|
HC DRUGS OF ABUSE SCREEN,URINE(7)
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912161
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$585.08 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Adventist Health Commercial |
$225.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$695.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.08
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$731.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$157.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$696.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.80
|
| Rate for Payer: Heritage Provider Network Senior |
$696.99
|
| Rate for Payer: Heritage Provider Network Senior |
$149.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$537.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$115.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$203.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$844.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRVVT
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
900912008
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$90.83 |
| Rate for Payer: Blue Shield of California EPN |
$61.77
|
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.83
|
| Rate for Payer: Blue Shield of California Commercial |
$77.01
|
| Rate for Payer: Blue Shield of California Commercial |
$77.01
|
| Rate for Payer: Blue Shield of California EPN |
$61.77
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$110.18
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$84.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.84
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.58
|
| Rate for Payer: TriValley Medical Group Senior |
$9.58
|
| Rate for Payer: TriValley Medical Group Senior |
$9.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Vantage Medical Group Senior |
$9.58
|
| Rate for Payer: Vantage Medical Group Senior |
$9.58
|
|
|
HC DRVVT
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
900912008
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.63
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.51
|
| Rate for Payer: Heritage Provider Network Senior |
$120.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
|
|
HC DRVVT CONFIRM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
900912009
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.63
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.51
|
| Rate for Payer: Heritage Provider Network Senior |
$120.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
|
|
HC DRVVT CONFIRM
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
900912009
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$90.83 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.83
|
| Rate for Payer: Blue Shield of California Commercial |
$77.01
|
| Rate for Payer: Blue Shield of California Commercial |
$77.01
|
| Rate for Payer: Blue Shield of California EPN |
$61.77
|
| Rate for Payer: Blue Shield of California EPN |
$61.77
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$110.18
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$84.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.84
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.58
|
| Rate for Payer: TriValley Medical Group Senior |
$9.58
|
| Rate for Payer: TriValley Medical Group Senior |
$9.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Vantage Medical Group Senior |
$9.58
|
| Rate for Payer: Vantage Medical Group Senior |
$9.58
|
|
|
HC DSCHG RCP EDU TRAINING EA 30MN
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
900898960
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$61.50 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.81
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.51
|
| Rate for Payer: Heritage Provider Network Senior |
$55.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
|
|
HC DSCHG RCP EDU TRAINING EA 30MN
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
900898960
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| 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 |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.76
|
| Rate for Payer: Heritage Provider Network Senior |
$50.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$39.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| 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 |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC DSDNAIGG
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
900913703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$130.46 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.46
|
| Rate for Payer: Blue Shield of California Commercial |
$110.59
|
| Rate for Payer: Blue Shield of California Commercial |
$110.59
|
| Rate for Payer: Blue Shield of California EPN |
$88.70
|
| Rate for Payer: Blue Shield of California EPN |
$88.70
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.41
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.74
|
| Rate for Payer: TriValley Medical Group Senior |
$13.74
|
| Rate for Payer: TriValley Medical Group Senior |
$13.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Vantage Medical Group Senior |
$13.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13.74
|
|
|
HC DSDNAIGG
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
900913703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.59
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
|
|
HC DSTRCTN NEORLTC AGT TRGMNL NRV
|
Facility
|
IP
|
$2,471.00
|
|
|
Service Code
|
CPT 64600
|
| Hospital Charge Code |
909004600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$447.25 |
| Max. Negotiated Rate |
$1,853.25 |
| Rate for Payer: Adventist Health Commercial |
$494.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,591.32
|
| Rate for Payer: Cash Price |
$1,111.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,672.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,672.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$447.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.75
|
| Rate for Payer: Multiplan Commercial |
$1,853.25
|
|
|
HC DSTRCTN NEORLTC AGT TRGMNL NRV
|
Facility
|
OP
|
$2,471.00
|
|
|
Service Code
|
CPT 64600
|
| Hospital Charge Code |
909004600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$447.25 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$494.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,527.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| 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 |
$1,111.95
|
| Rate for Payer: Cash Price |
$1,111.95
|
| Rate for Payer: Cash Price |
$1,111.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,606.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,529.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,161.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$447.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$1,853.25
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,251.34
|
| Rate for Payer: TriValley Medical Group Senior |
$1,251.34
|
| 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 |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC D TEST
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912427
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$65.39 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.39
|
| Rate for Payer: Blue Shield of California Commercial |
$55.47
|
| Rate for Payer: Blue Shield of California Commercial |
$55.47
|
| Rate for Payer: Blue Shield of California EPN |
$44.49
|
| Rate for Payer: Blue Shield of California EPN |
$44.49
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$101.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.57
|
| Rate for Payer: Heritage Provider Network Senior |
$96.56
|
| Rate for Payer: Heritage Provider Network Senior |
$44.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$74.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$34.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.02
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Senior |
$7.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7.48
|
|
|
HC D TEST
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912427
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.24 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.46
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.61
|
| Rate for Payer: Heritage Provider Network Senior |
$105.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
|
|
HC DT VACCINE IM LT 7 YRS
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 90702
|
| Hospital Charge Code |
900501449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.57
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.65
|
| Rate for Payer: Heritage Provider Network Senior |
$42.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
|
|
HC DT VACCINE IM LT 7 YRS
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 90702
|
| Hospital Charge Code |
900501449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$53.55 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.24
|
| Rate for Payer: Blue Shield of California Commercial |
$38.43
|
| Rate for Payer: Blue Shield of California EPN |
$30.74
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.00
|
| Rate for Payer: Heritage Provider Network Senior |
$39.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$30.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$44.10
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.55
|
| Rate for Payer: Vantage Medical Group Senior |
$53.55
|
|
|
HC DUCTOGRAM/ASPIRATION-2 OR MORE
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
909001446
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$205.25 |
| Max. Negotiated Rate |
$995.01 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$700.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$995.01
|
| Rate for Payer: Blue Shield of California Commercial |
$316.32
|
| Rate for Payer: Blue Shield of California EPN |
$254.37
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$737.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$669.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$701.95
|
| Rate for Payer: Heritage Provider Network Senior |
$701.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$540.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$850.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.88
|
| Rate for Payer: TriValley Medical Group Senior |
$306.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC DUCTOGRAM/ASPIRATION-2 OR MORE
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
909001446
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$205.25 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$730.30
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$767.72
|
| Rate for Payer: Heritage Provider Network Senior |
$767.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$850.50
|
|
|
HC DUCTOGRAM/ASPIRATION- SINGLE
|
Facility
|
IP
|
$1,034.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
909001433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.15 |
| Max. Negotiated Rate |
$775.50 |
| Rate for Payer: Adventist Health Commercial |
$206.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$665.90
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$700.02
|
| Rate for Payer: Heritage Provider Network Senior |
$700.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$187.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.50
|
| Rate for Payer: Multiplan Commercial |
$775.50
|
|
|
HC DUCTOGRAM/ASPIRATION- SINGLE
|
Facility
|
OP
|
$1,034.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
909001433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.88 |
| Max. Negotiated Rate |
$775.50 |
| Rate for Payer: Adventist Health Commercial |
$206.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$639.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$715.03
|
| Rate for Payer: Blue Shield of California Commercial |
$119.23
|
| Rate for Payer: Blue Shield of California EPN |
$95.88
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$672.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$610.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$640.05
|
| Rate for Payer: Heritage Provider Network Senior |
$640.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$493.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$187.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$775.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.88
|
| Rate for Payer: TriValley Medical Group Senior |
$306.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC DUPLEX ABD PELVIS SCROTAL CONTENTS AND OR RETROPERI ORGANS LIMITED
|
Facility
|
IP
|
$2,068.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
906601559
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$374.31 |
| Max. Negotiated Rate |
$1,551.00 |
| Rate for Payer: Adventist Health Commercial |
$413.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,331.79
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,400.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$374.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.00
|
| Rate for Payer: Multiplan Commercial |
$1,551.00
|
|
|
HC DUPLEX ABD PELVIS SCROTAL CONTENTS AND OR RETROPERI ORGANS LIMITED
|
Facility
|
OP
|
$2,068.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
906601559
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,551.00 |
| Rate for Payer: Adventist Health Commercial |
$413.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,278.02
|
| 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 |
$1,034.41
|
| Rate for Payer: Blue Shield of California Commercial |
$661.44
|
| Rate for Payer: Blue Shield of California EPN |
$531.91
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,344.20
|
| 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 |
$1,220.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,280.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,280.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$986.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$374.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,551.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.91
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| 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 DUPLEX SCAN AORTA/VENA CAVA
|
Facility
|
IP
|
$2,256.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
906601159
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$408.34 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,452.86
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,527.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,527.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
|
|
HC DUPLEX SCAN AORTA/VENA CAVA
|
Facility
|
OP
|
$2,256.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
906601159
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: TriValley Medical Group Senior |
$306.88
|
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,394.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,128.45
|
| Rate for Payer: Blue Shield of California Commercial |
$732.19
|
| Rate for Payer: Blue Shield of California EPN |
$588.80
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,466.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,396.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,396.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,076.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$337.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC DUPLX EXT VEIN BILAT
|
Facility
|
IP
|
$1,858.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
908100110
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$336.30 |
| Max. Negotiated Rate |
$1,393.50 |
| Rate for Payer: Adventist Health Commercial |
$371.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,196.55
|
| Rate for Payer: Cash Price |
$836.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,257.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,257.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$336.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.50
|
| Rate for Payer: Multiplan Commercial |
$1,393.50
|
|
|
HC DUPLX EXT VEIN BILAT
|
Facility
|
OP
|
$1,858.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
908100110
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$1,393.50 |
| Rate for Payer: Adventist Health Commercial |
$371.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,148.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$929.37
|
| Rate for Payer: Blue Shield of California Commercial |
$813.26
|
| Rate for Payer: Blue Shield of California EPN |
$654.00
|
| Rate for Payer: Cash Price |
$836.10
|
| Rate for Payer: Cash Price |
$836.10
|
| Rate for Payer: Cash Price |
$836.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,207.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,096.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,150.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,150.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$886.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$336.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,393.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$337.57
|
| Rate for Payer: TriValley Medical Group Senior |
$306.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
