|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
IP
|
$24,728.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
906820239
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,475.77 |
| Max. Negotiated Rate |
$18,546.00 |
| Rate for Payer: Adventist Health Commercial |
$4,945.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,988.14
|
| Rate for Payer: Cash Price |
$11,127.60
|
| Rate for Payer: Cash Price |
$11,127.60
|
| 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 |
$4,475.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,182.00
|
| Rate for Payer: Multiplan Commercial |
$18,546.00
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
IP
|
$46,221.00
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
906820257
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$34,665.75 |
| Rate for Payer: Adventist Health Commercial |
$9,244.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31,753.83
|
| Rate for Payer: Cash Price |
$20,799.45
|
| Rate for Payer: Cash Price |
$20,799.45
|
| 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 |
$8,366.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,555.25
|
| Rate for Payer: Multiplan Commercial |
$34,665.75
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
OP
|
$24,728.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
906820239
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$753.56 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$4,945.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,314.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,988.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$11,127.60
|
| Rate for Payer: Cash Price |
$11,127.60
|
| Rate for Payer: Cash Price |
$11,127.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,306.63
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$753.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,475.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,182.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$18,546.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$13,745.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
IP
|
$8,187.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906820083
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,481.85 |
| Max. Negotiated Rate |
$6,140.25 |
| Rate for Payer: Adventist Health Commercial |
$1,637.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,624.47
|
| Rate for Payer: Cash Price |
$3,684.15
|
| Rate for Payer: Cash Price |
$3,684.15
|
| 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 |
$1,481.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,046.75
|
| Rate for Payer: Multiplan Commercial |
$6,140.25
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
IP
|
$14,581.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906812217
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,639.16 |
| Max. Negotiated Rate |
$10,935.75 |
| Rate for Payer: Adventist Health Commercial |
$2,916.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,017.15
|
| Rate for Payer: Cash Price |
$6,561.45
|
| Rate for Payer: Cash Price |
$6,561.45
|
| 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 |
$2,639.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,645.25
|
| Rate for Payer: Multiplan Commercial |
$10,935.75
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
OP
|
$14,581.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906812217
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$228.87 |
| Max. Negotiated Rate |
$12,393.85 |
| Rate for Payer: Adventist Health Commercial |
$2,916.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$417.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,017.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,393.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,019.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,935.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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 |
$6,561.45
|
| Rate for Payer: Cash Price |
$6,561.45
|
| Rate for Payer: Cash Price |
$6,561.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,393.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,393.85
|
| Rate for Payer: Dignity Health Senior |
$12,393.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,477.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,025.64
|
| Rate for Payer: Heritage Provider Network Senior |
$9,025.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$228.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,028.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,639.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,645.25
|
| Rate for Payer: Multiplan Commercial |
$10,935.75
|
| 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 |
$12,393.85
|
| Rate for Payer: Vantage Medical Group Senior |
$12,393.85
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
OP
|
$8,187.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906820083
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$228.87 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,637.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$417.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,624.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,958.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,502.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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 |
$3,684.15
|
| Rate for Payer: Cash Price |
$3,684.15
|
| Rate for Payer: Cash Price |
$3,684.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,958.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,958.95
|
| Rate for Payer: Dignity Health Senior |
$6,958.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,321.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,067.75
|
| Rate for Payer: Heritage Provider Network Senior |
$5,067.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$228.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,946.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,481.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,046.75
|
| Rate for Payer: Multiplan Commercial |
$6,140.25
|
| 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 |
$6,958.95
|
| Rate for Payer: Vantage Medical Group Senior |
$6,958.95
|
|
|
HC CORPORA CAVERNOSA-GLANS PENIS
|
Facility
|
IP
|
$12,841.00
|
|
|
Service Code
|
CPT 54435
|
| Hospital Charge Code |
900501751
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,324.22 |
| Max. Negotiated Rate |
$9,630.75 |
| Rate for Payer: Adventist Health Commercial |
$2,568.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,821.77
|
| Rate for Payer: Cash Price |
$5,778.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,693.36
|
| Rate for Payer: Heritage Provider Network Senior |
$8,693.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,210.25
|
| Rate for Payer: Multiplan Commercial |
$9,630.75
|
|
|
HC CORPORA CAVERNOSA-GLANS PENIS
|
Facility
|
OP
|
$12,841.00
|
|
|
Service Code
|
CPT 54435
|
| Hospital Charge Code |
900501751
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,630.75 |
| Rate for Payer: Adventist Health Commercial |
$2,568.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,821.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$5,778.45
|
| Rate for Payer: Cash Price |
$5,778.45
|
| Rate for Payer: Cash Price |
$5,778.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,346.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: Dignity Health Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,355.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,693.36
|
| Rate for Payer: Heritage Provider Network Senior |
$8,693.36
|
| Rate for Payer: Humana Medicare |
$4,355.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,189.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,139.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,210.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.21
|
| Rate for Payer: Multiplan Commercial |
$9,630.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,662.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,290.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC CORPORA CAVERNOSOGRAPHY
|
Facility
|
IP
|
$1,574.00
|
|
|
Service Code
|
CPT 74445
|
| Hospital Charge Code |
909080040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$284.89 |
| Max. Negotiated Rate |
$1,180.50 |
| Rate for Payer: Adventist Health Commercial |
$314.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,081.34
|
| Rate for Payer: Cash Price |
$708.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,065.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1,065.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.50
|
| Rate for Payer: Multiplan Commercial |
$1,180.50
|
|
|
HC CORPORA CAVERNOSOGRAPHY
|
Facility
|
OP
|
$1,574.00
|
|
|
Service Code
|
CPT 74445
|
| Hospital Charge Code |
909080040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$1,180.50 |
| Rate for Payer: Adventist Health Commercial |
$314.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$391.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,081.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.78
|
| Rate for Payer: Blue Shield of California Commercial |
$230.02
|
| Rate for Payer: Blue Shield of California EPN |
$130.80
|
| Rate for Payer: Cash Price |
$708.30
|
| Rate for Payer: Cash Price |
$708.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,023.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,023.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$974.31
|
| Rate for Payer: Heritage Provider Network Senior |
$974.31
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,180.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CORTISOL
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.12
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.44
|
| Rate for Payer: Heritage Provider Network Senior |
$181.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
|
|
HC CORTISOL
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$136.59 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.59
|
| Rate for Payer: Blue Shield of California Commercial |
$127.34
|
| Rate for Payer: Blue Shield of California EPN |
$99.55
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.93
|
| Rate for Payer: Dignity Health Senior |
$16.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.43
|
| Rate for Payer: Heritage Provider Network Senior |
$33.43
|
| Rate for Payer: Humana Medicare |
$16.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.54
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.30
|
| Rate for Payer: TriValley Medical Group Senior |
$16.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$16.30
|
|
|
HC COUGH ASSIST
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801124
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$76.02 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$84.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$288.54
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$284.34
|
| Rate for Payer: Heritage Provider Network Senior |
$284.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
|
|
HC COUGH ASSIST
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801124
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$76.02 |
| Max. Negotiated Rate |
$370.82 |
| Rate for Payer: Adventist Health Commercial |
$84.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$224.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$288.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Blue Shield of California Commercial |
$260.82
|
| Rate for Payer: Blue Shield of California EPN |
$246.54
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$273.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$259.98
|
| Rate for Payer: Heritage Provider Network Senior |
$259.98
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC COVID19 CONVALESCENT PLASMA
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT C9507
|
| Hospital Charge Code |
900909507
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$156.02 |
| Max. Negotiated Rate |
$1,825.44 |
| Rate for Payer: Adventist Health Commercial |
$172.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,825.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$592.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$964.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$707.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$642.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$494.36
|
| Rate for Payer: Blue Shield of California Commercial |
$535.30
|
| Rate for Payer: Blue Shield of California EPN |
$505.99
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$560.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$964.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$707.00
|
| Rate for Payer: Dignity Health Senior |
$642.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$560.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$642.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$533.58
|
| Rate for Payer: Heritage Provider Network Senior |
$533.58
|
| Rate for Payer: Humana Medicare |
$642.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,177.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$642.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,221.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$758.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$809.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$809.84
|
| Rate for Payer: Multiplan Commercial |
$646.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$707.00
|
| Rate for Payer: TriValley Medical Group Senior |
$642.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$964.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$707.00
|
| Rate for Payer: Vantage Medical Group Senior |
$642.73
|
|
|
HC COVID19 CONVALESCENT PLASMA
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT C9507
|
| Hospital Charge Code |
900909507
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$156.02 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Adventist Health Commercial |
$172.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$592.19
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$583.57
|
| Rate for Payer: Heritage Provider Network Senior |
$583.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.50
|
| Rate for Payer: Multiplan Commercial |
$646.50
|
|
|
HC COVID 19 IGM IGG
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 86318
|
| Hospital Charge Code |
900912259
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Adventist Health Commercial |
$19.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.64
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.67
|
| Rate for Payer: Heritage Provider Network Senior |
$65.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.25
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
|
|
HC COVID 19 IGM IGG
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 86318
|
| Hospital Charge Code |
900912259
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$108.36 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.36
|
| Rate for Payer: Blue Shield of California Commercial |
$101.12
|
| Rate for Payer: Blue Shield of California EPN |
$79.05
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.90
|
| Rate for Payer: Dignity Health Senior |
$18.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.47
|
| Rate for Payer: Heritage Provider Network Senior |
$41.47
|
| Rate for Payer: Humana Medicare |
$18.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.79
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.09
|
| Rate for Payer: TriValley Medical Group Senior |
$18.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Vantage Medical Group Senior |
$18.09
|
|
|
HC COVID19 RNA STAT
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.61
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.00
|
| Rate for Payer: Heritage Provider Network Senior |
$109.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.25
|
| Rate for Payer: Multiplan Commercial |
$120.75
|
|
|
HC COVID19 RNA STAT
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$301.99 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.99
|
| Rate for Payer: Blue Shield of California Commercial |
$71.42
|
| Rate for Payer: Blue Shield of California EPN |
$67.50
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Senior |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.18
|
| Rate for Payer: Heritage Provider Network Senior |
$71.18
|
| Rate for Payer: Humana Medicare |
$51.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$97.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.65
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Senior |
$51.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC CPAP/BIPAP/NIPPV - DAILY
|
Facility
|
IP
|
$899.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
900800110
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$162.72 |
| Max. Negotiated Rate |
$674.25 |
| Rate for Payer: Adventist Health Commercial |
$179.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$617.61
|
| Rate for Payer: Cash Price |
$404.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$608.62
|
| Rate for Payer: Heritage Provider Network Senior |
$608.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.75
|
| Rate for Payer: Multiplan Commercial |
$674.25
|
|
|
HC CPAP/BIPAP/NIPPV - DAILY
|
Facility
|
OP
|
$899.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
900800110
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$63.65 |
| Max. Negotiated Rate |
$674.25 |
| Rate for Payer: Adventist Health Commercial |
$179.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$82.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$617.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$404.55
|
| Rate for Payer: Cash Price |
$404.55
|
| Rate for Payer: Cash Price |
$404.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$584.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: Dignity Health Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$584.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$266.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$556.48
|
| Rate for Payer: Heritage Provider Network Senior |
$556.48
|
| Rate for Payer: Humana Medicare |
$266.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$506.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$314.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.78
|
| Rate for Payer: Multiplan Commercial |
$674.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC CPM DORSAL SPLINT
|
Facility
|
IP
|
$217.00
|
|
| Hospital Charge Code |
901301036
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$162.75 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.08
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$146.91
|
| Rate for Payer: Heritage Provider Network Senior |
$146.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.25
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
|
|
HC CPM DORSAL SPLINT
|
Facility
|
OP
|
$217.00
|
|
| Hospital Charge Code |
901301036
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$115.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Senior |
$184.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.32
|
| Rate for Payer: Heritage Provider Network Senior |
$134.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$104.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.25
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
