|
HC BRONCH-RADIOELEMENT PLACEMENT
|
Facility
|
IP
|
$5,488.00
|
|
|
Service Code
|
CPT 31643
|
| Hospital Charge Code |
900803506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$993.33 |
| Max. Negotiated Rate |
$4,116.00 |
| Rate for Payer: Adventist Health Commercial |
$1,097.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,534.27
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,715.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,715.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$993.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,372.00
|
| Rate for Payer: Multiplan Commercial |
$4,116.00
|
|
|
HC BRONCH W BLLN OCC ADD LOBES
|
Facility
|
OP
|
$5,986.00
|
|
|
Service Code
|
CPT 31651
|
| Hospital Charge Code |
900831651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,197.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,699.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,088.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,292.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,489.50
|
| 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 |
$2,693.70
|
| Rate for Payer: Cash Price |
$2,693.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,890.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,088.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,088.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,088.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,705.33
|
| Rate for Payer: Heritage Provider Network Senior |
$3,705.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,855.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,083.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,496.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,190.20
|
| Rate for Payer: Multiplan Commercial |
$4,489.50
|
| 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 |
$5,088.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,088.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5,088.10
|
|
|
HC BRONCH W BLLN OCC ADD LOBES
|
Facility
|
IP
|
$5,986.00
|
|
|
Service Code
|
CPT 31651
|
| Hospital Charge Code |
900831651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,083.47 |
| Max. Negotiated Rate |
$4,489.50 |
| Rate for Payer: Adventist Health Commercial |
$1,197.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,854.98
|
| Rate for Payer: Cash Price |
$2,693.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,052.52
|
| Rate for Payer: Heritage Provider Network Senior |
$4,052.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,083.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,496.50
|
| Rate for Payer: Multiplan Commercial |
$4,489.50
|
|
|
HC BRONCH W/BLLN OCCLUSION
|
Facility
|
OP
|
$5,872.00
|
|
|
Service Code
|
CPT 31634
|
| Hospital Charge Code |
900803513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,062.83 |
| Max. Negotiated Rate |
$13,615.60 |
| Rate for Payer: Adventist Health Commercial |
$1,174.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,628.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,581.92
|
| Rate for Payer: Blue Shield of California EPN |
$2,865.54
|
| Rate for Payer: Cash Price |
$2,642.40
|
| Rate for Payer: Cash Price |
$2,642.40
|
| Rate for Payer: Cash Price |
$2,642.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,816.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,077.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,634.77
|
| Rate for Payer: Heritage Provider Network Senior |
$3,634.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,800.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,062.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,438.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,468.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan Commercial |
$4,404.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,984.78
|
| Rate for Payer: TriValley Medical Group Senior |
$9,984.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,936.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,936.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
HC BRONCH W/BLLN OCCLUSION
|
Facility
|
IP
|
$5,872.00
|
|
|
Service Code
|
CPT 31634
|
| Hospital Charge Code |
900803513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,062.83 |
| Max. Negotiated Rate |
$4,404.00 |
| Rate for Payer: Adventist Health Commercial |
$1,174.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,781.57
|
| Rate for Payer: Cash Price |
$2,642.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,975.34
|
| Rate for Payer: Heritage Provider Network Senior |
$3,975.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,062.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,468.00
|
| Rate for Payer: Multiplan Commercial |
$4,404.00
|
|
|
HC BRONCH W PLCMNT FIDUCIAL MRK
|
Facility
|
OP
|
$16,363.00
|
|
|
Service Code
|
CPT 31626
|
| Hospital Charge Code |
900531626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,961.70 |
| Max. Negotiated Rate |
$17,246.43 |
| Rate for Payer: Adventist Health Commercial |
$3,272.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,112.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$7,363.35
|
| Rate for Payer: Cash Price |
$7,363.35
|
| Rate for Payer: Cash Price |
$7,363.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,635.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,077.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,128.70
|
| Rate for Payer: Heritage Provider Network Senior |
$11,164.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,246.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,961.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,438.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,090.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan Commercial |
$12,272.25
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,984.78
|
| Rate for Payer: TriValley Medical Group Senior |
$9,984.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
HC BRONCH W PLCMNT FIDUCIAL MRK
|
Facility
|
IP
|
$16,363.00
|
|
|
Service Code
|
CPT 31626
|
| Hospital Charge Code |
900531626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,961.70 |
| Max. Negotiated Rate |
$12,272.25 |
| Rate for Payer: Adventist Health Commercial |
$3,272.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,537.77
|
| Rate for Payer: Cash Price |
$7,363.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,077.75
|
| Rate for Payer: Heritage Provider Network Senior |
$11,077.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,961.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,090.75
|
| Rate for Payer: Multiplan Commercial |
$12,272.25
|
|
|
HC BRONCH W/TUMOR EXCISION
|
Facility
|
IP
|
$12,302.00
|
|
|
Service Code
|
CPT 31640
|
| Hospital Charge Code |
900803516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,226.66 |
| Max. Negotiated Rate |
$9,226.50 |
| Rate for Payer: Adventist Health Commercial |
$2,460.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,922.49
|
| Rate for Payer: Cash Price |
$5,535.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,328.45
|
| Rate for Payer: Heritage Provider Network Senior |
$8,328.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,226.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,075.50
|
| Rate for Payer: Multiplan Commercial |
$9,226.50
|
|
|
HC BRONCH W/TUMOR EXCISION
|
Facility
|
OP
|
$12,302.00
|
|
|
Service Code
|
CPT 31640
|
| Hospital Charge Code |
900803516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,226.66 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,460.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,602.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,504.22
|
| Rate for Payer: Blue Shield of California EPN |
$6,003.38
|
| Rate for Payer: Cash Price |
$5,535.90
|
| Rate for Payer: Cash Price |
$5,535.90
|
| Rate for Payer: Cash Price |
$5,535.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,996.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,795.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,614.94
|
| Rate for Payer: Heritage Provider Network Senior |
$7,614.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,868.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,226.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,514.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,075.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,425.68
|
| Rate for Payer: Multiplan Commercial |
$9,226.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,274.81
|
| Rate for Payer: TriValley Medical Group Senior |
$5,274.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,151.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,151.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
HC BRUKER AER ID
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC BRUKER AER ID
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$76.64 |
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.64
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC BRUKER ANA ID
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900913002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.60
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.14
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$37.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC BRUKER ANA ID
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900913002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.64
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.62
|
| Rate for Payer: Heritage Provider Network Senior |
$40.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
|
|
HC BUFFY COAT EXAM
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
900910196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$198.75 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$163.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.28
|
| Rate for Payer: Blue Shield of California Commercial |
$29.89
|
| Rate for Payer: Blue Shield of California Commercial |
$29.89
|
| Rate for Payer: Blue Shield of California EPN |
$23.98
|
| Rate for Payer: Blue Shield of California EPN |
$23.98
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$172.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$164.03
|
| Rate for Payer: Heritage Provider Network Senior |
$8.67
|
| Rate for Payer: Heritage Provider Network Senior |
$164.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$126.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.79
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.07
|
| Rate for Payer: TriValley Medical Group Senior |
$5.07
|
| Rate for Payer: TriValley Medical Group Senior |
$5.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Vantage Medical Group Senior |
$5.07
|
| Rate for Payer: Vantage Medical Group Senior |
$5.07
|
|
|
HC BUFFY COAT EXAM
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
900910196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.97 |
| Max. Negotiated Rate |
$198.75 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$170.66
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$179.41
|
| Rate for Payer: Heritage Provider Network Senior |
$179.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.25
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
|
|
HC BUN
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910253
|
|
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: Aetna of CA Non-Gatekeeper |
$63.11
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC BUN
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.46
|
| Rate for Payer: Blue Shield of California Commercial |
$31.74
|
| Rate for Payer: Blue Shield of California Commercial |
$31.74
|
| Rate for Payer: Blue Shield of California EPN |
$25.46
|
| Rate for Payer: Blue Shield of California EPN |
$25.46
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.95
|
| Rate for Payer: TriValley Medical Group Senior |
$3.95
|
| Rate for Payer: TriValley Medical Group Senior |
$3.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BUN BODY FLUID
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900912241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.05
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.43
|
| Rate for Payer: Heritage Provider Network Senior |
$28.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
|
|
HC BUN BODY FLUID
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900912241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.46
|
| Rate for Payer: Blue Shield of California Commercial |
$31.74
|
| Rate for Payer: Blue Shield of California Commercial |
$31.74
|
| Rate for Payer: Blue Shield of California EPN |
$25.46
|
| Rate for Payer: Blue Shield of California EPN |
$25.46
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.95
|
| Rate for Payer: TriValley Medical Group Senior |
$3.95
|
| Rate for Payer: TriValley Medical Group Senior |
$3.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BUN INDIVIDUAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910492
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.46
|
| Rate for Payer: Blue Shield of California Commercial |
$31.74
|
| Rate for Payer: Blue Shield of California EPN |
$25.46
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.95
|
| Rate for Payer: TriValley Medical Group Senior |
$3.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BUN INDIVIDUAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910492
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC BX BREAST 1ST LESION MR IMAG
|
Facility
|
OP
|
$6,074.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,099.39 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,214.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,753.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$2,733.30
|
| Rate for Payer: Cash Price |
$2,733.30
|
| Rate for Payer: Cash Price |
$2,733.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,948.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,759.81
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,036.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,099.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,518.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$4,555.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,336.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2,336.65
|
| 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 |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC BX BREAST 1ST LESION MR IMAG
|
Facility
|
IP
|
$6,074.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,099.39 |
| Max. Negotiated Rate |
$4,555.50 |
| Rate for Payer: Adventist Health Commercial |
$1,214.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,911.66
|
| Rate for Payer: Cash Price |
$2,733.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,112.10
|
| Rate for Payer: Heritage Provider Network Senior |
$4,112.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,099.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,518.50
|
| Rate for Payer: Multiplan Commercial |
$4,555.50
|
|
|
HC BX BREAST 1ST LESION STRTCTC
|
Facility
|
IP
|
$5,327.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$964.19 |
| Max. Negotiated Rate |
$3,995.25 |
| Rate for Payer: Adventist Health Commercial |
$1,065.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,430.59
|
| Rate for Payer: Cash Price |
$2,397.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,606.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,606.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$964.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.75
|
| Rate for Payer: Multiplan Commercial |
$3,995.25
|
|
|
HC BX BREAST 1ST LESION STRTCTC
|
Facility
|
OP
|
$5,327.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$964.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,065.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,292.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$2,397.15
|
| Rate for Payer: Cash Price |
$2,397.15
|
| Rate for Payer: Cash Price |
$2,397.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,462.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,297.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,036.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$964.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$3,995.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,336.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2,336.65
|
| 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 |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
