|
HC LIQUID COILS
|
Facility
|
IP
|
$1,030.40
|
|
| Hospital Charge Code |
909081813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.08 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$206.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$494.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$414.22
|
| Rate for Payer: Blue Shield of California EPN |
$414.22
|
| Rate for Payer: Cash Price |
$566.72
|
| Rate for Payer: Cash Price |
$566.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$473.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$556.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$477.08
|
| Rate for Payer: Heritage Provider Network Senior |
$477.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$515.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$372.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$341.17
|
|
|
HC LIQUID COILS
|
Facility
|
OP
|
$1,030.40
|
|
| Hospital Charge Code |
909081813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.08 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$206.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$494.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$707.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$875.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$772.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$414.22
|
| Rate for Payer: Blue Shield of California EPN |
$414.22
|
| Rate for Payer: Cash Price |
$566.72
|
| Rate for Payer: Cash Price |
$566.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$473.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$875.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$875.84
|
| Rate for Payer: Dignity Health Senior |
$875.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$477.08
|
| Rate for Payer: Heritage Provider Network Senior |
$477.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$515.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$721.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$721.28
|
| Rate for Payer: Multiplan Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$372.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$341.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$875.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$875.84
|
| Rate for Payer: Vantage Medical Group Senior |
$875.84
|
|
|
HC LITHIUM
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
900910332
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$63.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.86
|
| Rate for Payer: Heritage Provider Network Senior |
$77.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
|
|
HC LITHIUM
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
900910332
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.30
|
| Rate for Payer: Blue Shield of California Commercial |
$53.22
|
| Rate for Payer: Blue Shield of California EPN |
$42.69
|
| Rate for Payer: Cash Price |
$63.25
|
| Rate for Payer: Cash Price |
$63.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.27
|
| Rate for Payer: Dignity Health Senior |
$6.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.19
|
| Rate for Payer: Heritage Provider Network Senior |
$71.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$54.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.33
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.61
|
| Rate for Payer: TriValley Medical Group Senior |
$6.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.27
|
| Rate for Payer: Vantage Medical Group Senior |
$6.61
|
|
|
HC LITHOTRIPSY STENT ATHERECTOMY
|
Facility
|
IP
|
$46,704.00
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
906820315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,453.42 |
| Max. Negotiated Rate |
$35,028.00 |
| Rate for Payer: Adventist Health Commercial |
$9,340.80
|
| Rate for Payer: Cash Price |
$25,687.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$31,618.61
|
| Rate for Payer: Heritage Provider Network Senior |
$31,618.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,453.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,676.00
|
| Rate for Payer: Multiplan Commercial |
$35,028.00
|
|
|
HC LITHOTRIPSY STENT ATHERECTOMY
|
Facility
|
OP
|
$46,704.00
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
906820315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$9,340.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32,085.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$25,687.20
|
| Rate for Payer: Cash Price |
$25,687.20
|
| Rate for Payer: Cash Price |
$25,687.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$30,357.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,022.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,909.78
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,453.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,676.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$35,028.00
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$25,097.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC LITHOTRIPSY STENT ATHERECTOMY
|
Facility
|
OP
|
$41,959.00
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
906819767
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$8,391.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,825.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$23,077.45
|
| Rate for Payer: Cash Price |
$23,077.45
|
| Rate for Payer: Cash Price |
$23,077.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27,273.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,175.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,972.62
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,594.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,489.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$31,469.25
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$25,097.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC LITHOTRIPSY STENT ATHERECTOMY
|
Facility
|
IP
|
$41,959.00
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
906819767
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,594.58 |
| Max. Negotiated Rate |
$31,469.25 |
| Rate for Payer: Adventist Health Commercial |
$8,391.80
|
| Rate for Payer: Cash Price |
$23,077.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,406.24
|
| Rate for Payer: Heritage Provider Network Senior |
$28,406.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,594.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,489.75
|
| Rate for Payer: Multiplan Commercial |
$31,469.25
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$2,383.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$476.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,637.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,453.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,162.90
|
| Rate for Payer: Cash Price |
$1,310.65
|
| Rate for Payer: Cash Price |
$1,310.65
|
| Rate for Payer: Cash Price |
$1,310.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,548.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,475.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,475.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$272.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,136.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$595.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$1,787.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,058.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,058.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,191.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,191.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$2,383.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$431.32 |
| Max. Negotiated Rate |
$1,787.25 |
| Rate for Payer: Adventist Health Commercial |
$476.60
|
| Rate for Payer: Cash Price |
$1,310.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,613.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,613.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$595.75
|
| Rate for Payer: Multiplan Commercial |
$1,787.25
|
|
|
HC LIVER BIOPSY W OTHER PROC
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 47001
|
| Hospital Charge Code |
909000141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$182.09 |
| Max. Negotiated Rate |
$754.50 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Cash Price |
$553.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$681.06
|
| Rate for Payer: Heritage Provider Network Senior |
$681.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.50
|
| Rate for Payer: Multiplan Commercial |
$754.50
|
|
|
HC LIVER BIOPSY W OTHER PROC
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 47001
|
| Hospital Charge Code |
909000141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$691.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$855.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$553.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$754.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$553.30
|
| Rate for Payer: Cash Price |
$553.30
|
| Rate for Payer: Cash Price |
$553.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$653.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$855.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.10
|
| Rate for Payer: Dignity Health Senior |
$855.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$622.71
|
| Rate for Payer: Heritage Provider Network Senior |
$622.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$479.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$704.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$704.20
|
| Rate for Payer: Multiplan Commercial |
$754.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$855.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.10
|
| Rate for Payer: Vantage Medical Group Senior |
$855.10
|
|
|
HC LIVER SPECT
|
Facility
|
OP
|
$2,144.00
|
|
|
Service Code
|
CPT 78205
|
| Hospital Charge Code |
909301350
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$388.06 |
| Max. Negotiated Rate |
$1,822.40 |
| Rate for Payer: Adventist Health Commercial |
$428.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,145.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,472.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,822.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,179.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,608.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,307.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,046.27
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,393.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,822.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,822.40
|
| Rate for Payer: Dignity Health Senior |
$1,822.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,393.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,327.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,327.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,022.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.80
|
| Rate for Payer: Multiplan Commercial |
$1,608.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,072.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,072.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,822.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,822.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,822.40
|
|
|
HC LIVER SPECT
|
Facility
|
IP
|
$2,144.00
|
|
|
Service Code
|
CPT 78205
|
| Hospital Charge Code |
909301350
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$388.06 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Adventist Health Commercial |
$428.80
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,451.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,451.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.00
|
| Rate for Payer: Multiplan Commercial |
$1,608.00
|
|
|
HC LIVER/SPLEEN SCAN
|
Facility
|
OP
|
$1,627.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
909301351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$1,220.25 |
| Rate for Payer: Adventist Health Commercial |
$325.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$869.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,117.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$616.13
|
| Rate for Payer: Blue Shield of California EPN |
$495.47
|
| Rate for Payer: Cash Price |
$894.85
|
| Rate for Payer: Cash Price |
$894.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,057.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,057.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,007.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1,007.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$776.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$406.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$1,220.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$813.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$813.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC LIVER/SPLEEN SCAN
|
Facility
|
IP
|
$1,627.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
909301351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$294.49 |
| Max. Negotiated Rate |
$1,220.25 |
| Rate for Payer: Adventist Health Commercial |
$325.40
|
| Rate for Payer: Cash Price |
$894.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,101.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,101.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$406.75
|
| Rate for Payer: Multiplan Commercial |
$1,220.25
|
|
|
HC LIVER/SPLEEN VAS FLO
|
Facility
|
IP
|
$2,150.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
909301352
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$389.15 |
| Max. Negotiated Rate |
$1,612.50 |
| Rate for Payer: Adventist Health Commercial |
$430.00
|
| Rate for Payer: Cash Price |
$1,182.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,455.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,455.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.50
|
| Rate for Payer: Multiplan Commercial |
$1,612.50
|
|
|
HC LIVER/SPLEEN VAS FLO
|
Facility
|
OP
|
$2,150.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
909301352
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$184.36 |
| Max. Negotiated Rate |
$1,612.50 |
| Rate for Payer: Adventist Health Commercial |
$430.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,149.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,477.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$730.99
|
| Rate for Payer: Blue Shield of California EPN |
$587.84
|
| Rate for Payer: Cash Price |
$1,182.50
|
| Rate for Payer: Cash Price |
$1,182.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,397.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,397.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,330.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,330.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,025.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$1,612.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,075.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,075.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC LMA AIRWARY
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800911
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$62.99 |
| Max. Negotiated Rate |
$298.20 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$186.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$239.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Blue Shield of California Commercial |
$212.28
|
| Rate for Payer: Blue Shield of California EPN |
$169.82
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$226.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.41
|
| Rate for Payer: Heritage Provider Network Senior |
$215.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$166.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$218.68
|
| Rate for Payer: TriValley Medical Group Senior |
$198.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$174.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$174.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC LMA AIRWARY
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800911
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$62.99 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$235.60
|
| Rate for Payer: Heritage Provider Network Senior |
$235.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$261.00
|
|
|
HC LNGL FCTN STUDIES, AD TSTNG/ACOUSTIC TSTNG
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 92520
|
| Hospital Charge Code |
905625200
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$169.25
|
| Rate for Payer: Heritage Provider Network Senior |
$169.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.50
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
|
|
HC LNGL FCTN STUDIES, AD TSTNG/ACOUSTIC TSTNG
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 92520
|
| Hospital Charge Code |
905625200
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$102.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$133.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$162.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Senior |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$154.75
|
| Rate for Payer: Heritage Provider Network Senior |
$154.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$119.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.36
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC LOCALIZATION OF TUMOR PLANAR
|
Facility
|
OP
|
$904.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
909301253
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$163.62 |
| Max. Negotiated Rate |
$888.24 |
| Rate for Payer: Adventist Health Commercial |
$180.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$483.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$621.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$888.24
|
| Rate for Payer: Blue Shield of California EPN |
$714.29
|
| Rate for Payer: Cash Price |
$497.20
|
| Rate for Payer: Cash Price |
$497.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$587.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$587.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$559.58
|
| Rate for Payer: Heritage Provider Network Senior |
$559.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$214.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$431.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$678.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$452.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$452.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC LOCALIZATION OF TUMOR PLANAR
|
Facility
|
IP
|
$904.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
909301253
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$163.62 |
| Max. Negotiated Rate |
$678.00 |
| Rate for Payer: Adventist Health Commercial |
$180.80
|
| Rate for Payer: Cash Price |
$497.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$612.01
|
| Rate for Payer: Heritage Provider Network Senior |
$612.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.00
|
| Rate for Payer: Multiplan Commercial |
$678.00
|
|
|
HC LOCM (HEXABRIX) PER ML
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
909081002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Adventist Health Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.91
|
| Rate for Payer: Heritage Provider Network Senior |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$3.23
|
|
