|
HC GADOLINIUM MR CONTRAST PER ML
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT A9579
|
| Hospital Charge Code |
909081000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.97
|
|
|
HC GADOLINIUM MR CONTRAST PER ML
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT A9579
|
| Hospital Charge Code |
909081000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7.32
|
| Rate for Payer: Blue Shield of California EPN |
$5.86
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Senior |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Senior |
$5.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
HC GADOXETATE DISODIUM PER ML
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT A9581
|
| Hospital Charge Code |
908801701
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.41
|
| Rate for Payer: Heritage Provider Network Senior |
$70.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$34.43
|
|
|
HC GADOXETATE DISODIUM PER ML
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT A9581
|
| Hospital Charge Code |
908801701
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.00
|
| Rate for Payer: Blue Shield of California Commercial |
$63.44
|
| Rate for Payer: Blue Shield of California EPN |
$50.75
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.40
|
| Rate for Payer: Dignity Health Senior |
$88.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.38
|
| Rate for Payer: Heritage Provider Network Senior |
$64.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$34.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.40
|
| Rate for Payer: Vantage Medical Group Senior |
$88.40
|
|
|
HC GAIT TRAINING 15 MIN MCAL
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
900400037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$75.75 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$55.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.38
|
| Rate for Payer: Heritage Provider Network Senior |
$68.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
|
|
HC GAIT TRAINING 15 MIN MCAL
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
900400037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.27 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$41.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$55.55
|
| Rate for Payer: Cash Price |
$55.55
|
| Rate for Payer: Cash Price |
$55.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.85
|
| Rate for Payer: Dignity Health Senior |
$85.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.52
|
| Rate for Payer: Heritage Provider Network Senior |
$62.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.70
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| 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 |
$85.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.85
|
| Rate for Payer: Vantage Medical Group Senior |
$85.85
|
|
|
HC GAIT TRAINING 15 MIN PT
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
900417116
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$75.75 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$55.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.38
|
| Rate for Payer: Heritage Provider Network Senior |
$68.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
|
|
HC GAIT TRAINING 15 MIN PT
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
900417116
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.27 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$41.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$55.55
|
| Rate for Payer: Cash Price |
$55.55
|
| Rate for Payer: Cash Price |
$55.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.85
|
| Rate for Payer: Dignity Health Senior |
$85.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.52
|
| Rate for Payer: Heritage Provider Network Senior |
$62.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.70
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| 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 |
$85.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.85
|
| Rate for Payer: Vantage Medical Group Senior |
$85.85
|
|
|
HC GAIT TRAINING 15 MIN PT
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
905103143
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$75.75 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$55.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.38
|
| Rate for Payer: Heritage Provider Network Senior |
$68.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
|
|
HC GAIT TRAINING 15 MIN PT
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
905103143
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.27 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$41.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$55.55
|
| Rate for Payer: Cash Price |
$55.55
|
| Rate for Payer: Cash Price |
$55.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.85
|
| Rate for Payer: Dignity Health Senior |
$85.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.52
|
| Rate for Payer: Heritage Provider Network Senior |
$62.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.70
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| 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 |
$85.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.85
|
| Rate for Payer: Vantage Medical Group Senior |
$85.85
|
|
|
HC GAIT TRAINING 30 MIN PT
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
905103363
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$75.75 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$55.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.38
|
| Rate for Payer: Heritage Provider Network Senior |
$68.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
|
|
HC GAIT TRAINING 30 MIN PT
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
905103363
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.27 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$41.41
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$55.55
|
| Rate for Payer: Cash Price |
$55.55
|
| Rate for Payer: Cash Price |
$55.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.85
|
| Rate for Payer: Dignity Health Senior |
$85.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.52
|
| Rate for Payer: Heritage Provider Network Senior |
$62.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.70
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| 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 |
$85.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.85
|
| Rate for Payer: Vantage Medical Group Senior |
$85.85
|
|
|
HC GALLBLDR/LIVER FUNC
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
909301353
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$429.88 |
| Max. Negotiated Rate |
$2,216.85 |
| Rate for Payer: Adventist Health Commercial |
$475.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,269.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,631.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,216.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,739.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,398.79
|
| Rate for Payer: Cash Price |
$1,306.25
|
| Rate for Payer: Cash Price |
$1,306.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,543.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,543.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,470.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1,470.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$471.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,132.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$1,781.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,187.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC GALLBLDR/LIVER FUNC
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
909301353
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$429.88 |
| Max. Negotiated Rate |
$1,781.25 |
| Rate for Payer: Adventist Health Commercial |
$475.00
|
| Rate for Payer: Cash Price |
$1,306.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,607.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,607.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.75
|
| Rate for Payer: Multiplan Commercial |
$1,781.25
|
|
|
HC GALLIUM SCAN LIMITED
|
Facility
|
OP
|
$1,413.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
909301446
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$144.37 |
| Max. Negotiated Rate |
$1,059.75 |
| Rate for Payer: Adventist Health Commercial |
$282.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$755.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$970.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$714.82
|
| Rate for Payer: Blue Shield of California EPN |
$574.83
|
| Rate for Payer: Cash Price |
$777.15
|
| Rate for Payer: Cash Price |
$777.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$918.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$918.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.65
|
| Rate for Payer: Heritage Provider Network Senior |
$874.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$144.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$674.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$1,059.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$706.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$706.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC GALLIUM SCAN LIMITED
|
Facility
|
IP
|
$1,413.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
909301446
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$255.75 |
| Max. Negotiated Rate |
$1,059.75 |
| Rate for Payer: Adventist Health Commercial |
$282.60
|
| Rate for Payer: Cash Price |
$777.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$956.60
|
| Rate for Payer: Heritage Provider Network Senior |
$956.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.25
|
| Rate for Payer: Multiplan Commercial |
$1,059.75
|
|
|
HC GAMMA GLUTAMYL TRANSFERASE
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
900910225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.01
|
| Rate for Payer: Blue Shield of California Commercial |
$57.95
|
| Rate for Payer: Blue Shield of California EPN |
$46.48
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.92
|
| Rate for Payer: Dignity Health Senior |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.07
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: Vantage Medical Group Senior |
$7.20
|
|
|
HC GAMMA GLUTAMYL TRANSFERASE
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
900910225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC GASTRIC EMPTYING
|
Facility
|
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
909301364
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$416.84 |
| Max. Negotiated Rate |
$1,727.25 |
| Rate for Payer: Adventist Health Commercial |
$460.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,230.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,582.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$868.03
|
| Rate for Payer: Blue Shield of California EPN |
$698.04
|
| Rate for Payer: Cash Price |
$1,266.65
|
| Rate for Payer: Cash Price |
$1,266.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,496.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,496.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,425.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1,425.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$478.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,098.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$575.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$1,727.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,151.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,151.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC GASTRIC EMPTYING
|
Facility
|
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
909301364
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$416.84 |
| Max. Negotiated Rate |
$1,727.25 |
| Rate for Payer: Adventist Health Commercial |
$460.60
|
| Rate for Payer: Cash Price |
$1,266.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,559.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,559.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$575.75
|
| Rate for Payer: Multiplan Commercial |
$1,727.25
|
|
|
HC GASTRIC INTUB W/ASPIRATIOIN
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$625.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$501.05
|
| Rate for Payer: Cash Price |
$501.05
|
| Rate for Payer: Cash Price |
$501.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$592.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Senior |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$395.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$616.75
|
| Rate for Payer: Heritage Provider Network Senior |
$616.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$434.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$455.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$498.53
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
| Rate for Payer: Multiplan WC |
$630.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$327.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$301.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC GASTRIC INTUB W/ASPIRATIOIN
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
900501762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.89 |
| Max. Negotiated Rate |
$683.25 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Cash Price |
$501.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$616.75
|
| Rate for Payer: Heritage Provider Network Senior |
$616.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.75
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
|
|
HC GASTRIC MOTIL MANOMETRC STUDY
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT 91020
|
| Hospital Charge Code |
906791020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$317.84 |
| Max. Negotiated Rate |
$1,317.00 |
| Rate for Payer: Adventist Health Commercial |
$351.20
|
| Rate for Payer: Cash Price |
$965.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.00
|
| Rate for Payer: Multiplan Commercial |
$1,317.00
|
|
|
HC GASTRIC MOTIL MANOMETRC STUDY
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT 91020
|
| Hospital Charge Code |
906791020
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$351.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,206.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| 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 |
$965.80
|
| Rate for Payer: Cash Price |
$965.80
|
| Rate for Payer: Cash Price |
$965.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,141.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Senior |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,053.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$674.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,086.96
|
| Rate for Payer: Heritage Provider Network Senior |
$829.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$149.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$837.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$775.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$849.47
|
| Rate for Payer: Multiplan Commercial |
$1,317.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC GASTRODUODENOSTOMY
|
Facility
|
IP
|
$10,218.00
|
|
|
Service Code
|
CPT 43810
|
| Hospital Charge Code |
906743810
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,849.46 |
| Max. Negotiated Rate |
$7,663.50 |
| Rate for Payer: Adventist Health Commercial |
$2,043.60
|
| Rate for Payer: Cash Price |
$5,619.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,917.59
|
| Rate for Payer: Heritage Provider Network Senior |
$6,917.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,849.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,554.50
|
| Rate for Payer: Multiplan Commercial |
$7,663.50
|
|
