|
HC COVID19 CONVALESCENT PLASMA
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
CPT C9507
|
| Hospital Charge Code |
900909507
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$234.40 |
| Max. Negotiated Rate |
$1,223.04 |
| Rate for Payer: Adventist Health Commercial |
$259.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$692.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$889.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$811.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$594.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$540.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$734.78
|
| Rate for Payer: Blue Shield of California Commercial |
$789.95
|
| Rate for Payer: Blue Shield of California EPN |
$631.96
|
| Rate for Payer: Cash Price |
$712.25
|
| Rate for Payer: Cash Price |
$712.25
|
| Rate for Payer: Cash Price |
$712.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$841.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$811.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$594.87
|
| Rate for Payer: Dignity Health Senior |
$540.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$841.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$540.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$801.61
|
| Rate for Payer: Heritage Provider Network Senior |
$801.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,223.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$540.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$617.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$621.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$681.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$681.40
|
| Rate for Payer: Multiplan Commercial |
$971.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$594.87
|
| Rate for Payer: TriValley Medical Group Senior |
$540.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$811.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$594.87
|
| Rate for Payer: Vantage Medical Group Senior |
$540.79
|
|
|
HC COVID19 CONVALESCENT PLASMA
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
CPT C9507
|
| Hospital Charge Code |
900909507
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$234.40 |
| Max. Negotiated Rate |
$971.25 |
| Rate for Payer: Adventist Health Commercial |
$259.00
|
| Rate for Payer: Cash Price |
$712.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$876.72
|
| Rate for Payer: Heritage Provider Network Senior |
$876.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.75
|
| Rate for Payer: Multiplan Commercial |
$971.25
|
|
|
HC COVID19 CONVLESNT PLASMA, DIVIDED
|
Facility
|
OP
|
$1,228.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$180.17 |
| Max. Negotiated Rate |
$921.00 |
| Rate for Payer: Adventist Health Commercial |
$245.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$656.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$843.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$696.77
|
| Rate for Payer: Blue Shield of California Commercial |
$749.08
|
| Rate for Payer: Blue Shield of California EPN |
$599.26
|
| Rate for Payer: Cash Price |
$675.40
|
| Rate for Payer: Cash Price |
$675.40
|
| Rate for Payer: Cash Price |
$675.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$798.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.19
|
| Rate for Payer: Dignity Health Senior |
$180.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$798.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$180.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$760.13
|
| Rate for Payer: Heritage Provider Network Senior |
$760.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$180.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$585.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.01
|
| Rate for Payer: Multiplan Commercial |
$921.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$198.19
|
| Rate for Payer: TriValley Medical Group Senior |
$180.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Vantage Medical Group Senior |
$180.17
|
|
|
HC COVID19 CONVLESNT PLASMA, DIVIDED
|
Facility
|
IP
|
$1,228.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$222.27 |
| Max. Negotiated Rate |
$921.00 |
| Rate for Payer: Adventist Health Commercial |
$245.60
|
| Rate for Payer: Cash Price |
$675.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.36
|
| Rate for Payer: Heritage Provider Network Senior |
$831.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.00
|
| Rate for Payer: Multiplan Commercial |
$921.00
|
|
|
HC COVID 19 IGM IGG
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 86318
|
| Hospital Charge Code |
900912259
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$96.75 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Cash Price |
$70.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.33
|
| Rate for Payer: Heritage Provider Network Senior |
$87.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.25
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
|
|
HC COVID 19 IGM IGG
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 86318
|
| Hospital Charge Code |
900912259
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$18.09 |
| Max. Negotiated Rate |
$118.19 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$68.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.19
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$70.95
|
| Rate for Payer: Cash Price |
$70.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$83.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.90
|
| Rate for Payer: Dignity Health Senior |
$18.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.85
|
| Rate for Payer: Heritage Provider Network Senior |
$79.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$61.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.79
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.09
|
| Rate for Payer: TriValley Medical Group Senior |
$18.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Vantage Medical Group Senior |
$18.09
|
|
|
HC COVID19 RNA STAT
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$329.38 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$329.38
|
| Rate for Payer: Blue Shield of California Commercial |
$225.70
|
| Rate for Payer: Blue Shield of California EPN |
$180.56
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$240.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Senior |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$229.03
|
| Rate for Payer: Heritage Provider Network Senior |
$229.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$176.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.65
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Senior |
$51.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC COVID19 RNA STAT
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$250.49
|
| Rate for Payer: Heritage Provider Network Senior |
$250.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
|
|
HC COVID19 SCREEN POOL
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900912262
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$329.38 |
| Rate for Payer: Adventist Health Commercial |
$77.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$329.38
|
| Rate for Payer: Blue Shield of California Commercial |
$235.46
|
| Rate for Payer: Blue Shield of California EPN |
$188.37
|
| Rate for Payer: Cash Price |
$212.30
|
| Rate for Payer: Cash Price |
$212.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$250.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Senior |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$238.93
|
| Rate for Payer: Heritage Provider Network Senior |
$238.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$184.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.65
|
| Rate for Payer: Multiplan Commercial |
$289.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Senior |
$51.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC COVID19 SCREEN POOL
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900912262
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$69.87 |
| Max. Negotiated Rate |
$289.50 |
| Rate for Payer: Adventist Health Commercial |
$77.20
|
| Rate for Payer: Cash Price |
$212.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.32
|
| Rate for Payer: Heritage Provider Network Senior |
$261.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.50
|
| Rate for Payer: Multiplan Commercial |
$289.50
|
|
|
HC CPAP/BIPAP/NIPPV - DAILY
|
Facility
|
OP
|
$726.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
900800110
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$66.10 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Adventist Health Commercial |
$145.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$388.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$498.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$471.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Senior |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$449.39
|
| Rate for Payer: Heritage Provider Network Senior |
$449.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$66.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$346.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$325.62
|
| Rate for Payer: Multiplan Commercial |
$544.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC CPAP/BIPAP/NIPPV - DAILY
|
Facility
|
IP
|
$726.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
900800110
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$131.41 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Adventist Health Commercial |
$145.20
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$491.50
|
| Rate for Payer: Heritage Provider Network Senior |
$491.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.50
|
| Rate for Payer: Multiplan Commercial |
$544.50
|
|
|
HC CPM DORSAL SPLINT
|
Facility
|
IP
|
$230.00
|
|
| Hospital Charge Code |
901301036
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.71
|
| Rate for Payer: Heritage Provider Network Senior |
$155.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
|
|
HC CPM DORSAL SPLINT
|
Facility
|
OP
|
$230.00
|
|
| Hospital Charge Code |
901301036
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$94.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$122.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$158.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$149.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Senior |
$195.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.37
|
| Rate for Payer: Heritage Provider Network Senior |
$142.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$109.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC CPS ST J STANDARD PACKAGE
|
Facility
|
OP
|
$2,277.00
|
|
| Hospital Charge Code |
906812549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$412.14 |
| Max. Negotiated Rate |
$1,935.45 |
| Rate for Payer: Adventist Health Commercial |
$455.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,217.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,564.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,935.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,707.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,388.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,111.18
|
| Rate for Payer: Cash Price |
$1,252.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,480.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,935.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,935.45
|
| Rate for Payer: Dignity Health Senior |
$1,935.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,480.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,409.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,409.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,086.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$412.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,593.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,593.90
|
| Rate for Payer: Multiplan Commercial |
$1,707.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,138.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,138.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,935.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,935.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,935.45
|
|
|
HC CPS ST J STANDARD PACKAGE
|
Facility
|
IP
|
$2,277.00
|
|
| Hospital Charge Code |
906812549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$412.14 |
| Max. Negotiated Rate |
$1,707.75 |
| Rate for Payer: Adventist Health Commercial |
$455.40
|
| Rate for Payer: Cash Price |
$1,252.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,541.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,541.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$412.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.25
|
| Rate for Payer: Multiplan Commercial |
$1,707.75
|
|
|
HC CR51 SOD CHROMATE TO 250 UCI
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT A9553
|
| Hospital Charge Code |
909301525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$272.22 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.50
|
| Rate for Payer: Blue Shield of California Commercial |
$23.18
|
| Rate for Payer: Blue Shield of California EPN |
$18.54
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.30
|
| Rate for Payer: Dignity Health Senior |
$32.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.59
|
| Rate for Payer: Heritage Provider Network Senior |
$17.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$272.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.20
|
| Rate for Payer: TriValley Medical Group Senior |
$15.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.30
|
| Rate for Payer: Vantage Medical Group Senior |
$32.30
|
|
|
HC CR51 SOD CHROMATE TO 250 UCI
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT A9553
|
| Hospital Charge Code |
909301525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.59
|
| Rate for Payer: Heritage Provider Network Senior |
$17.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.58
|
|
|
HC C-REACTIVE PROTEIN
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
900910887
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.20
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.90
|
| Rate for Payer: Heritage Provider Network Senior |
$61.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC C-REACTIVE PROTEIN
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
900910887
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Senior |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
|
|
HC C-REACTIVE PROTEIN HI SENSITIVITY
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
900912102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.13
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Senior |
$12.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.99
|
| Rate for Payer: Heritage Provider Network Senior |
$194.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.32
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.95
|
| Rate for Payer: TriValley Medical Group Senior |
$12.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
|
|
HC C-REACTIVE PROTEIN HI SENSITIVITY
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
900912102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.25
|
| Rate for Payer: Heritage Provider Network Senior |
$213.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
|
|
HC CREATINE KINASE
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
900910222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.58
|
| Rate for Payer: Heritage Provider Network Senior |
$103.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
|
|
HC CREATINE KINASE
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
900910222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$81.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.86
|
| Rate for Payer: Blue Shield of California Commercial |
$52.42
|
| Rate for Payer: Blue Shield of California EPN |
$42.04
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$99.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.16
|
| Rate for Payer: Dignity Health Senior |
$6.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.71
|
| Rate for Payer: Heritage Provider Network Senior |
$94.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$72.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.20
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.51
|
| Rate for Payer: TriValley Medical Group Senior |
$6.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.16
|
| Rate for Payer: Vantage Medical Group Senior |
$6.51
|
|
|
HC CREATININE
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
900910247
|
|
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
|
|
