|
HC CNVRT NEHPU TO NEPH CATH PERCU
|
Facility
|
OP
|
$1,359.00
|
|
|
Service Code
|
CPT 50434
|
| Hospital Charge Code |
909050434
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$271.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$933.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| 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 |
$747.45
|
| Rate for Payer: Cash Price |
$747.45
|
| Rate for Payer: Cash Price |
$747.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$883.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Senior |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,602.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$841.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,201.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,338.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,945.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,993.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,279.58
|
| Rate for Payer: Multiplan Commercial |
$1,019.25
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,863.12
|
| Rate for Payer: TriValley Medical Group Senior |
$2,863.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CNVRT NEHPU TO NEPH CATH PERCU
|
Facility
|
IP
|
$1,359.00
|
|
|
Service Code
|
CPT 50434
|
| Hospital Charge Code |
909050434
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$245.98 |
| Max. Negotiated Rate |
$1,019.25 |
| Rate for Payer: Adventist Health Commercial |
$271.80
|
| Rate for Payer: Cash Price |
$747.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$920.04
|
| Rate for Payer: Heritage Provider Network Senior |
$920.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.75
|
| Rate for Payer: Multiplan Commercial |
$1,019.25
|
|
|
HC CO2
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
900910258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC CO2
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
900910258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.33
|
| Rate for Payer: Blue Shield of California Commercial |
$39.34
|
| Rate for Payer: Blue Shield of California EPN |
$31.55
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.37
|
| Rate for Payer: Dignity Health Senior |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.15
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.88
|
| Rate for Payer: TriValley Medical Group Senior |
$4.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
HC CO2 RESPONSE TEST
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT 94400
|
| Hospital Charge Code |
900801030
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$81.09 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$303.30
|
| Rate for Payer: Heritage Provider Network Senior |
$303.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
|
|
HC CO2 RESPONSE TEST
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT 94400
|
| Hospital Charge Code |
900801030
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$81.09 |
| Max. Negotiated Rate |
$380.80 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$239.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$307.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$380.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.00
|
| Rate for Payer: Blue Shield of California Commercial |
$273.28
|
| Rate for Payer: Blue Shield of California EPN |
$218.62
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$291.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$380.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$380.80
|
| Rate for Payer: Dignity Health Senior |
$380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$277.31
|
| Rate for Payer: Heritage Provider Network Senior |
$277.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$213.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.60
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$224.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$224.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$380.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$380.80
|
|
|
HC CO57 CYANOCOBALAMIN UP TO 1MCI
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
CPT A9559
|
| Hospital Charge Code |
909301530
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$296.25 |
| Rate for Payer: Adventist Health Commercial |
$79.00
|
| Rate for Payer: Cash Price |
$217.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$181.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.88
|
| Rate for Payer: Heritage Provider Network Senior |
$182.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.75
|
| Rate for Payer: Multiplan Commercial |
$296.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$142.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$130.78
|
|
|
HC CO57 CYANOCOBALAMIN UP TO 1MCI
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
CPT A9559
|
| Hospital Charge Code |
909301530
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$335.75 |
| Rate for Payer: Adventist Health Commercial |
$79.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$335.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$217.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$296.25
|
| Rate for Payer: Blue Shield of California Commercial |
$240.95
|
| Rate for Payer: Blue Shield of California EPN |
$192.76
|
| Rate for Payer: Cash Price |
$217.25
|
| Rate for Payer: Cash Price |
$217.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$181.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$335.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.75
|
| Rate for Payer: Dignity Health Senior |
$335.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.88
|
| Rate for Payer: Heritage Provider Network Senior |
$182.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$188.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$276.50
|
| Rate for Payer: Multiplan Commercial |
$296.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$158.00
|
| Rate for Payer: TriValley Medical Group Senior |
$158.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$142.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$130.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$335.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.75
|
| Rate for Payer: Vantage Medical Group Senior |
$335.75
|
|
|
HC COAG FVIII INHIB EVAL BTHSDA U
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900913970
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.04
|
| Rate for Payer: Heritage Provider Network Senior |
$90.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
|
|
HC COAG FVIII INHIB EVAL BTHSDA U
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900913970
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$117.52 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$71.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$91.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.52
|
| Rate for Payer: Blue Shield of California Commercial |
$103.62
|
| Rate for Payer: Blue Shield of California EPN |
$83.11
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$86.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.33
|
| Rate for Payer: Heritage Provider Network Senior |
$82.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$63.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.87
|
| Rate for Payer: TriValley Medical Group Senior |
$12.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC COAG TIME ACTIVATED
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900910011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$51.40 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Cash Price |
$156.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$192.27
|
| Rate for Payer: Heritage Provider Network Senior |
$192.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.00
|
| Rate for Payer: Multiplan Commercial |
$213.00
|
|
|
HC COAG TIME ACTIVATED
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900910011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$151.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$195.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.84
|
| Rate for Payer: Blue Shield of California Commercial |
$34.27
|
| Rate for Payer: Blue Shield of California EPN |
$27.49
|
| Rate for Payer: Cash Price |
$156.20
|
| Rate for Payer: Cash Price |
$156.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$184.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: Dignity Health Senior |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$175.80
|
| Rate for Payer: Heritage Provider Network Senior |
$175.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$135.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$213.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.28
|
| Rate for Payer: TriValley Medical Group Senior |
$4.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
HC COCAINE METABOLITE CONF
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900910518
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$305.15 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$191.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$246.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$305.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$197.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$269.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.76
|
| Rate for Payer: Cash Price |
$197.45
|
| Rate for Payer: Cash Price |
$197.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$233.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$305.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.15
|
| Rate for Payer: Dignity Health Senior |
$305.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$222.22
|
| Rate for Payer: Heritage Provider Network Senior |
$222.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$171.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$251.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$251.30
|
| Rate for Payer: Multiplan Commercial |
$269.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$179.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$179.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$305.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.15
|
| Rate for Payer: Vantage Medical Group Senior |
$305.15
|
|
|
HC COCAINE METABOLITE CONF
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900910518
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$269.25 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Cash Price |
$197.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$243.04
|
| Rate for Payer: Heritage Provider Network Senior |
$243.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.75
|
| Rate for Payer: Multiplan Commercial |
$269.25
|
|
|
HC CO DIFFUSION CAPACITY
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
900801004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$78.08 |
| Max. Negotiated Rate |
$453.90 |
| Rate for Payer: Adventist Health Commercial |
$106.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$285.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$366.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$453.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.50
|
| Rate for Payer: Blue Shield of California Commercial |
$268.08
|
| Rate for Payer: Blue Shield of California EPN |
$215.58
|
| Rate for Payer: Cash Price |
$293.70
|
| Rate for Payer: Cash Price |
$293.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$347.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$453.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$453.90
|
| Rate for Payer: Dignity Health Senior |
$453.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$330.55
|
| Rate for Payer: Heritage Provider Network Senior |
$330.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$254.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$373.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$373.80
|
| Rate for Payer: Multiplan Commercial |
$400.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$267.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$267.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$453.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$453.90
|
| Rate for Payer: Vantage Medical Group Senior |
$453.90
|
|
|
HC CO DIFFUSION CAPACITY
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
900801004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$96.65 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$106.80
|
| Rate for Payer: Cash Price |
$293.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$361.52
|
| Rate for Payer: Heritage Provider Network Senior |
$361.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.50
|
| Rate for Payer: Multiplan Commercial |
$400.50
|
|
|
HC COIL AXIUM
|
Facility
|
OP
|
$3,375.00
|
|
| Hospital Charge Code |
909020035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$675.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,318.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,868.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,856.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,531.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,356.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,356.75
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,552.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,868.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,868.75
|
| Rate for Payer: Dignity Health Senior |
$2,868.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,160.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,562.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,562.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,687.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,687.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,687.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,362.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,362.50
|
| Rate for Payer: Multiplan Commercial |
$2,531.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,219.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,117.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,868.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,868.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,868.75
|
|
|
HC COIL AXIUM
|
Facility
|
IP
|
$3,375.00
|
|
| Hospital Charge Code |
909020035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$675.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,620.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,356.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,356.75
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,552.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,822.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,562.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,562.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,687.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,687.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,687.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.75
|
| Rate for Payer: Multiplan Commercial |
$2,531.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,219.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,117.46
|
|
|
HC COIL AXIUM 3D
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,084.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,379.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,903.20
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,535.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,414.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,414.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,860.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,950.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL AXIUM 3D
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020107
|
|
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: Cash Price |
$2,145.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
|
|
HC COIL CASHMERE
|
Facility
|
IP
|
$4,575.00
|
|
| Hospital Charge Code |
909020101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$828.08 |
| Max. Negotiated Rate |
$3,431.25 |
| Rate for Payer: Adventist Health Commercial |
$915.00
|
| Rate for Payer: Cash Price |
$2,516.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,097.28
|
| Rate for Payer: Heritage Provider Network Senior |
$3,097.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$828.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,143.75
|
| Rate for Payer: Multiplan Commercial |
$3,431.25
|
|
|
HC COIL CASHMERE
|
Facility
|
OP
|
$4,575.00
|
|
| Hospital Charge Code |
909020101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$828.08 |
| Max. Negotiated Rate |
$3,888.75 |
| Rate for Payer: Adventist Health Commercial |
$915.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,445.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,143.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,888.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,516.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,431.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,790.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,232.60
|
| Rate for Payer: Cash Price |
$2,516.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,973.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,888.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,888.75
|
| Rate for Payer: Dignity Health Senior |
$3,888.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,973.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,831.93
|
| Rate for Payer: Heritage Provider Network Senior |
$2,831.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,182.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$828.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,143.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,202.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,202.50
|
| Rate for Payer: Multiplan Commercial |
$3,431.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,287.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,287.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,888.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,888.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,888.75
|
|
|
HC COIL DELTA PLUSH
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,084.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,379.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,903.20
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,535.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,414.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,414.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,860.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,950.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL DELTA PLUSH
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020100
|
|
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: Cash Price |
$2,145.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
|
|
HC COIL GDC-10
|
Facility
|
IP
|
$4,850.00
|
|
| Hospital Charge Code |
909020104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$877.85 |
| Max. Negotiated Rate |
$3,637.50 |
| Rate for Payer: Adventist Health Commercial |
$970.00
|
| Rate for Payer: Cash Price |
$2,667.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,283.45
|
| Rate for Payer: Heritage Provider Network Senior |
$3,283.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$877.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,212.50
|
| Rate for Payer: Multiplan Commercial |
$3,637.50
|
|
