|
HC BX BREAST 1ST LESION US IMAG
|
Facility
|
OP
|
$4,793.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
900100006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$867.53 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$958.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,962.07
|
| 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 |
$2,156.85
|
| Rate for Payer: Cash Price |
$2,156.85
|
| Rate for Payer: Cash Price |
$2,156.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,115.45
|
| 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 |
$2,966.87
|
| 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 |
$867.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,198.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$3,594.75
|
| 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 US IMAG
|
Facility
|
IP
|
$4,793.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
900100006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$867.53 |
| Max. Negotiated Rate |
$3,594.75 |
| Rate for Payer: Adventist Health Commercial |
$958.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,086.69
|
| Rate for Payer: Cash Price |
$2,156.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,244.86
|
| Rate for Payer: Heritage Provider Network Senior |
$3,244.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$867.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,198.25
|
| Rate for Payer: Multiplan Commercial |
$3,594.75
|
|
|
HC BX BREAST ADD LESION MR IMAG
|
Facility
|
OP
|
$6,392.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,278.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,950.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,433.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,515.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,794.00
|
| 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 |
$2,876.40
|
| Rate for Payer: Cash Price |
$2,876.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,154.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,433.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,433.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,433.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,956.65
|
| Rate for Payer: Heritage Provider Network Senior |
$3,956.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,048.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,156.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,598.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,474.40
|
| Rate for Payer: Multiplan Commercial |
$4,794.00
|
| 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 |
$5,433.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,433.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,433.20
|
|
|
HC BX BREAST ADD LESION MR IMAG
|
Facility
|
IP
|
$6,392.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,156.95 |
| Max. Negotiated Rate |
$4,794.00 |
| Rate for Payer: Adventist Health Commercial |
$1,278.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,116.45
|
| Rate for Payer: Cash Price |
$2,876.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,327.38
|
| Rate for Payer: Heritage Provider Network Senior |
$4,327.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,156.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,598.00
|
| Rate for Payer: Multiplan Commercial |
$4,794.00
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
|
OP
|
$5,327.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| 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 |
$4,527.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,929.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,995.25
|
| 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: Cigna of CA HMO/PPO |
$3,462.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,527.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,527.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,527.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,297.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3,297.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,540.98
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$3,728.90
|
| Rate for Payer: Multiplan Commercial |
$3,995.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,527.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,527.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,527.95
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
|
IP
|
$5,327.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
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 ADD LESION US IMAG
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$724.36 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$800.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,473.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,001.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,441.22
|
| Rate for Payer: Blue Shield of California EPN |
$1,952.98
|
| Rate for Payer: Cash Price |
$1,800.90
|
| Rate for Payer: Cash Price |
$1,800.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,601.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,401.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,401.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,401.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,477.24
|
| Rate for Payer: Heritage Provider Network Senior |
$2,477.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,908.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$724.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,801.40
|
| Rate for Payer: Multiplan Commercial |
$3,001.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,001.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,401.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3,401.70
|
|
|
HC BX BREAST ADD LESION US IMAG
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$724.36 |
| Max. Negotiated Rate |
$3,001.50 |
| Rate for Payer: Adventist Health Commercial |
$800.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,577.29
|
| Rate for Payer: Cash Price |
$1,800.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,709.35
|
| Rate for Payer: Heritage Provider Network Senior |
$2,709.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$724.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.50
|
| Rate for Payer: Multiplan Commercial |
$3,001.50
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.68 |
| Max. Negotiated Rate |
$881.25 |
| Rate for Payer: Adventist Health Commercial |
$235.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$756.70
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$795.48
|
| Rate for Payer: Heritage Provider Network Senior |
$795.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.75
|
| Rate for Payer: Multiplan Commercial |
$881.25
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.68 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$235.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$726.15
|
| 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 |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$558.12
|
| Rate for Payer: Blue Shield of California EPN |
$444.15
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$763.75
|
| 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 |
$795.48
|
| Rate for Payer: Heritage Provider Network Senior |
$795.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$560.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$881.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$705.00
|
| Rate for Payer: TriValley Medical Group Senior |
$705.00
|
| 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 OR EXC OF LN OPEN, INGFEM NODES
|
Facility
|
IP
|
$9,658.00
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
909008531
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,748.10 |
| Max. Negotiated Rate |
$7,243.50 |
| Rate for Payer: Adventist Health Commercial |
$1,931.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,219.75
|
| Rate for Payer: Cash Price |
$4,346.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,538.47
|
| Rate for Payer: Heritage Provider Network Senior |
$6,538.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,748.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,414.50
|
| Rate for Payer: Multiplan Commercial |
$7,243.50
|
|
|
HC BX OR EXC OF LN OPEN, INGFEM NODES
|
Facility
|
OP
|
$9,658.00
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
909008531
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,748.10 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$1,931.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,968.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| 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 |
$4,346.10
|
| Rate for Payer: Cash Price |
$4,346.10
|
| Rate for Payer: Cash Price |
$4,346.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,277.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$5,035.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,978.30
|
| Rate for Payer: Heritage Provider Network Senior |
$6,194.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,568.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,748.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,791.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,414.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan Commercial |
$7,243.50
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,539.49
|
| Rate for Payer: TriValley Medical Group Senior |
$5,539.49
|
| 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 |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
|
IP
|
$1,996.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$361.28 |
| Max. Negotiated Rate |
$1,497.00 |
| Rate for Payer: Adventist Health Commercial |
$399.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,285.42
|
| Rate for Payer: Cash Price |
$898.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,351.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,351.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$361.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.00
|
| Rate for Payer: Multiplan Commercial |
$1,497.00
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
|
OP
|
$1,996.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$361.28 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$399.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,233.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| 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 |
$898.20
|
| Rate for Payer: Cash Price |
$898.20
|
| Rate for Payer: Cash Price |
$898.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,297.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,235.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,730.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$361.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,497.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,001.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,001.86
|
| 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 |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC C-14 UREA BREATH TEST ACQ
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 78267
|
| Hospital Charge Code |
909301257
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Adventist Health Commercial |
$85.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$263.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.09
|
| Rate for Payer: Blue Shield of California Commercial |
$259.86
|
| Rate for Payer: Blue Shield of California EPN |
$207.89
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$276.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$263.69
|
| Rate for Payer: Heritage Provider Network Senior |
$263.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$203.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.82
|
| Rate for Payer: Multiplan Commercial |
$319.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.17
|
| Rate for Payer: TriValley Medical Group Senior |
$11.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$213.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$213.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.17
|
| Rate for Payer: Vantage Medical Group Senior |
$11.06
|
|
|
HC C-14 UREA BREATH TEST ACQ
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 78267
|
| Hospital Charge Code |
909301257
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$77.11 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Adventist Health Commercial |
$85.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.34
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$288.40
|
| Rate for Payer: Heritage Provider Network Senior |
$288.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.50
|
| Rate for Payer: Multiplan Commercial |
$319.50
|
|
|
HC C-14 UREA BREATH TEST ANAL
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT 78268
|
| Hospital Charge Code |
909301258
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$340.50 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$280.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.09
|
| Rate for Payer: Blue Shield of California Commercial |
$276.94
|
| Rate for Payer: Blue Shield of California EPN |
$221.55
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$295.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$94.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$94.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$281.03
|
| Rate for Payer: Heritage Provider Network Senior |
$281.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$94.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$216.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$126.51
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$103.85
|
| Rate for Payer: TriValley Medical Group Senior |
$94.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$227.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$227.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.85
|
| Rate for Payer: Vantage Medical Group Senior |
$94.41
|
|
|
HC C-14 UREA BREATH TEST ANAL
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
CPT 78268
|
| Hospital Charge Code |
909301258
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$340.50 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$292.38
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$307.36
|
| Rate for Payer: Heritage Provider Network Senior |
$307.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.50
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
|
|
HC CA CALCIUM IONIZED
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900910502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.42 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Adventist Health Commercial |
$75.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$243.43
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.91
|
| Rate for Payer: Heritage Provider Network Senior |
$255.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
|
|
HC CA CALCIUM IONIZED
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900910502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Adventist Health Commercial |
$75.60
|
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$233.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.76
|
| Rate for Payer: Blue Shield of California Commercial |
$109.96
|
| Rate for Payer: Blue Shield of California Commercial |
$109.96
|
| Rate for Payer: Blue Shield of California EPN |
$88.20
|
| Rate for Payer: Blue Shield of California EPN |
$88.20
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$245.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.98
|
| Rate for Payer: Heritage Provider Network Senior |
$61.90
|
| Rate for Payer: Heritage Provider Network Senior |
$233.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$180.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.68
|
| Rate for Payer: TriValley Medical Group Senior |
$13.68
|
| Rate for Payer: TriValley Medical Group Senior |
$13.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
|
HC CAFFEINE SERUM
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910538
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$138.26 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.26
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.47
|
| Rate for Payer: Heritage Provider Network Senior |
$97.80
|
| Rate for Payer: Heritage Provider Network Senior |
$28.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$75.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC CAFFEINE SERUM
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910538
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.75
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.97
|
| Rate for Payer: Heritage Provider Network Senior |
$106.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.50
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
|
|
HC CA IONIZED (POC)
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900912118
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$199.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.76
|
| Rate for Payer: Blue Shield of California Commercial |
$109.96
|
| Rate for Payer: Blue Shield of California EPN |
$88.20
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$209.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$199.94
|
| Rate for Payer: Heritage Provider Network Senior |
$199.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$154.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$242.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.68
|
| Rate for Payer: TriValley Medical Group Senior |
$13.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
|
HC CA IONIZED (POC)
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900912118
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.46 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$208.01
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$218.67
|
| Rate for Payer: Heritage Provider Network Senior |
$218.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.75
|
| Rate for Payer: Multiplan Commercial |
$242.25
|
|
|
HC C ALBICANS OR C TROPICALIS NAT
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900912492
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.26
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.76
|
| Rate for Payer: Heritage Provider Network Senior |
$71.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
|
