|
HC HCV RNA QUANT
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$116.38 |
| Max. Negotiated Rate |
$482.25 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$353.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$435.31
|
| Rate for Payer: Heritage Provider Network Senior |
$435.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.75
|
| Rate for Payer: Multiplan Commercial |
$482.25
|
|
|
HC HCV RNA QUANT PCR TEST
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
|
|
HC HCV RNA QUANT PCR TEST
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$344.74 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$85.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.20
|
| Rate for Payer: Blue Shield of California Commercial |
$344.74
|
| Rate for Payer: Blue Shield of California EPN |
$276.51
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$104.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.04
|
| Rate for Payer: Heritage Provider Network Senior |
$99.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$76.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.98
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC HEAD ECHO
|
Facility
|
OP
|
$1,084.00
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
906601400
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$813.00 |
| Rate for Payer: Adventist Health Commercial |
$216.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$579.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$744.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$300.43
|
| Rate for Payer: Blue Shield of California EPN |
$241.60
|
| Rate for Payer: Cash Price |
$596.20
|
| Rate for Payer: Cash Price |
$596.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$704.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$671.00
|
| Rate for Payer: Heritage Provider Network Senior |
$671.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$517.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$813.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC HEAD ECHO
|
Facility
|
IP
|
$1,084.00
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
906601400
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$813.00 |
| Rate for Payer: Adventist Health Commercial |
$216.80
|
| Rate for Payer: Cash Price |
$596.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$733.87
|
| Rate for Payer: Heritage Provider Network Senior |
$733.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.00
|
| Rate for Payer: Multiplan Commercial |
$813.00
|
|
|
HC HEART CATH CONGENITAL R & L
|
Facility
|
OP
|
$6,869.00
|
|
|
Service Code
|
CPT 93531
|
| Hospital Charge Code |
906811251
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,243.29 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$1,373.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,719.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,838.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,777.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,151.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,838.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,838.65
|
| Rate for Payer: Dignity Health Senior |
$5,838.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,464.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,251.91
|
| Rate for Payer: Heritage Provider Network Senior |
$4,251.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,276.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,243.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,808.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,808.30
|
| Rate for Payer: Multiplan Commercial |
$5,151.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,434.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,434.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,838.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,838.65
|
| Rate for Payer: Vantage Medical Group Senior |
$5,838.65
|
|
|
HC HEART CATH CONGENITAL R & L
|
Facility
|
IP
|
$6,869.00
|
|
|
Service Code
|
CPT 93531
|
| Hospital Charge Code |
906811251
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,243.29 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,373.80
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,243.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.25
|
| Rate for Payer: Multiplan Commercial |
$5,151.75
|
|
|
HC HEART CATH CONGENITAL RT
|
Facility
|
OP
|
$6,869.00
|
|
|
Service Code
|
CPT 93530
|
| Hospital Charge Code |
906811250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,243.29 |
| Max. Negotiated Rate |
$9,354.00 |
| Rate for Payer: Adventist Health Commercial |
$1,373.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,719.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,838.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,777.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,151.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| 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 |
$3,777.95
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,838.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,838.65
|
| Rate for Payer: Dignity Health Senior |
$5,838.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,464.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,251.91
|
| Rate for Payer: Heritage Provider Network Senior |
$4,251.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,276.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,243.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,808.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,808.30
|
| Rate for Payer: Multiplan Commercial |
$5,151.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,434.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,434.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,838.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,838.65
|
| Rate for Payer: Vantage Medical Group Senior |
$5,838.65
|
|
|
HC HEART CATH CONGENITAL RT
|
Facility
|
IP
|
$6,869.00
|
|
|
Service Code
|
CPT 93530
|
| Hospital Charge Code |
906811250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,243.29 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,373.80
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,243.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.25
|
| Rate for Payer: Multiplan Commercial |
$5,151.75
|
|
|
HC HELIOX THERAPY PER DAY
|
Facility
|
OP
|
$2,615.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800410
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$1,961.25 |
| Rate for Payer: Adventist Health Commercial |
$523.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,397.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,796.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,595.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,276.12
|
| Rate for Payer: Cash Price |
$1,438.25
|
| Rate for Payer: Cash Price |
$1,438.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,699.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,699.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,618.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,618.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,247.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$1,961.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$218.68
|
| Rate for Payer: TriValley Medical Group Senior |
$198.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,307.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,307.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC HELIOX THERAPY PER DAY
|
Facility
|
IP
|
$2,615.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800410
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$473.31 |
| Max. Negotiated Rate |
$1,961.25 |
| Rate for Payer: Adventist Health Commercial |
$523.00
|
| Rate for Payer: Cash Price |
$1,438.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,770.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,770.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.75
|
| Rate for Payer: Multiplan Commercial |
$1,961.25
|
|
|
HC HEMATOCRIT HCT POC
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
900912115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$71.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$91.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.57
|
| Rate for Payer: Blue Shield of California Commercial |
$19.07
|
| Rate for Payer: Blue Shield of California EPN |
$15.29
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$86.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.61
|
| Rate for Payer: Dignity Health Senior |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.33
|
| Rate for Payer: Heritage Provider Network Senior |
$82.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$63.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.99
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.37
|
| Rate for Payer: TriValley Medical Group Senior |
$2.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Vantage Medical Group Senior |
$2.37
|
|
|
HC HEMATOCRIT HCT POC
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
900912115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.04
|
| Rate for Payer: Heritage Provider Network Senior |
$90.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
|
|
HC HEMATOPOIETIC PROGENITOR CELLS
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900912029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$79.82 |
| Max. Negotiated Rate |
$330.75 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.56
|
| Rate for Payer: Heritage Provider Network Senior |
$298.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.25
|
| Rate for Payer: Multiplan Commercial |
$330.75
|
|
|
HC HEMATOPOIETIC PROGENITOR CELLS
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900912029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$68.33 |
| Max. Negotiated Rate |
$685.59 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$235.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$302.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.12
|
| Rate for Payer: Blue Shield of California Commercial |
$269.52
|
| Rate for Payer: Blue Shield of California EPN |
$216.74
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$286.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Senior |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$457.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$272.98
|
| Rate for Payer: Heritage Provider Network Senior |
$272.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$210.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$575.90
|
| Rate for Payer: Multiplan Commercial |
$330.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$457.06
|
| Rate for Payer: TriValley Medical Group Senior |
$457.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC HEMECH-EPINEPHRINE
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900910197
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$333.75 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$237.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$305.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.63
|
| Rate for Payer: Blue Shield of California Commercial |
$172.86
|
| Rate for Payer: Blue Shield of California EPN |
$138.65
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$289.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Senior |
$24.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$275.45
|
| Rate for Payer: Heritage Provider Network Senior |
$275.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$212.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.39
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.91
|
| Rate for Payer: TriValley Medical Group Senior |
$24.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC HEMECH-EPINEPHRINE
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900910197
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$80.55 |
| Max. Negotiated Rate |
$333.75 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$301.26
|
| Rate for Payer: Heritage Provider Network Senior |
$301.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.25
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
|
|
HC HEMECH SCRN-ARACHEDONIC ACID A
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$250.49
|
| Rate for Payer: Heritage Provider Network Senior |
$250.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
|
|
HC HEMECH SCRN-ARACHEDONIC ACID A
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$197.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$254.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.63
|
| Rate for Payer: Blue Shield of California Commercial |
$172.86
|
| Rate for Payer: Blue Shield of California EPN |
$138.65
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$240.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Senior |
$24.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$229.03
|
| Rate for Payer: Heritage Provider Network Senior |
$229.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$176.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.39
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.91
|
| Rate for Payer: TriValley Medical Group Senior |
$24.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC HEMODIALYSIS, ONE EVALUATION
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
900501419
|
|
Hospital Revenue Code
|
821
|
| Min. Negotiated Rate |
$91.69 |
| Max. Negotiated Rate |
$1,484.25 |
| Rate for Payer: Adventist Health Commercial |
$395.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,057.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,359.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$889.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,207.19
|
| Rate for Payer: Blue Shield of California EPN |
$965.75
|
| Rate for Payer: Cash Price |
$1,088.45
|
| Rate for Payer: Cash Price |
$1,088.45
|
| Rate for Payer: Cash Price |
$1,088.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$900.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.97
|
| Rate for Payer: Dignity Health Senior |
$889.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,286.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$889.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,225.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,225.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$889.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$943.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,022.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,120.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,120.22
|
| Rate for Payer: Multiplan Commercial |
$1,484.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$977.97
|
| Rate for Payer: TriValley Medical Group Senior |
$889.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,081.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$913.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Vantage Medical Group Senior |
$889.06
|
|
|
HC HEMODIALYSIS, ONE EVALUATION
|
Facility
|
OP
|
$1,979.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
900501419
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$358.20 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$395.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,057.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,359.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$889.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$1,088.45
|
| Rate for Payer: Cash Price |
$1,088.45
|
| Rate for Payer: Cash Price |
$1,088.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,286.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.97
|
| Rate for Payer: Dignity Health Senior |
$889.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,286.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$889.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,339.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,339.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$889.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$943.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,022.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,120.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,120.22
|
| Rate for Payer: Multiplan Commercial |
$1,484.25
|
| Rate for Payer: Multiplan WC |
$1,416.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$712.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$655.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Vantage Medical Group Senior |
$889.06
|
|
|
HC HEMODIALYSIS, ONE EVALUATION
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
900501419
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$358.20 |
| Max. Negotiated Rate |
$1,484.25 |
| Rate for Payer: Adventist Health Commercial |
$395.80
|
| Rate for Payer: Cash Price |
$1,088.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,339.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,339.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.75
|
| Rate for Payer: Multiplan Commercial |
$1,484.25
|
|
|
HC HEMODIALYSIS, ONE EVALUATION
|
Facility
|
IP
|
$1,979.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
900501419
|
|
Hospital Revenue Code
|
821
|
| Min. Negotiated Rate |
$358.20 |
| Max. Negotiated Rate |
$1,484.25 |
| Rate for Payer: Adventist Health Commercial |
$395.80
|
| Rate for Payer: Cash Price |
$1,088.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,339.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,339.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.75
|
| Rate for Payer: Multiplan Commercial |
$1,484.25
|
|
|
HC HEMOGLOBIN A1C
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
900912128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.53 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.09
|
| Rate for Payer: Heritage Provider Network Senior |
$159.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.75
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
|
|
HC HEMOGLOBIN A1C
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
900912128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$125.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$161.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.63
|
| Rate for Payer: Blue Shield of California Commercial |
$78.11
|
| Rate for Payer: Blue Shield of California EPN |
$62.65
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$152.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.68
|
| Rate for Payer: Dignity Health Senior |
$9.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.47
|
| Rate for Payer: Heritage Provider Network Senior |
$145.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$112.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.23
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.71
|
| Rate for Payer: TriValley Medical Group Senior |
$9.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Vantage Medical Group Senior |
$9.71
|
|
