
| Rate for Payer: Blue Shield of California EPN |
$249.34
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$38.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$38.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.14
|
| Rate for Payer: Heritage Provider Network Senior |
$76.76
|
| Rate for Payer: Heritage Provider Network Senior |
$102.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$59.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$78.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.62
|
| Rate for Payer: TriValley Medical Group Senior |
$38.62
|
| Rate for Payer: TriValley Medical Group Senior |
$38.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Vantage Medical Group Senior |
$38.62
|
| Rate for Payer: Vantage Medical Group Senior |
$38.62
|
|
|
HC ACTH
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
900912120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.26
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.70
|
| Rate for Payer: Heritage Provider Network Senior |
$111.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
|
