|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.68 |
| Max. Negotiated Rate |
$881.25 |
| Rate for Payer: Adventist Health Commercial |
$235.00
|
| Rate for Payer: Cash Price |
$646.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$795.48
|
| Rate for Payer: Heritage Provider Network Senior |
$795.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.75
|
| Rate for Payer: Multiplan Commercial |
$881.25
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$235.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$807.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$646.25
|
| Rate for Payer: Cash Price |
$646.25
|
| Rate for Payer: Cash Price |
$646.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$763.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$795.48
|
| Rate for Payer: Heritage Provider Network Senior |
$795.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$560.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$881.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$422.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$389.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC BX OR EXC OF LN OPEN, INGFEM NODES
|
Facility
|
IP
|
$9,658.00
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
909008531
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,748.10 |
| Max. Negotiated Rate |
$7,243.50 |
| Rate for Payer: Adventist Health Commercial |
$1,931.60
|
| Rate for Payer: Cash Price |
$5,311.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,538.47
|
| Rate for Payer: Heritage Provider Network Senior |
$6,538.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,748.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,414.50
|
| Rate for Payer: Multiplan Commercial |
$7,243.50
|
|
|
HC BX OR EXC OF LN OPEN, INGFEM NODES
|
Facility
|
OP
|
$9,658.00
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
909008531
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$1,931.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,635.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$5,311.90
|
| Rate for Payer: Cash Price |
$5,311.90
|
| Rate for Payer: Cash Price |
$5,311.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,277.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Senior |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,865.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,978.30
|
| Rate for Payer: Heritage Provider Network Senior |
$5,984.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$609.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,244.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,748.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,595.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,414.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,130.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,130.50
|
| Rate for Payer: Multiplan Commercial |
$7,243.50
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,352.03
|
| Rate for Payer: TriValley Medical Group Senior |
$5,352.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
|
IP
|
$1,996.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$361.28 |
| Max. Negotiated Rate |
$1,497.00 |
| Rate for Payer: Adventist Health Commercial |
$399.20
|
| Rate for Payer: Cash Price |
$1,097.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,351.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,351.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.00
|
| Rate for Payer: Multiplan Commercial |
$1,497.00
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
|
OP
|
$1,996.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$399.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,371.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,097.80
|
| Rate for Payer: Cash Price |
$1,097.80
|
| Rate for Payer: Cash Price |
$1,097.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,297.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,235.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,099.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,698.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$1,497.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$983.38
|
| Rate for Payer: TriValley Medical Group Senior |
$983.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC C-14 UREA BREATH TEST ACQ
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 78267
|
| Hospital Charge Code |
909301257
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$77.11 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Adventist Health Commercial |
$85.20
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$288.40
|
| Rate for Payer: Heritage Provider Network Senior |
$288.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.50
|
| Rate for Payer: Multiplan Commercial |
$319.50
|
|
|
HC C-14 UREA BREATH TEST ACQ
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 78267
|
| Hospital Charge Code |
909301257
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Adventist Health Commercial |
$85.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$227.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$292.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.06
|
| Rate for Payer: Blue Shield of California Commercial |
$259.86
|
| Rate for Payer: Blue Shield of California EPN |
$207.89
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$276.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.17
|
| Rate for Payer: Dignity Health Senior |
$11.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$263.69
|
| Rate for Payer: Heritage Provider Network Senior |
$263.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$203.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.94
|
| Rate for Payer: Multiplan Commercial |
$319.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.17
|
| Rate for Payer: TriValley Medical Group Senior |
$11.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$213.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$213.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.17
|
| Rate for Payer: Vantage Medical Group Senior |
$11.06
|
|
|
HC C-14 UREA BREATH TEST ANAL
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT 78268
|
| Hospital Charge Code |
909301258
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$340.50 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$242.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$311.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.41
|
| Rate for Payer: Blue Shield of California Commercial |
$276.94
|
| Rate for Payer: Blue Shield of California EPN |
$221.55
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$295.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.85
|
| Rate for Payer: Dignity Health Senior |
$94.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$94.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$281.03
|
| Rate for Payer: Heritage Provider Network Senior |
$281.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$94.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$216.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.96
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$103.85
|
| Rate for Payer: TriValley Medical Group Senior |
$94.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$227.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$227.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.85
|
| Rate for Payer: Vantage Medical Group Senior |
$94.41
|
|
|
HC C-14 UREA BREATH TEST ANAL
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
CPT 78268
|
| Hospital Charge Code |
909301258
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$340.50 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$307.36
|
| Rate for Payer: Heritage Provider Network Senior |
$307.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.50
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
|
|
HC CA CALCIUM IONIZED
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900910502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.42 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Adventist Health Commercial |
$75.60
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.91
|
| Rate for Payer: Heritage Provider Network Senior |
$255.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
|
|
HC CA CALCIUM IONIZED
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900910502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Adventist Health Commercial |
$75.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$202.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.77
|
| Rate for Payer: Blue Shield of California Commercial |
$109.96
|
| Rate for Payer: Blue Shield of California EPN |
$88.20
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$245.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Senior |
$13.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.98
|
| Rate for Payer: Heritage Provider Network Senior |
$233.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$180.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.24
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.68
|
| Rate for Payer: TriValley Medical Group Senior |
$13.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
|
HC CAFFEINE SERUM
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910538
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$132.94 |
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$84.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$108.55
|
| 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 Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.94
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$86.90
|
| Rate for Payer: Cash Price |
$86.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.80
|
| Rate for Payer: Heritage Provider Network Senior |
$97.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$75.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$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 Navigate/Select/Select+ |
$20.14
|
| 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 Senior |
$18.64
|
|
|
HC CAFFEINE SERUM
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910538
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Cash Price |
$86.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.97
|
| Rate for Payer: Heritage Provider Network Senior |
$106.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.50
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
|
|
HC CA IONIZED (POC)
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900912118
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.46 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Cash Price |
$177.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$218.67
|
| Rate for Payer: Heritage Provider Network Senior |
$218.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.75
|
| Rate for Payer: Multiplan Commercial |
$242.25
|
|
|
HC CA IONIZED (POC)
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900912118
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$172.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$221.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.77
|
| Rate for Payer: Blue Shield of California Commercial |
$109.96
|
| Rate for Payer: Blue Shield of California EPN |
$88.20
|
| Rate for Payer: Cash Price |
$177.65
|
| Rate for Payer: Cash Price |
$177.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$209.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Senior |
$13.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$199.94
|
| Rate for Payer: Heritage Provider Network Senior |
$199.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$154.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.24
|
| Rate for Payer: Multiplan Commercial |
$242.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.68
|
| Rate for Payer: TriValley Medical Group Senior |
$13.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
|
HC CALCIUM IONIZED CH
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900912178
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$124.77 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.77
|
| Rate for Payer: Blue Shield of California Commercial |
$109.96
|
| Rate for Payer: Blue Shield of California EPN |
$88.20
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Senior |
$13.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.66
|
| Rate for Payer: Heritage Provider Network Senior |
$34.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.24
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.68
|
| Rate for Payer: TriValley Medical Group Senior |
$13.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
|
HC CALCIUM IONIZED CH
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900912178
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.91
|
| Rate for Payer: Heritage Provider Network Senior |
$37.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
|
|
HC CALCIUM TOTAL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
900910239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC CALCIUM TOTAL
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
900910239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.96
|
| Rate for Payer: Blue Shield of California Commercial |
$41.47
|
| Rate for Payer: Blue Shield of California EPN |
$33.26
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.68
|
| Rate for Payer: Dignity Health Senior |
$5.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.16
|
| Rate for Payer: TriValley Medical Group Senior |
$5.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: Vantage Medical Group Senior |
$5.16
|
|
|
HC CALCIUM URINE 24 HOURS
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$55.07 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.07
|
| Rate for Payer: Blue Shield of California Commercial |
$48.56
|
| Rate for Payer: Blue Shield of California EPN |
$38.95
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Senior |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.52
|
| Rate for Payer: Heritage Provider Network Senior |
$36.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.03
|
| Rate for Payer: TriValley Medical Group Senior |
$6.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.03
|
|
|
HC CALCIUM URINE 24 HOURS
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$44.25 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.94
|
| Rate for Payer: Heritage Provider Network Senior |
$39.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.75
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
|
|
HC CALCIUM URINE RANDOM
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$44.25 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.94
|
| Rate for Payer: Heritage Provider Network Senior |
$39.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.75
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
|
|
HC CALCIUM URINE RANDOM
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$55.07 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.07
|
| Rate for Payer: Blue Shield of California Commercial |
$48.56
|
| Rate for Payer: Blue Shield of California EPN |
$38.95
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Senior |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.52
|
| Rate for Payer: Heritage Provider Network Senior |
$36.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.03
|
| Rate for Payer: TriValley Medical Group Senior |
$6.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.03
|
|
|
HC CANALITH REPOSITIONING PROC
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
905103410
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
