|
HC BALLOON HYPERFORM
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
909020050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,511.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
|
|
HC BALLOON NANOCROSS
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$521.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$325.62
|
| Rate for Payer: Blue Shield of California EPN |
$325.62
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$372.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.03
|
| Rate for Payer: Heritage Provider Network Senior |
$375.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$405.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$405.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$405.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$292.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$268.19
|
|
|
HC BALLOON NANOCROSS
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$500.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$688.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$445.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$607.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$325.62
|
| Rate for Payer: Blue Shield of California EPN |
$325.62
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$372.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$688.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$688.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$688.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$518.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.03
|
| Rate for Payer: Heritage Provider Network Senior |
$375.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$405.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$405.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$405.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$567.00
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$292.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$268.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$688.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$688.50
|
| Rate for Payer: Vantage Medical Group Senior |
$688.50
|
|
|
HC BALLOON OCCLUSION ADDL LOBES
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
CPT 31651
|
| Hospital Charge Code |
900531651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$882.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,012.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,168.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,143.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,017.62
|
| Rate for Payer: Heritage Provider Network Senior |
$3,017.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,325.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$882.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,412.50
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
HC BALLOON OCCLUSION ADDL LOBES
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
CPT 31651
|
| Hospital Charge Code |
900531651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$882.38 |
| Max. Negotiated Rate |
$3,656.25 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,300.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,300.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$882.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
|
|
HC BALLOON, OCCLUSION/RETRIEVAL
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
900803815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.74 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$333.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.11
|
| Rate for Payer: Blue Shield of California Commercial |
$329.40
|
| Rate for Payer: Blue Shield of California EPN |
$263.52
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$351.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.26
|
| Rate for Payer: Heritage Provider Network Senior |
$334.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$257.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$378.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$270.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$270.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
HC BALLOON, OCCLUSION/RETRIEVAL
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
900803815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.74 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$347.76
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$365.58
|
| Rate for Payer: Heritage Provider Network Senior |
$365.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
|
|
HC BALLOON, REEF/ADMIRAL
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$879.75 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$639.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$879.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$569.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$776.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$517.71
|
| Rate for Payer: Blue Shield of California Commercial |
$631.35
|
| Rate for Payer: Blue Shield of California EPN |
$505.08
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$672.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$879.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$879.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$610.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$640.66
|
| Rate for Payer: Heritage Provider Network Senior |
$640.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$493.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$187.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$724.50
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$517.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$517.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$879.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$879.75
|
| Rate for Payer: Vantage Medical Group Senior |
$879.75
|
|
|
HC BALLOON, REEF/ADMIRAL
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$776.25 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$666.54
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$700.70
|
| Rate for Payer: Heritage Provider Network Senior |
$700.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$187.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
|
|
HC BALLOON, VIATRAC
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$374.67 |
| Max. Negotiated Rate |
$1,552.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,333.08
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,401.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,401.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$374.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.50
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
|
|
HC BALLOON, VIATRAC
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$374.67 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,279.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,138.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,552.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,035.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1,262.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,010.16
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,345.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,759.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,759.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,281.33
|
| Rate for Payer: Heritage Provider Network Senior |
$1,281.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$987.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$374.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,449.00
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,035.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,035.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,759.50
|
|
|
HC BARBITUATES CONF & ID
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910519
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.47 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Vantage Medical Group Senior |
$220.15
|
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$194.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.32
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$168.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$202.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$220.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$265.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$220.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$265.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$160.32
|
| Rate for Payer: Heritage Provider Network Senior |
$160.32
|
| Rate for Payer: Heritage Provider Network Senior |
$193.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$148.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$123.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$218.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$181.30
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$156.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$129.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$129.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$156.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$265.20
|
| Rate for Payer: Vantage Medical Group Senior |
$265.20
|
|
|
HC BARBITUATES CONF & ID
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910519
|
|
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: Aetna of CA Non-Gatekeeper |
$200.93
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.22
|
| Rate for Payer: Heritage Provider Network Senior |
$211.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
|
|
HC BARIUM ENEMA W/AIR C
|
Facility
|
IP
|
$1,647.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
909001808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.11 |
| Max. Negotiated Rate |
$1,235.25 |
| Rate for Payer: Adventist Health Commercial |
$329.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,060.67
|
| Rate for Payer: Cash Price |
$741.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,115.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,115.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$298.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.75
|
| Rate for Payer: Multiplan Commercial |
$1,235.25
|
|
|
HC BARIUM ENEMA W/AIR C
|
Facility
|
OP
|
$1,647.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
909001808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$1,235.25 |
| Rate for Payer: Adventist Health Commercial |
$329.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,017.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$525.18
|
| Rate for Payer: Blue Shield of California Commercial |
$471.26
|
| Rate for Payer: Blue Shield of California EPN |
$378.97
|
| Rate for Payer: Cash Price |
$741.15
|
| Rate for Payer: Cash Price |
$741.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,070.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$971.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,019.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,019.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$785.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$298.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$1,235.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.59
|
| Rate for Payer: TriValley Medical Group Senior |
$225.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$227.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$227.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC BARRIER SKIN SUR FIT 2.25"
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901698376
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1.67
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.32
|
| Rate for Payer: Vantage Medical Group Senior |
$2.32
|
|
|
HC BARRIER SKIN SUR FIT 2.25"
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901698376
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.76
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$2.05
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
900910421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Adventist Health Commercial |
$90.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$278.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.35
|
| Rate for Payer: Blue Shield of California Commercial |
$68.14
|
| Rate for Payer: Blue Shield of California Commercial |
$68.14
|
| Rate for Payer: Blue Shield of California EPN |
$54.65
|
| Rate for Payer: Blue Shield of California EPN |
$54.65
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$292.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.71
|
| Rate for Payer: Heritage Provider Network Senior |
$278.55
|
| Rate for Payer: Heritage Provider Network Senior |
$29.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$214.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$22.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.34
|
| Rate for Payer: Multiplan Commercial |
$337.50
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.46
|
| Rate for Payer: TriValley Medical Group Senior |
$8.46
|
| Rate for Payer: TriValley Medical Group Senior |
$8.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: Vantage Medical Group Senior |
$8.46
|
| Rate for Payer: Vantage Medical Group Senior |
$8.46
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
900910421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Adventist Health Commercial |
$90.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$289.80
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$304.65
|
| Rate for Payer: Heritage Provider Network Senior |
$304.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.50
|
| Rate for Payer: Multiplan Commercial |
$337.50
|
|
|
HC BCEDP CASE MANAGEMENT FEE
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
909099998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.01
|
| Rate for Payer: Blue Shield of California Commercial |
$23.18
|
| Rate for Payer: Blue Shield of California EPN |
$18.54
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.30
|
| Rate for Payer: Vantage Medical Group Senior |
$32.30
|
|
|
HC BCEDP CASE MANAGEMENT FEE
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
909099998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.47
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.73
|
| Rate for Payer: Heritage Provider Network Senior |
$25.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
|
|
HC B-CELL LYMPH FISH DNA PROBE SO
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914114
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$1,610.83 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,610.83
|
| Rate for Payer: Blue Shield of California Commercial |
$172.40
|
| Rate for Payer: Blue Shield of California EPN |
$138.28
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.23
|
| Rate for Payer: Heritage Provider Network Senior |
$53.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC B-CELL LYMPH FISH DNA PROBE SO
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914114
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.38
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.22
|
| Rate for Payer: Heritage Provider Network Senior |
$58.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
|
|
HC B-CELL LYMPH FISH INTRPHAS IN
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914115
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.92
|
| Rate for Payer: Heritage Provider Network Senior |
$125.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
|
|
HC B-CELL LYMPH FISH INTRPHAS IN
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914115
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$2,485.29 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.29
|
| Rate for Payer: Blue Shield of California Commercial |
$323.19
|
| Rate for Payer: Blue Shield of California EPN |
$259.23
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.13
|
| Rate for Payer: Heritage Provider Network Senior |
$115.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.19
|
| Rate for Payer: TriValley Medical Group Senior |
$51.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
