|
HC MICROHEMATOCRIT SPUN BODY FLUID
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 85013
|
| Hospital Charge Code |
900910159
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.78
|
| Rate for Payer: Blue Shield of California Commercial |
$18.50
|
| Rate for Payer: Blue Shield of California EPN |
$14.46
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.70
|
| Rate for Payer: Dignity Health Senior |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.00
|
| Rate for Payer: TriValley Medical Group Senior |
$7.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Vantage Medical Group Senior |
$7.00
|
|
|
HC MICROWIRE MIRAGE
|
Facility
|
OP
|
$2,254.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.10 |
| Max. Negotiated Rate |
$1,915.90 |
| Rate for Payer: Adventist Health Commercial |
$450.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,548.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,915.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,239.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,690.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,399.73
|
| Rate for Payer: Blue Shield of California EPN |
$1,323.10
|
| Rate for Payer: Cash Price |
$1,014.30
|
| Rate for Payer: Cash Price |
$1,014.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,465.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,915.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,915.90
|
| Rate for Payer: Dignity Health Senior |
$1,915.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,465.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,395.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,395.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,086.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.50
|
| Rate for Payer: Multiplan Commercial |
$1,690.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,915.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,915.90
|
|
|
HC MICROWIRE MIRAGE
|
Facility
|
IP
|
$2,254.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.97 |
| Max. Negotiated Rate |
$1,690.50 |
| Rate for Payer: Adventist Health Commercial |
$450.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,548.50
|
| Rate for Payer: Cash Price |
$1,014.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,525.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,525.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.50
|
| Rate for Payer: Multiplan Commercial |
$1,690.50
|
|
|
HC MOD/TRAIN IN USE VOICE PROSTHE
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
905601759
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$46.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$269.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$198.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.50
|
| 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 |
$105.30
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$152.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$198.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.90
|
| Rate for Payer: Dignity Health Senior |
$198.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.85
|
| Rate for Payer: Heritage Provider Network Senior |
$144.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$112.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$175.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.90
|
| Rate for Payer: Vantage Medical Group Senior |
$198.90
|
|
|
HC MOD/TRAIN IN USE VOICE PROSTHE
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
905601759
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Adventist Health Commercial |
$46.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.76
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$158.42
|
| Rate for Payer: Heritage Provider Network Senior |
$158.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$175.50
|
|
|
HC MOD/TRAIN IN USE VOICE PROSTHE MCAL
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
907000029
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$269.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.75
|
| 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 |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$195.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.85
|
| Rate for Payer: Dignity Health Senior |
$255.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.32
|
| Rate for Payer: Heritage Provider Network Senior |
$186.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.25
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.85
|
| Rate for Payer: Vantage Medical Group Senior |
$255.85
|
|
|
HC MOD/TRAIN IN USE VOICE PROSTHE MCAL
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
907000029
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$225.75 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.79
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.78
|
| Rate for Payer: Heritage Provider Network Senior |
$203.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.25
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
|
|
HC MOD VOICE/AUG DVC MCAL
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000027
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.45 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$161.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.75
|
| 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 |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$148.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.65
|
| Rate for Payer: Dignity Health Senior |
$194.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.75
|
| Rate for Payer: Heritage Provider Network Senior |
$141.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.25
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.65
|
| Rate for Payer: Vantage Medical Group Senior |
$194.65
|
|
|
HC MOD VOICE/AUG DVC MCAL
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000027
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.45 |
| Max. Negotiated Rate |
$171.75 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.32
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.03
|
| Rate for Payer: Heritage Provider Network Senior |
$155.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.25
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
|
|
HC MOHC LNAR DISK
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
909001084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.36
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.02
|
| Rate for Payer: Heritage Provider Network Senior |
$23.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
|
|
HC MOHC LNAR DISK
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
909001084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.50
|
| Rate for Payer: Blue Shield of California Commercial |
$21.11
|
| Rate for Payer: Blue Shield of California EPN |
$19.96
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.90
|
| Rate for Payer: Dignity Health Senior |
$28.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.90
|
| Rate for Payer: Vantage Medical Group Senior |
$28.90
|
|
|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$377.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.66
|
| Rate for Payer: Heritage Provider Network Senior |
$392.66
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$279.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$210.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$193.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.66
|
| Rate for Payer: Heritage Provider Network Senior |
$392.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
|
|
HC MONOSPOT (INFECT. MONO TEST)
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900910867
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC MONOSPOT (INFECT. MONO TEST)
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900910867
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$43.28 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.28
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC MR ANGIO ABD W/O CONTRAST
|
Facility
|
IP
|
$4,176.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801089
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$755.86 |
| Max. Negotiated Rate |
$3,132.00 |
| Rate for Payer: Adventist Health Commercial |
$835.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,868.91
|
| Rate for Payer: Cash Price |
$1,879.20
|
| Rate for Payer: Cash Price |
$1,879.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,827.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,827.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$755.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.00
|
| Rate for Payer: Multiplan Commercial |
$3,132.00
|
|
|
HC MR ANGIO ABD W/O CONTRAST
|
Facility
|
OP
|
$5,640.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801089
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,794.00 |
| Rate for Payer: Adventist Health Commercial |
$1,128.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,874.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,794.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,102.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,230.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$2,538.00
|
| Rate for Payer: Cash Price |
$2,538.00
|
| Rate for Payer: Cash Price |
$2,538.00
|
| Rate for Payer: Cash Price |
$2,538.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,794.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,794.00
|
| Rate for Payer: Dignity Health Senior |
$4,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$517.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,718.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,020.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.00
|
| Rate for Payer: Multiplan Commercial |
$4,230.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$694.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$694.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,794.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,794.00
|
|
|
HC MR ANGIO CHEST W CONTRAST
|
Facility
|
IP
|
$5,420.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801090
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,065.00 |
| Rate for Payer: Adventist Health Commercial |
$1,084.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,723.54
|
| Rate for Payer: Cash Price |
$2,439.00
|
| Rate for Payer: Cash Price |
$2,439.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,669.34
|
| Rate for Payer: Heritage Provider Network Senior |
$3,669.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$981.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,355.00
|
| Rate for Payer: Multiplan Commercial |
$4,065.00
|
|
|
HC MR ANGIO CHEST W CONTRAST
|
Facility
|
OP
|
$5,295.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801090
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,500.75 |
| Rate for Payer: Adventist Health Commercial |
$1,059.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,637.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,500.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,912.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,971.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$2,382.75
|
| Rate for Payer: Cash Price |
$2,382.75
|
| Rate for Payer: Cash Price |
$2,382.75
|
| Rate for Payer: Cash Price |
$2,382.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,500.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,500.75
|
| Rate for Payer: Dignity Health Senior |
$4,500.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$514.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,552.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$958.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,323.75
|
| Rate for Payer: Multiplan Commercial |
$3,971.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$693.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$693.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,500.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,500.75
|
|
|
HC MR ANGIO CHEST W/O CONTRAST
|
Facility
|
IP
|
$4,065.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801091
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$735.76 |
| Max. Negotiated Rate |
$3,048.75 |
| Rate for Payer: Adventist Health Commercial |
$813.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,792.66
|
| Rate for Payer: Cash Price |
$1,829.25
|
| Rate for Payer: Cash Price |
$1,829.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,752.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,752.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$735.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,016.25
|
| Rate for Payer: Multiplan Commercial |
$3,048.75
|
|
|
HC MR ANGIO CHEST W/O CONTRAST
|
Facility
|
OP
|
$4,919.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801091
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,181.15 |
| Rate for Payer: Adventist Health Commercial |
$983.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,379.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,181.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,705.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,689.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$2,213.55
|
| Rate for Payer: Cash Price |
$2,213.55
|
| Rate for Payer: Cash Price |
$2,213.55
|
| Rate for Payer: Cash Price |
$2,213.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,181.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,181.15
|
| Rate for Payer: Dignity Health Senior |
$4,181.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$514.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,370.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$890.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,229.75
|
| Rate for Payer: Multiplan Commercial |
$3,689.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$693.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$693.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,181.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,181.15
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
IP
|
$7,055.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$5,291.25 |
| Rate for Payer: Adventist Health Commercial |
$1,411.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,846.78
|
| Rate for Payer: Cash Price |
$3,174.75
|
| Rate for Payer: Cash Price |
$3,174.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,776.24
|
| Rate for Payer: Heritage Provider Network Senior |
$4,776.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,276.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,763.75
|
| Rate for Payer: Multiplan Commercial |
$5,291.25
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
OP
|
$4,426.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,762.10 |
| Rate for Payer: Adventist Health Commercial |
$885.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,040.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,762.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,434.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,319.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$1,991.70
|
| Rate for Payer: Cash Price |
$1,991.70
|
| Rate for Payer: Cash Price |
$1,991.70
|
| Rate for Payer: Cash Price |
$1,991.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,762.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,762.10
|
| Rate for Payer: Dignity Health Senior |
$3,762.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$514.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,133.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,106.50
|
| Rate for Payer: Multiplan Commercial |
$3,319.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,762.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3,762.10
|
|
|
HC MR ANGIO LOW EXT WO CONT
|
Facility
|
IP
|
$7,055.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$5,291.25 |
| Rate for Payer: Adventist Health Commercial |
$1,411.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,846.78
|
| Rate for Payer: Cash Price |
$3,174.75
|
| Rate for Payer: Cash Price |
$3,174.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,776.24
|
| Rate for Payer: Heritage Provider Network Senior |
$4,776.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,276.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,763.75
|
| Rate for Payer: Multiplan Commercial |
$5,291.25
|
|
|
HC MR ANGIO LOW EXT WO CONT
|
Facility
|
OP
|
$4,048.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,440.80 |
| Rate for Payer: Adventist Health Commercial |
$809.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,780.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,226.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,036.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,440.80
|
| Rate for Payer: Dignity Health Senior |
$3,440.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$514.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,951.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$732.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.00
|
| Rate for Payer: Multiplan Commercial |
$3,036.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,440.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,440.80
|
|
