|
HC IMMUNOGLOBULINS IGG
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910857
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.63
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.51
|
| Rate for Payer: Heritage Provider Network Senior |
$120.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
|
|
HC IMMUNOGLOBULINS IGM
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910856
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$74.82 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.57
|
| Rate for Payer: Blue Shield of California Commercial |
$74.82
|
| Rate for Payer: Blue Shield of California Commercial |
$74.82
|
| Rate for Payer: Blue Shield of California EPN |
$60.01
|
| Rate for Payer: Blue Shield of California EPN |
$60.01
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.28
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$48.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$100.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.30
|
| Rate for Payer: TriValley Medical Group Senior |
$9.30
|
| Rate for Payer: TriValley Medical Group Senior |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC IMMUNOGLOBULINS IGM
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910856
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$135.24
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC IMMUNOHISTO ANTIBOD ADD SLID
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
903800241
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$543.00 |
| Rate for Payer: Adventist Health Commercial |
$144.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$466.26
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$490.15
|
| Rate for Payer: Heritage Provider Network Senior |
$490.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.00
|
| Rate for Payer: Multiplan Commercial |
$543.00
|
|
|
HC IMMUNOHISTO ANTIBOD ADD SLID
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
903800241
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$709.47 |
| Rate for Payer: Adventist Health Commercial |
$144.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$447.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$709.47
|
| Rate for Payer: Blue Shield of California Commercial |
$433.73
|
| Rate for Payer: Blue Shield of California EPN |
$348.79
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$470.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$461.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$448.16
|
| Rate for Payer: Heritage Provider Network Senior |
$448.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$345.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$530.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.77
|
| Rate for Payer: Multiplan Commercial |
$543.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$461.02
|
| Rate for Payer: TriValley Medical Group Senior |
$461.02
|
| 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 |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ABY STAIN
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
903800031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.51 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$107.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$391.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.51
|
| Rate for Payer: Blue Shield of California Commercial |
$200.83
|
| Rate for Payer: Blue Shield of California Commercial |
$200.83
|
| Rate for Payer: Blue Shield of California EPN |
$161.50
|
| Rate for Payer: Blue Shield of California EPN |
$161.50
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.45
|
| Rate for Payer: Heritage Provider Network Senior |
$107.71
|
| Rate for Payer: Heritage Provider Network Senior |
$392.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$83.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$302.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ABY STAIN
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
903800031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
|
|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ADDITIONAL ABY STAIN
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
903800252
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$86.70 |
| Max. Negotiated Rate |
$359.25 |
| Rate for Payer: Adventist Health Commercial |
$95.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$308.48
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.28
|
| Rate for Payer: Heritage Provider Network Senior |
$324.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.75
|
| Rate for Payer: Multiplan Commercial |
$359.25
|
|
|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ADDITIONAL ABY STAIN
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
903800252
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.53 |
| Max. Negotiated Rate |
$421.69 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.15
|
| Rate for Payer: Adventist Health Commercial |
$95.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$296.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$407.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$263.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.69
|
| Rate for Payer: Blue Shield of California Commercial |
$255.94
|
| Rate for Payer: Blue Shield of California EPN |
$205.82
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$311.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$407.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$407.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$296.50
|
| Rate for Payer: Heritage Provider Network Senior |
$296.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$228.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$335.30
|
| Rate for Payer: Multiplan Commercial |
$359.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$66.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$407.15
|
| Rate for Payer: Vantage Medical Group Senior |
$407.15
|
|
|
HC IMMUNOHISTOCHEM STAIN ER/PR
|
Facility
|
OP
|
$777.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
903800179
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$140.64 |
| Max. Negotiated Rate |
$582.75 |
| Rate for Payer: Adventist Health Commercial |
$155.40
|
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$480.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$353.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$353.74
|
| Rate for Payer: Blue Shield of California Commercial |
$257.42
|
| Rate for Payer: Blue Shield of California Commercial |
$257.42
|
| Rate for Payer: Blue Shield of California EPN |
$207.01
|
| Rate for Payer: Blue Shield of California EPN |
$207.01
|
| Rate for Payer: Cash Price |
$349.65
|
| Rate for Payer: Cash Price |
$349.65
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$505.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$480.96
|
| Rate for Payer: Heritage Provider Network Senior |
$118.85
|
| Rate for Payer: Heritage Provider Network Senior |
$480.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$91.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$370.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$582.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC IMMUNOHISTOCHEM STAIN ER/PR
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
903800179
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$140.64 |
| Max. Negotiated Rate |
$582.75 |
| Rate for Payer: Adventist Health Commercial |
$155.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$500.39
|
| Rate for Payer: Cash Price |
$349.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$526.03
|
| Rate for Payer: Heritage Provider Network Senior |
$526.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.25
|
| Rate for Payer: Multiplan Commercial |
$582.75
|
|
|
HC IMMUNOTYPING
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900913720
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.03
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.96
|
| Rate for Payer: Heritage Provider Network Senior |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
|
|
HC IMMUNOTYPING
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900913720
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$212.09 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.09
|
| Rate for Payer: Blue Shield of California Commercial |
$179.77
|
| Rate for Payer: Blue Shield of California Commercial |
$179.77
|
| Rate for Payer: Blue Shield of California EPN |
$144.19
|
| Rate for Payer: Blue Shield of California EPN |
$144.19
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$14.24
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.94
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.34
|
| Rate for Payer: TriValley Medical Group Senior |
$22.34
|
| Rate for Payer: TriValley Medical Group Senior |
$22.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Vantage Medical Group Senior |
$22.34
|
| Rate for Payer: Vantage Medical Group Senior |
$22.34
|
|
|
HC IMMUNOTYPING ELECTROPHORESIS
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900913611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$252.75 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$217.03
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$228.15
|
| Rate for Payer: Heritage Provider Network Senior |
$228.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.25
|
| Rate for Payer: Multiplan Commercial |
$252.75
|
|
|
HC IMMUNOTYPING ELECTROPHORESIS
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900913611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$252.75 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$208.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.09
|
| Rate for Payer: Blue Shield of California Commercial |
$179.77
|
| Rate for Payer: Blue Shield of California Commercial |
$179.77
|
| Rate for Payer: Blue Shield of California EPN |
$144.19
|
| Rate for Payer: Blue Shield of California EPN |
$144.19
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$127.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$219.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.60
|
| Rate for Payer: Heritage Provider Network Senior |
$121.32
|
| Rate for Payer: Heritage Provider Network Senior |
$208.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$93.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$160.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.94
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$252.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.34
|
| Rate for Payer: TriValley Medical Group Senior |
$22.34
|
| Rate for Payer: TriValley Medical Group Senior |
$22.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Vantage Medical Group Senior |
$22.34
|
| Rate for Payer: Vantage Medical Group Senior |
$22.34
|
|
|
HC IMPELLA LT ART VEN TRANS
|
Facility
|
OP
|
$12,136.00
|
|
|
Service Code
|
CPT 33991
|
| Hospital Charge Code |
906811991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,196.62 |
| Max. Negotiated Rate |
$12,185.00 |
| Rate for Payer: Adventist Health Commercial |
$2,427.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,500.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,315.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,674.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,102.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,185.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,551.84
|
| Rate for Payer: Blue Shield of California EPN |
$8,451.82
|
| Rate for Payer: Cash Price |
$5,461.20
|
| Rate for Payer: Cash Price |
$5,461.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,888.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,315.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,315.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,315.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,512.18
|
| Rate for Payer: Heritage Provider Network Senior |
$7,512.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,788.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,196.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,034.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,495.20
|
| Rate for Payer: Multiplan Commercial |
$9,102.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,315.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,315.60
|
| Rate for Payer: Vantage Medical Group Senior |
$10,315.60
|
|
|
HC IMPELLA LT ART VEN TRANS
|
Facility
|
IP
|
$12,136.00
|
|
|
Service Code
|
CPT 33991
|
| Hospital Charge Code |
906811991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,196.62 |
| Max. Negotiated Rate |
$9,102.00 |
| Rate for Payer: Adventist Health Commercial |
$2,427.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,815.58
|
| Rate for Payer: Cash Price |
$5,461.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,216.07
|
| Rate for Payer: Heritage Provider Network Senior |
$8,216.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,196.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,034.00
|
| Rate for Payer: Multiplan Commercial |
$9,102.00
|
|
|
HC IMPL AGA DUCT OCCL DEVICE
|
Facility
|
OP
|
$11,408.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,281.60 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$2,281.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,050.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,274.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,556.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,586.02
|
| Rate for Payer: Blue Shield of California EPN |
$4,586.02
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,247.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,696.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,696.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,301.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,281.90
|
| Rate for Payer: Heritage Provider Network Senior |
$5,281.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,704.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,704.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,704.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,852.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,985.60
|
| Rate for Payer: Multiplan Commercial |
$8,556.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,121.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,777.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,696.80
|
| Rate for Payer: Vantage Medical Group Senior |
$9,696.80
|
|
|
HC IMPL AGA DUCT OCCL DEVICE
|
Facility
|
IP
|
$11,408.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,281.60 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$2,281.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,346.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,586.02
|
| Rate for Payer: Blue Shield of California EPN |
$4,586.02
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,247.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,160.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,281.90
|
| Rate for Payer: Heritage Provider Network Senior |
$5,281.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,704.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,704.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,704.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,852.00
|
| Rate for Payer: Multiplan Commercial |
$8,556.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,121.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,777.19
|
|
|
HC IMPLANTABLE PORT FOR MEDS
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,001.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$651.24
|
| Rate for Payer: Blue Shield of California EPN |
$651.24
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$745.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,377.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,036.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$750.06
|
| Rate for Payer: Heritage Provider Network Senior |
$750.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$810.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$810.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$810.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$585.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$536.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC IMPLANTABLE PORT FOR MEDS
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,043.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$651.24
|
| Rate for Payer: Blue Shield of California EPN |
$651.24
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$745.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$750.06
|
| Rate for Payer: Heritage Provider Network Senior |
$750.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$810.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$810.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$810.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$585.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$536.38
|
|
|
HC IMPLANTED PERIONEAL PORT
|
Facility
|
OP
|
$28,856.00
|
|
|
Service Code
|
CPT 49419
|
| Hospital Charge Code |
909001457
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,158.00 |
| Max. Negotiated Rate |
$21,642.00 |
| Rate for Payer: Adventist Health Commercial |
$5,771.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,833.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$12,985.20
|
| Rate for Payer: Cash Price |
$12,985.20
|
| Rate for Payer: Cash Price |
$12,985.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,756.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,156.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,861.86
|
| Rate for Payer: Heritage Provider Network Senior |
$8,802.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,598.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,222.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,230.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,214.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$21,642.00
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,872.55
|
| Rate for Payer: TriValley Medical Group Senior |
$7,872.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC IMPLANTED PERIONEAL PORT
|
Facility
|
IP
|
$28,856.00
|
|
|
Service Code
|
CPT 49419
|
| Hospital Charge Code |
909001457
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,222.94 |
| Max. Negotiated Rate |
$21,642.00 |
| Rate for Payer: Adventist Health Commercial |
$5,771.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,583.26
|
| Rate for Payer: Cash Price |
$12,985.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,535.51
|
| Rate for Payer: Heritage Provider Network Senior |
$19,535.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,222.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,214.00
|
| Rate for Payer: Multiplan Commercial |
$21,642.00
|
|
|
HC IMPL DRESSING WOUND 3X3.5CM OASIS ULTRA
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT Q4124
|
| Hospital Charge Code |
900104052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$61.50 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.81
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.97
|
| Rate for Payer: Heritage Provider Network Senior |
$37.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.15
|
|
|
HC IMPL DRESSING WOUND 3X3.5CM OASIS ULTRA
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT Q4124
|
| Hospital Charge Code |
900104052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$240.09 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.87
|
| Rate for Payer: Blue Shield of California Commercial |
$50.02
|
| Rate for Payer: Blue Shield of California EPN |
$40.02
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.97
|
| Rate for Payer: Heritage Provider Network Senior |
$37.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$39.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$32.80
|
| Rate for Payer: TriValley Medical Group Senior |
$32.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
