|
HC CANALITH REPOSITIONING PROC
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
905103410
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$36.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.65
|
| Rate for Payer: Dignity Health Senior |
$75.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.09
|
| Rate for Payer: Heritage Provider Network Senior |
$55.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.45
|
| 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: Molina Healthcare of CA Medi-Cal |
$62.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.30
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.65
|
| Rate for Payer: Vantage Medical Group Senior |
$75.65
|
|
|
HC CANDIDA AURIS PCR
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900913697
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.43
|
| Rate for Payer: Heritage Provider Network Senior |
$33.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC CANDIDA AURIS PCR
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900913697
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.56
|
| Rate for Payer: Heritage Provider Network Senior |
$36.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
|
|
HC CANNABINOIDS SEMI-QUANTITATIVE
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.54 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.56
|
| Rate for Payer: Heritage Provider Network Senior |
$80.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.75
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
|
|
HC CANNABINOIDS SEMI-QUANTITATIVE
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$132.94 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$63.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.75
|
| 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 |
$65.45
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.35
|
| 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 |
$77.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.66
|
| Rate for Payer: Heritage Provider Network Senior |
$73.66
|
| 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 |
$56.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.75
|
| 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 |
$89.25
|
| 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 CANTHOTOMY
|
Facility
|
IP
|
$4,880.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
900501183
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$883.28 |
| Max. Negotiated Rate |
$3,660.00 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Cash Price |
$2,684.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$883.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
|
|
HC CANTHOTOMY
|
Facility
|
OP
|
$4,880.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
900501183
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4,723.01 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,352.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,684.00
|
| Rate for Payer: Cash Price |
$2,684.00
|
| Rate for Payer: Cash Price |
$2,684.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,172.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Senior |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,172.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,964.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,327.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$883.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,408.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,734.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,734.97
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,755.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,615.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC CAPD TRAINING
|
Facility
|
IP
|
$2,149.00
|
|
|
Service Code
|
CPT 90993
|
| Hospital Charge Code |
942000201
|
|
Hospital Revenue Code
|
841
|
| Min. Negotiated Rate |
$388.97 |
| Max. Negotiated Rate |
$1,611.75 |
| Rate for Payer: Adventist Health Commercial |
$429.80
|
| Rate for Payer: Cash Price |
$1,181.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,454.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,454.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.25
|
| Rate for Payer: Multiplan Commercial |
$1,611.75
|
|
|
HC CAPD TRAINING
|
Facility
|
OP
|
$2,149.00
|
|
|
Service Code
|
CPT 90993
|
| Hospital Charge Code |
942000201
|
|
Hospital Revenue Code
|
841
|
| Min. Negotiated Rate |
$45.13 |
| Max. Negotiated Rate |
$1,826.65 |
| Rate for Payer: Adventist Health Commercial |
$429.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,148.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,476.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,826.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,611.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,310.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,048.71
|
| Rate for Payer: Cash Price |
$1,181.95
|
| Rate for Payer: Cash Price |
$1,181.95
|
| Rate for Payer: Cash Price |
$1,181.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,396.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,826.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,826.65
|
| Rate for Payer: Dignity Health Senior |
$1,826.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,396.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,330.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,330.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,025.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,504.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,504.30
|
| Rate for Payer: Multiplan Commercial |
$1,611.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$471.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$394.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,826.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,826.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,826.65
|
|
|
HC CAPILLARY BLOOD DRAW HEEL FNGR EAR
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
902400137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$31.72
|
| Rate for Payer: Blue Shield of California EPN |
$25.38
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.20
|
| Rate for Payer: Dignity Health Senior |
$44.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Heritage Provider Network Senior |
$32.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.20
|
| Rate for Payer: Vantage Medical Group Senior |
$44.20
|
|
|
HC CAPILLARY BLOOD DRAW HEEL FNGR EAR
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
902400137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.20
|
| Rate for Payer: Heritage Provider Network Senior |
$35.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
|
|
HC CAPILLARY BLOOD DRAW HEEL FNGR EAR
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
900802002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$31.72
|
| Rate for Payer: Blue Shield of California EPN |
$25.38
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.20
|
| Rate for Payer: Dignity Health Senior |
$44.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Heritage Provider Network Senior |
$32.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.20
|
| Rate for Payer: Vantage Medical Group Senior |
$44.20
|
|
|
HC CAPILLARY BLOOD DRAW HEEL FNGR EAR
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
900802002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.20
|
| Rate for Payer: Heritage Provider Network Senior |
$35.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
|
|
HC CAPTOPRIL RENOGRAM
|
Facility
|
OP
|
$2,921.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
909301431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$252.06 |
| Max. Negotiated Rate |
$2,190.75 |
| Rate for Payer: Adventist Health Commercial |
$584.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,561.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,006.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Blue Shield of California Commercial |
$938.16
|
| Rate for Payer: Blue Shield of California EPN |
$754.44
|
| Rate for Payer: Cash Price |
$1,606.55
|
| Rate for Payer: Cash Price |
$1,606.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,898.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Senior |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,898.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$683.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,808.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,808.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$252.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,393.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$528.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$786.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$730.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$861.75
|
| Rate for Payer: Multiplan Commercial |
$2,190.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$752.32
|
| Rate for Payer: TriValley Medical Group Senior |
$683.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,460.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,460.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC CAPTOPRIL RENOGRAM
|
Facility
|
IP
|
$2,921.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
909301431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$528.70 |
| Max. Negotiated Rate |
$2,190.75 |
| Rate for Payer: Adventist Health Commercial |
$584.20
|
| Rate for Payer: Cash Price |
$1,606.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,977.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,977.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$528.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$730.25
|
| Rate for Payer: Multiplan Commercial |
$2,190.75
|
|
|
HC CARBA5
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900913012
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC CARBA5
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900913012
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.31
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC CARBAMATES CONF & ID
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
900910513
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.47 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.22
|
| Rate for Payer: Heritage Provider Network Senior |
$211.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
|
|
HC CARBAMATES CONF & ID
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
900910513
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$166.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$214.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.13
|
| Rate for Payer: Blue Shield of California Commercial |
$61.86
|
| Rate for Payer: Blue Shield of California EPN |
$49.62
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$202.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.79
|
| Rate for Payer: Dignity Health Senior |
$9.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.13
|
| Rate for Payer: Heritage Provider Network Senior |
$193.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$148.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.36
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.81
|
| Rate for Payer: TriValley Medical Group Senior |
$9.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Vantage Medical Group Senior |
$9.81
|
|
|
HC CARBAMAZEPINE
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
900910396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.62 |
| Max. Negotiated Rate |
$180.75 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Cash Price |
$132.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$163.16
|
| Rate for Payer: Heritage Provider Network Senior |
$163.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.25
|
| Rate for Payer: Multiplan Commercial |
$180.75
|
|
|
HC CARBAMAZEPINE
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
900910396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$180.75 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$128.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$165.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.94
|
| Rate for Payer: Blue Shield of California Commercial |
$117.16
|
| Rate for Payer: Blue Shield of California EPN |
$93.97
|
| Rate for Payer: Cash Price |
$132.55
|
| Rate for Payer: Cash Price |
$132.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$156.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.03
|
| Rate for Payer: Dignity Health Senior |
$14.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.18
|
| Rate for Payer: Heritage Provider Network Senior |
$149.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$114.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.36
|
| Rate for Payer: Multiplan Commercial |
$180.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.57
|
| Rate for Payer: TriValley Medical Group Senior |
$14.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Vantage Medical Group Senior |
$14.57
|
|
|
HC CARBA NP
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900913010
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$26.31 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.31
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC CARBA NP
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900913010
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.89
|
| Rate for Payer: Heritage Provider Network Senior |
$14.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
|
|
HC CARBOXYHGB CH
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
900912179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.96
|
| Rate for Payer: Heritage Provider Network Senior |
$18.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
|
|
HC CARBOXYHGB CH
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
900912179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$112.54 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.54
|
| Rate for Payer: Blue Shield of California Commercial |
$99.19
|
| Rate for Payer: Blue Shield of California EPN |
$79.56
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.55
|
| Rate for Payer: Dignity Health Senior |
$12.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.52
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.32
|
| Rate for Payer: TriValley Medical Group Senior |
$12.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.55
|
| Rate for Payer: Vantage Medical Group Senior |
$12.32
|
|
