|
HC CORPORA CAVERNOSA-GLANS PENIS
|
Facility
|
OP
|
$14,422.00
|
|
|
Service Code
|
CPT 54435
|
| Hospital Charge Code |
900501751
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,610.38 |
| Max. Negotiated Rate |
$10,816.50 |
| Rate for Payer: Adventist Health Commercial |
$2,884.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,912.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,850.45
|
| Rate for Payer: Blue Shield of California EPN |
$5,451.52
|
| Rate for Payer: Cash Price |
$6,489.90
|
| Rate for Payer: Cash Price |
$6,489.90
|
| Rate for Payer: Cash Price |
$6,489.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,374.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,533.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,763.69
|
| Rate for Payer: Heritage Provider Network Senior |
$9,763.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,879.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,610.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,213.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,605.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,075.17
|
| Rate for Payer: Multiplan Commercial |
$10,816.50
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,653.20
|
| Rate for Payer: TriValley Medical Group Senior |
$8,653.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
HC CORPORA CAVERNOSA-GLANS PENIS
|
Facility
|
IP
|
$14,422.00
|
|
|
Service Code
|
CPT 54435
|
| Hospital Charge Code |
900501751
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,610.38 |
| Max. Negotiated Rate |
$10,816.50 |
| Rate for Payer: Adventist Health Commercial |
$2,884.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,287.77
|
| Rate for Payer: Cash Price |
$6,489.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,763.69
|
| Rate for Payer: Heritage Provider Network Senior |
$9,763.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,610.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,605.50
|
| Rate for Payer: Multiplan Commercial |
$10,816.50
|
|
|
HC CORPORA CAVERNOSOGRAPHY
|
Facility
|
IP
|
$1,719.00
|
|
|
Service Code
|
CPT 74445
|
| Hospital Charge Code |
909080040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$311.14 |
| Max. Negotiated Rate |
$1,289.25 |
| Rate for Payer: Adventist Health Commercial |
$343.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,107.04
|
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,163.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,163.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$311.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.75
|
| Rate for Payer: Multiplan Commercial |
$1,289.25
|
|
|
HC CORPORA CAVERNOSOGRAPHY
|
Facility
|
OP
|
$1,719.00
|
|
|
Service Code
|
CPT 74445
|
| Hospital Charge Code |
909080040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,289.25 |
| Rate for Payer: Adventist Health Commercial |
$343.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,062.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.30
|
| Rate for Payer: Blue Shield of California Commercial |
$236.93
|
| Rate for Payer: Blue Shield of California EPN |
$190.53
|
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,117.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,064.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,064.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$819.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$311.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,289.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC CORTISOL
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.58 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.62
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$200.39
|
| Rate for Payer: Heritage Provider Network Senior |
$200.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
|
|
HC CORTISOL
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$182.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.95
|
| Rate for Payer: Blue Shield of California Commercial |
$131.21
|
| Rate for Payer: Blue Shield of California Commercial |
$131.21
|
| Rate for Payer: Blue Shield of California EPN |
$105.24
|
| Rate for Payer: Blue Shield of California EPN |
$105.24
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$83.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$192.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.22
|
| Rate for Payer: Heritage Provider Network Senior |
$79.23
|
| Rate for Payer: Heritage Provider Network Senior |
$183.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$61.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$141.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.30
|
| Rate for Payer: TriValley Medical Group Senior |
$16.30
|
| Rate for Payer: TriValley Medical Group Senior |
$16.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$16.30
|
| Rate for Payer: Vantage Medical Group Senior |
$16.30
|
|
|
HC COUGH ASSIST
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801124
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$66.79 |
| Max. Negotiated Rate |
$276.75 |
| Rate for Payer: Adventist Health Commercial |
$73.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$237.64
|
| Rate for Payer: Cash Price |
$166.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$249.81
|
| Rate for Payer: Heritage Provider Network Senior |
$249.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.25
|
| Rate for Payer: Multiplan Commercial |
$276.75
|
|
|
HC COUGH ASSIST
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801124
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$66.79 |
| Max. Negotiated Rate |
$276.75 |
| Rate for Payer: Adventist Health Commercial |
$73.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.57
|
| Rate for Payer: Blue Shield of California Commercial |
$225.09
|
| Rate for Payer: Blue Shield of California EPN |
$180.07
|
| Rate for Payer: Cash Price |
$166.05
|
| Rate for Payer: Cash Price |
$166.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$239.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$228.41
|
| Rate for Payer: Heritage Provider Network Senior |
$228.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$176.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$276.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$182.04
|
| Rate for Payer: TriValley Medical Group Senior |
$165.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$184.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$184.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC COVID 19 IGM IGG
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 86318
|
| Hospital Charge Code |
900912259
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$122.92 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.14
|
| 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 Medi-Cal |
$19.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.92
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$83.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.09
|
| Rate for Payer: Heritage Provider Network Senior |
$79.85
|
| Rate for Payer: Heritage Provider Network Senior |
$55.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$61.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$42.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.24
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.09
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$19.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$27.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Vantage Medical Group Senior |
$18.09
|
| Rate for Payer: Vantage Medical Group Senior |
$18.09
|
|
|
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: Aetna of CA Non-Gatekeeper |
$83.08
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.33
|
| Rate for Payer: Heritage Provider Network Senior |
$87.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.25
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
|
|
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: Aetna of CA Non-Gatekeeper |
$238.28
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$250.49
|
| Rate for Payer: Heritage Provider Network Senior |
$250.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
|
|
HC COVID19 RNA STAT
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.78 |
| Max. Negotiated Rate |
$342.56 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| 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 Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.56
|
| Rate for Payer: Blue Shield of California Commercial |
$161.04
|
| Rate for Payer: Blue Shield of California Commercial |
$225.70
|
| Rate for Payer: Blue Shield of California EPN |
$180.56
|
| Rate for Payer: Blue Shield of California EPN |
$128.83
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$171.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$240.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$163.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$229.03
|
| Rate for Payer: Heritage Provider Network Senior |
$163.42
|
| Rate for Payer: Heritage Provider Network Senior |
$229.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$125.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$176.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$55.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
| 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: Aetna of CA Non-Gatekeeper |
$248.58
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.32
|
| Rate for Payer: Heritage Provider Network Senior |
$261.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.50
|
| Rate for Payer: Multiplan Commercial |
$289.50
|
|
|
HC COVID19 SCREEN POOL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900912262
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$342.56 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Commercial |
$77.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| 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 Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.56
|
| Rate for Payer: Blue Shield of California Commercial |
$12.20
|
| Rate for Payer: Blue Shield of California Commercial |
$235.46
|
| Rate for Payer: Blue Shield of California EPN |
$188.37
|
| Rate for Payer: Blue Shield of California EPN |
$9.76
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$250.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$238.93
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$238.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$184.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$289.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$55.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC CPAP/BIPAP/NIPPV - DAILY
|
Facility
|
OP
|
$726.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
900800110
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Adventist Health Commercial |
$145.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$448.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| 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 |
$326.70
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$471.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$281.64
|
| 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) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$346.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.40
|
| 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 |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
|
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: Aetna of CA Non-Gatekeeper |
$467.54
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$491.50
|
| Rate for Payer: Heritage Provider Network Senior |
$491.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.50
|
| Rate for Payer: Multiplan Commercial |
$544.50
|
|
|
HC C PARAPSILOSIS NAT
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 87481 59
|
| Hospital Charge Code |
900912493
|
|
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
|
|
|
HC C PARAPSILOSIS NAT
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 87481 59
|
| Hospital Charge Code |
900912493
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.42
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.04
|
| Rate for Payer: Heritage Provider Network Senior |
$65.61
|
| Rate for Payer: Heritage Provider Network Senior |
$47.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$50.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$90.10
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
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 Non-Gatekeeper |
$142.14
|
| 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 |
$347.00
|
| 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 |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$109.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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: Aetna of CA Non-Gatekeeper |
$148.12
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.71
|
| Rate for Payer: Heritage Provider Network Senior |
$155.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
|
|
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: Aetna of CA Non-Gatekeeper |
$1,466.39
|
| Rate for Payer: Cash Price |
$1,024.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,541.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,541.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$412.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.25
|
| Rate for Payer: Multiplan Commercial |
$1,707.75
|
|
|
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 Non-Gatekeeper |
$1,407.19
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$1,138.96
|
| 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 |
$1,024.65
|
| 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 Medicare Advantage |
$1,935.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,343.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,409.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,409.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,086.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$412.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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: Aetna of CA Non-Gatekeeper |
$24.47
|
| Rate for Payer: Cash Price |
$17.10
|
| 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 Foundation Hospitals 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 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 |
$2,876.94 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,876.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,109.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.96
|
| 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 |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,876.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,109.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,917.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,917.96
|
| 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) Medicare Advantage |
$1,917.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,205.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,570.07
|
| 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 |
$2,876.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,109.76
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.96
|
|
|
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: Aetna of CA Non-Gatekeeper |
$64.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Senior |
$67.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
|
