|
HC MAXILLOFACIAL FIXATION
|
Facility
|
OP
|
$9,575.00
|
|
|
Service Code
|
CPT 21100
|
| Hospital Charge Code |
900501456
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$10,975.35 |
| Rate for Payer: Adventist Health Commercial |
$1,915.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,578.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$4,308.75
|
| Rate for Payer: Cash Price |
$4,308.75
|
| Rate for Payer: Cash Price |
$4,308.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,223.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: Dignity Health Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,482.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6,482.28
|
| Rate for Payer: Humana Medicare |
$7,316.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,615.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,733.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,633.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,393.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,219.29
|
| Rate for Payer: Multiplan Commercial |
$7,181.25
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,476.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,199.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
HC MAXILLOFACIAL FIXATION
|
Facility
|
IP
|
$9,575.00
|
|
|
Service Code
|
CPT 21100
|
| Hospital Charge Code |
900501456
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,733.08 |
| Max. Negotiated Rate |
$7,181.25 |
| Rate for Payer: Adventist Health Commercial |
$1,915.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,578.02
|
| Rate for Payer: Cash Price |
$4,308.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,482.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6,482.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,733.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,393.75
|
| Rate for Payer: Multiplan Commercial |
$7,181.25
|
|
|
HC MEASLES AB
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913530
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.15
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.11
|
| Rate for Payer: Heritage Provider Network Senior |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
|
|
HC MEASLES AB
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913530
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.86
|
| Rate for Payer: Blue Shield of California Commercial |
$100.62
|
| Rate for Payer: Blue Shield of California EPN |
$78.66
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.71
|
| Rate for Payer: Heritage Provider Network Senior |
$16.71
|
| Rate for Payer: Humana Medicare |
$12.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC MECHANICAL CHEST WALL OSCILL
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
900100003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$27.87 |
| Max. Negotiated Rate |
$506.33 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$85.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: Dignity Health Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$266.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.33
|
| Rate for Payer: Heritage Provider Network Senior |
$95.33
|
| Rate for Payer: Humana Medicare |
$266.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$506.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$314.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.78
|
| Rate for Payer: Multiplan Commercial |
$115.50
|
| 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 |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC MECHANICAL CHEST WALL OSCILL
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
900100003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$27.87 |
| Max. Negotiated Rate |
$115.50 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.80
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.26
|
| Rate for Payer: Heritage Provider Network Senior |
$104.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.50
|
| Rate for Payer: Multiplan Commercial |
$115.50
|
|
|
HC MECH CORO THROMBECTOMY UNLIST
|
Facility
|
IP
|
$12,895.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820328
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,334.00 |
| Max. Negotiated Rate |
$9,671.25 |
| Rate for Payer: Adventist Health Commercial |
$2,579.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,858.86
|
| Rate for Payer: Cash Price |
$5,802.75
|
| Rate for Payer: Cash Price |
$5,802.75
|
| 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 |
$2,334.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,223.75
|
| Rate for Payer: Multiplan Commercial |
$9,671.25
|
|
|
HC MECH CORO THROMBECTOMY UNLIST
|
Facility
|
OP
|
$12,895.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820328
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$9,671.25 |
| Rate for Payer: Adventist Health Commercial |
$2,579.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,892.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,858.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$5,802.75
|
| Rate for Payer: Cash Price |
$5,802.75
|
| Rate for Payer: Cash Price |
$5,802.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,381.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,982.00
|
| Rate for Payer: Heritage Provider Network Senior |
$240.06
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,334.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,223.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$9,671.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC MECKELS SCAN
|
Facility
|
IP
|
$1,798.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
909301366
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$325.44 |
| Max. Negotiated Rate |
$1,348.50 |
| Rate for Payer: Adventist Health Commercial |
$359.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,235.23
|
| Rate for Payer: Cash Price |
$809.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,217.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1,217.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.50
|
| Rate for Payer: Multiplan Commercial |
$1,348.50
|
|
|
HC MECKELS SCAN
|
Facility
|
OP
|
$1,798.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
909301366
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$168.70 |
| Max. Negotiated Rate |
$1,348.50 |
| Rate for Payer: Adventist Health Commercial |
$359.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$532.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,235.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$622.53
|
| Rate for Payer: Blue Shield of California EPN |
$354.01
|
| Rate for Payer: Cash Price |
$809.10
|
| Rate for Payer: Cash Price |
$809.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,168.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,168.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,112.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,112.96
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,348.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC MEDCOMP TEMP DIALYSIS CATH
|
Facility
|
OP
|
$441.60
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
909081724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$88.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$211.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$303.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$331.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$274.23
|
| Rate for Payer: Blue Shield of California EPN |
$259.22
|
| Rate for Payer: Cash Price |
$198.72
|
| Rate for Payer: Cash Price |
$198.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$203.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$375.36
|
| Rate for Payer: Dignity Health Senior |
$375.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.46
|
| Rate for Payer: Heritage Provider Network Senior |
$204.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$220.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.40
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$161.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$147.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$375.36
|
| Rate for Payer: Vantage Medical Group Senior |
$375.36
|
|
|
HC MEDCOMP TEMP DIALYSIS CATH
|
Facility
|
IP
|
$441.60
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
909081724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$88.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$211.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$303.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$198.72
|
| Rate for Payer: Cash Price |
$198.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$203.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.96
|
| Rate for Payer: Heritage Provider Network Senior |
$298.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$220.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.40
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$161.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$147.54
|
|
|
HC MENINGITIS PANEL NUCLEIC ACID
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
900913643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.65 |
| Max. Negotiated Rate |
$574.50 |
| Rate for Payer: Adventist Health Commercial |
$153.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$526.24
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$518.58
|
| Rate for Payer: Heritage Provider Network Senior |
$518.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.50
|
| Rate for Payer: Multiplan Commercial |
$574.50
|
|
|
HC MENINGITIS PANEL NUCLEIC ACID
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
900913643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.56 |
| Max. Negotiated Rate |
$3,195.91 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,182.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$442.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,920.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3,195.91
|
| Rate for Payer: Blue Shield of California EPN |
$2,498.42
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$418.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Senior |
$416.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$416.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$398.64
|
| Rate for Payer: Heritage Provider Network Senior |
$398.64
|
| Rate for Payer: Humana Medicare |
$416.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$577.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$791.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$491.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.14
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$416.78
|
| Rate for Payer: TriValley Medical Group Senior |
$416.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$450.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$450.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC MERCI BALLOON CATHETER
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.20 |
| Max. Negotiated Rate |
$1,902.75 |
| Rate for Payer: Adventist Health Commercial |
$507.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,742.92
|
| Rate for Payer: Cash Price |
$1,141.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,717.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,717.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.25
|
| Rate for Payer: Multiplan Commercial |
$1,902.75
|
|
|
HC MERCI BALLOON CATHETER
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$2,156.45 |
| Rate for Payer: Adventist Health Commercial |
$507.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,742.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,156.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,395.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,902.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,575.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,489.22
|
| Rate for Payer: Cash Price |
$1,141.65
|
| Rate for Payer: Cash Price |
$1,141.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,649.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,156.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,156.45
|
| Rate for Payer: Dignity Health Senior |
$2,156.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,649.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,570.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,570.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,222.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.25
|
| Rate for Payer: Multiplan Commercial |
$1,902.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,156.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,156.45
|
|
|
HC MERCI MICROCATHETER
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$374.67 |
| Max. Negotiated Rate |
$1,552.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,422.09
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,401.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,401.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.50
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
|
|
HC MERCI MICROCATHETER
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,422.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,138.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,552.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,285.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,215.09
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,345.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,759.50
|
| Rate for Payer: Dignity Health Senior |
$1,759.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,345.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,281.33
|
| Rate for Payer: Heritage Provider Network Senior |
$1,281.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$997.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.50
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,759.50
|
|
|
HC MERCI RETRIEVER
|
Facility
|
OP
|
$7,125.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909020000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$999.85 |
| Max. Negotiated Rate |
$6,056.25 |
| Rate for Payer: Adventist Health Commercial |
$1,425.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$999.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,894.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,056.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,918.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,343.75
|
| Rate for Payer: Blue Shield of California Commercial |
$4,424.62
|
| Rate for Payer: Blue Shield of California EPN |
$4,182.38
|
| Rate for Payer: Cash Price |
$3,206.25
|
| Rate for Payer: Cash Price |
$3,206.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,631.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,056.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,056.25
|
| Rate for Payer: Dignity Health Senior |
$6,056.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,631.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,410.38
|
| Rate for Payer: Heritage Provider Network Senior |
$4,410.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,434.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,289.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,781.25
|
| Rate for Payer: Multiplan Commercial |
$5,343.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,056.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,056.25
|
|
|
HC MERCI RETRIEVER
|
Facility
|
IP
|
$7,125.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909020000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,289.62 |
| Max. Negotiated Rate |
$5,343.75 |
| Rate for Payer: Adventist Health Commercial |
$1,425.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,894.88
|
| Rate for Payer: Cash Price |
$3,206.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,823.62
|
| Rate for Payer: Heritage Provider Network Senior |
$4,823.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,289.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,781.25
|
| Rate for Payer: Multiplan Commercial |
$5,343.75
|
|
|
HC METANEPHRINES FRACTIONATED UR
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900910288
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.48
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.77
|
| Rate for Payer: Heritage Provider Network Senior |
$115.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
|
|
HC METANEPHRINES FRACTIONATED UR
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900910288
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$141.84 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.84
|
| Rate for Payer: Blue Shield of California Commercial |
$132.32
|
| Rate for Payer: Blue Shield of California EPN |
$103.44
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Senior |
$16.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.24
|
| Rate for Payer: Heritage Provider Network Senior |
$40.24
|
| Rate for Payer: Humana Medicare |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.34
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.94
|
| Rate for Payer: TriValley Medical Group Senior |
$16.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC METANEPHRINE URINE 24 HOURS
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912209
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.48
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.77
|
| Rate for Payer: Heritage Provider Network Senior |
$115.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
|
|
HC METANEPHRINE URINE 24 HOURS
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912209
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$141.84 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.84
|
| Rate for Payer: Blue Shield of California Commercial |
$132.32
|
| Rate for Payer: Blue Shield of California EPN |
$103.44
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Senior |
$16.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.24
|
| Rate for Payer: Heritage Provider Network Senior |
$40.24
|
| Rate for Payer: Humana Medicare |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.34
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.94
|
| Rate for Payer: TriValley Medical Group Senior |
$16.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC METANEPHRINE URINE RANDOM
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.48
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.77
|
| Rate for Payer: Heritage Provider Network Senior |
$115.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
|
