|
HC CHROM ANLZ ADDL KARYO
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900918018
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.59
|
| Rate for Payer: Heritage Provider Network Senior |
$38.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
|
|
HC CHROM ANLZ ADDL KARYO
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900918018
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$229.13 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.13
|
| Rate for Payer: Blue Shield of California Commercial |
$202.00
|
| Rate for Payer: Blue Shield of California EPN |
$162.02
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.82
|
| Rate for Payer: Dignity Health Senior |
$33.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$33.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.17
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$33.47
|
| Rate for Payer: TriValley Medical Group Senior |
$33.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Vantage Medical Group Senior |
$33.47
|
|
|
HC CILIARY TRANSSLERAL THERAPY
|
Facility
|
OP
|
$8,891.00
|
|
|
Service Code
|
CPT 66710
|
| Hospital Charge Code |
900566710
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$6,668.25 |
| Rate for Payer: Adventist Health Commercial |
$1,778.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,108.12
|
| 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 |
$4,959.00
|
| Rate for Payer: Cash Price |
$4,000.95
|
| Rate for Payer: Cash Price |
$4,000.95
|
| Rate for Payer: Cash Price |
$4,000.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,779.15
|
| 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 |
$5,779.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,964.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,019.21
|
| Rate for Payer: Heritage Provider Network Senior |
$6,019.21
|
| 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 |
$4,241.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,609.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,408.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,222.75
|
| 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 |
$6,668.25
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,198.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,943.81
|
| 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 CILIARY TRANSSLERAL THERAPY
|
Facility
|
IP
|
$8,891.00
|
|
|
Service Code
|
CPT 66710
|
| Hospital Charge Code |
900566710
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,609.27 |
| Max. Negotiated Rate |
$6,668.25 |
| Rate for Payer: Adventist Health Commercial |
$1,778.20
|
| Rate for Payer: Cash Price |
$4,000.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,019.21
|
| Rate for Payer: Heritage Provider Network Senior |
$6,019.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,609.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,222.75
|
| Rate for Payer: Multiplan Commercial |
$6,668.25
|
|
|
HC CIPROFLOXACIN E TEST
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912443
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$23.16 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| 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 |
$20.59
|
| 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 |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| 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 |
$11.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| 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 |
$13.50
|
| 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 CIPROFLOXACIN E TEST
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912443
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Heritage Provider Network Senior |
$57.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
|
|
HC CIRC ANTICOAG SCRN
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910015
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$59.07 |
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.07
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.71
|
| Rate for Payer: Heritage Provider Network Senior |
$42.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$51.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CIRC ANTICOAG SCRN
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910015
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$42.72 |
| Max. Negotiated Rate |
$177.00 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.77
|
| Rate for Payer: Heritage Provider Network Senior |
$159.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.00
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
|
|
HC CISTERNOGRAM
|
Facility
|
IP
|
$2,601.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
909301413
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$470.78 |
| Max. Negotiated Rate |
$1,950.75 |
| Rate for Payer: Adventist Health Commercial |
$520.20
|
| Rate for Payer: Cash Price |
$1,170.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,760.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,760.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.25
|
| Rate for Payer: Multiplan Commercial |
$1,950.75
|
|
|
HC CISTERNOGRAM
|
Facility
|
OP
|
$2,601.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
909301413
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$274.09 |
| Max. Negotiated Rate |
$1,950.75 |
| Rate for Payer: Adventist Health Commercial |
$520.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,390.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,786.89
|
| 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 |
$1,059.07
|
| Rate for Payer: Blue Shield of California EPN |
$851.67
|
| Rate for Payer: Cash Price |
$1,170.45
|
| Rate for Payer: Cash Price |
$1,170.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,690.65
|
| 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 |
$1,690.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$683.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,610.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,610.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$274.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,240.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$786.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.25
|
| 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 |
$1,950.75
|
| 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 |
$1,300.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,300.50
|
| 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 CITRATE EXCRETION PEDS RAND U
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
900914034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$253.78 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$253.78
|
| Rate for Payer: Blue Shield of California Commercial |
$223.78
|
| Rate for Payer: Blue Shield of California EPN |
$179.49
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.58
|
| Rate for Payer: Dignity Health Senior |
$27.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.03
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.80
|
| Rate for Payer: TriValley Medical Group Senior |
$27.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$30.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: Vantage Medical Group Senior |
$27.80
|
|
|
HC CITRATE EXCRETION PEDS RAND U
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
900914034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC CITRULLINATED PEPTIDE AB
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
900913554
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
|
|
HC CITRULLINATED PEPTIDE AB
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
900913554
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$115.61 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.61
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Senior |
$12.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.09
|
| Rate for Payer: Heritage Provider Network Senior |
$42.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.32
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.95
|
| Rate for Payer: TriValley Medical Group Senior |
$12.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
|
|
HC CK-MB
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
900910805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$105.41 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$44.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.41
|
| Rate for Payer: Blue Shield of California Commercial |
$92.91
|
| Rate for Payer: Blue Shield of California EPN |
$74.52
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.71
|
| Rate for Payer: Dignity Health Senior |
$11.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.00
|
| Rate for Payer: Heritage Provider Network Senior |
$52.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.55
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.55
|
| Rate for Payer: TriValley Medical Group Senior |
$11.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.71
|
| Rate for Payer: Vantage Medical Group Senior |
$11.55
|
|
|
HC CK-MB
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
900910805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$223.50 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.75
|
| Rate for Payer: Heritage Provider Network Senior |
$201.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
|
|
HC CLAVICLE
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
909001478
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.27 |
| Max. Negotiated Rate |
$415.50 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.06
|
| Rate for Payer: Heritage Provider Network Senior |
$375.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.50
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
|
|
HC CLAVICLE
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
909001478
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$415.50 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$296.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$380.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.32
|
| Rate for Payer: Blue Shield of California Commercial |
$107.90
|
| Rate for Payer: Blue Shield of California EPN |
$86.77
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$360.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$342.93
|
| Rate for Payer: Heritage Provider Network Senior |
$342.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$264.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC CLNC LVG 35ML H2O INSRTN RCTL CATH
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT 0736T
|
| Hospital Charge Code |
906700736
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$78.92 |
| Max. Negotiated Rate |
$327.00 |
| Rate for Payer: Adventist Health Commercial |
$87.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$295.17
|
| Rate for Payer: Heritage Provider Network Senior |
$295.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.00
|
| Rate for Payer: Multiplan Commercial |
$327.00
|
|
|
HC CLNC LVG 35ML H2O INSRTN RCTL CATH
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT 0736T
|
| Hospital Charge Code |
906700736
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$87.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$299.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| 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 |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$283.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.88
|
| Rate for Payer: Heritage Provider Network Senior |
$244.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$207.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$327.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| 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 |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC CLNSCPY STOMA W SUBMUCOSAL INJ
|
Facility
|
IP
|
$2,542.00
|
|
|
Service Code
|
CPT 44404
|
| Hospital Charge Code |
906744404
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$460.10 |
| Max. Negotiated Rate |
$1,906.50 |
| Rate for Payer: Adventist Health Commercial |
$508.40
|
| Rate for Payer: Cash Price |
$1,143.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,720.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,720.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$460.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$635.50
|
| Rate for Payer: Multiplan Commercial |
$1,906.50
|
|
|
HC CLNSCPY STOMA W SUBMUCOSAL INJ
|
Facility
|
OP
|
$2,542.00
|
|
|
Service Code
|
CPT 44404
|
| Hospital Charge Code |
906744404
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$508.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,746.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| 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 |
$1,143.90
|
| Rate for Payer: Cash Price |
$1,143.90
|
| Rate for Payer: Cash Price |
$1,143.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,652.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,573.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,212.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$460.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$635.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$1,906.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC CLOSED TX VERTEBRAL FX W/MAN
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
CPT 22315
|
| Hospital Charge Code |
900501789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,400.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,809.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$3,150.00
|
| Rate for Payer: Cash Price |
$3,150.00
|
| Rate for Payer: Cash Price |
$3,150.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,550.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Senior |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,122.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,739.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,739.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,339.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,267.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,740.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,194.48
|
| Rate for Payer: Multiplan Commercial |
$5,250.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,518.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,317.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC CLOSED TX VERTEBRAL FX W/MAN
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
CPT 22315
|
| Hospital Charge Code |
900501789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,267.00 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Adventist Health Commercial |
$1,400.00
|
| Rate for Payer: Cash Price |
$3,150.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,739.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,739.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,267.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,750.00
|
| Rate for Payer: Multiplan Commercial |
$5,250.00
|
|
|
HC CLOSE TREAT CALCANEAL FX W/O M
|
Facility
|
IP
|
$524.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
900501669
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.84 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Adventist Health Commercial |
$104.80
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$354.75
|
| Rate for Payer: Heritage Provider Network Senior |
$354.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.00
|
| Rate for Payer: Multiplan Commercial |
$393.00
|
|
