|
HC MRI PELVIS W & WO CONTRAST
|
Facility
|
IP
|
$5,607.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
908801352
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,205.25 |
| Rate for Payer: Adventist Health Commercial |
$1,121.40
|
| Rate for Payer: Cash Price |
$3,083.85
|
| Rate for Payer: Cash Price |
$3,083.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,795.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3,795.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,014.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,401.75
|
| Rate for Payer: Multiplan Commercial |
$4,205.25
|
|
|
HC MRI PROCEDURE
|
Facility
|
IP
|
$2,672.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$483.63 |
| Max. Negotiated Rate |
$2,004.00 |
| Rate for Payer: Adventist Health Commercial |
$534.40
|
| Rate for Payer: Cash Price |
$1,469.60
|
| Rate for Payer: Cash Price |
$1,469.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,808.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1,808.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$483.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.00
|
| Rate for Payer: Multiplan Commercial |
$2,004.00
|
|
|
HC MRI PROCEDURE
|
Facility
|
OP
|
$2,672.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
908801008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$2,004.00 |
| Rate for Payer: Adventist Health Commercial |
$534.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,428.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,835.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,629.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,303.94
|
| Rate for Payer: Cash Price |
$1,469.60
|
| Rate for Payer: Cash Price |
$1,469.60
|
| Rate for Payer: Cash Price |
$1,469.60
|
| Rate for Payer: Cash Price |
$1,469.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| 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) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,274.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$483.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$2,004.00
|
| 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 |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC MRI SPECTROSCOPY
|
Facility
|
OP
|
$3,474.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$2,605.50 |
| Rate for Payer: Adventist Health Commercial |
$694.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,856.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,386.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,309.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,857.01
|
| Rate for Payer: Cash Price |
$1,910.70
|
| Rate for Payer: Cash Price |
$1,910.70
|
| Rate for Payer: Cash Price |
$1,910.70
|
| Rate for Payer: Cash Price |
$1,910.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| 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) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,657.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$628.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$868.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$2,605.50
|
| 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 |
$666.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$666.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC MRI SPECTROSCOPY
|
Facility
|
IP
|
$3,474.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$628.79 |
| Max. Negotiated Rate |
$2,605.50 |
| Rate for Payer: Adventist Health Commercial |
$694.80
|
| Rate for Payer: Cash Price |
$1,910.70
|
| Rate for Payer: Cash Price |
$1,910.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,351.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,351.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$628.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$868.50
|
| Rate for Payer: Multiplan Commercial |
$2,605.50
|
|
|
HC MRI T-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$6,067.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,235.12 |
| Rate for Payer: Adventist Health Commercial |
$1,213.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,242.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,168.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Blue Shield of California Commercial |
$5,235.12
|
| Rate for Payer: Blue Shield of California EPN |
$4,209.91
|
| Rate for Payer: Cash Price |
$3,336.85
|
| Rate for Payer: Cash Price |
$3,336.85
|
| Rate for Payer: Cash Price |
$3,336.85
|
| Rate for Payer: Cash Price |
$3,336.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| 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 |
$508.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,893.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,098.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$4,550.25
|
| 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 |
$854.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$854.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRI T-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$6,067.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,550.25 |
| Rate for Payer: Adventist Health Commercial |
$1,213.40
|
| Rate for Payer: Cash Price |
$3,336.85
|
| Rate for Payer: Cash Price |
$3,336.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,107.36
|
| Rate for Payer: Heritage Provider Network Senior |
$4,107.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,098.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.75
|
| Rate for Payer: Multiplan Commercial |
$4,550.25
|
|
|
HC MRI UPPER EXTREM W/O CONT
|
Facility
|
IP
|
$3,480.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
908801413
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$629.88 |
| Max. Negotiated Rate |
$2,610.00 |
| Rate for Payer: Adventist Health Commercial |
$696.00
|
| Rate for Payer: Cash Price |
$1,914.00
|
| Rate for Payer: Cash Price |
$1,914.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,355.96
|
| Rate for Payer: Heritage Provider Network Senior |
$2,355.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.00
|
| Rate for Payer: Multiplan Commercial |
$2,610.00
|
|
|
HC MRI UPPER EXTREM W/O CONT
|
Facility
|
OP
|
$3,480.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
908801413
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$2,610.00 |
| Rate for Payer: Adventist Health Commercial |
$696.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,390.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2,326.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,871.10
|
| Rate for Payer: Cash Price |
$1,914.00
|
| Rate for Payer: Cash Price |
$1,914.00
|
| Rate for Payer: Cash Price |
$1,914.00
|
| Rate for Payer: Cash Price |
$1,914.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| 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 |
$491.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,659.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$2,610.00
|
| 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 |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MRI UPPER EXTREM W & WO CONT
|
Facility
|
IP
|
$4,727.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
908801411
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$855.59 |
| Max. Negotiated Rate |
$3,545.25 |
| Rate for Payer: Adventist Health Commercial |
$945.40
|
| Rate for Payer: Cash Price |
$2,599.85
|
| Rate for Payer: Cash Price |
$2,599.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,200.18
|
| Rate for Payer: Heritage Provider Network Senior |
$3,200.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$855.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,181.75
|
| Rate for Payer: Multiplan Commercial |
$3,545.25
|
|
|
HC MRI UPPER EXTREM W & WO CONT
|
Facility
|
OP
|
$4,727.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
908801411
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,167.15 |
| Rate for Payer: Adventist Health Commercial |
$945.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,247.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Blue Shield of California Commercial |
$5,167.15
|
| Rate for Payer: Blue Shield of California EPN |
$4,155.25
|
| Rate for Payer: Cash Price |
$2,599.85
|
| Rate for Payer: Cash Price |
$2,599.85
|
| Rate for Payer: Cash Price |
$2,599.85
|
| Rate for Payer: Cash Price |
$2,599.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| 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 |
$632.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,254.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$855.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,181.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$3,545.25
|
| 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 |
$854.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$854.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC MRSA DNA
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
900912328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$313.46 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$313.46
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.90
|
| Rate for Payer: Heritage Provider Network Senior |
$113.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$87.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC MRSA DNA
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
900912328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.57
|
| Rate for Payer: Heritage Provider Network Senior |
$124.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
|
|
HC MSI
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
CPT 81301
|
| Hospital Charge Code |
903800318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$224.80 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$248.40
|
| Rate for Payer: Cash Price |
$683.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$840.83
|
| Rate for Payer: Heritage Provider Network Senior |
$840.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.50
|
| Rate for Payer: Multiplan Commercial |
$931.50
|
|
|
HC MSI
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
CPT 81301
|
| Hospital Charge Code |
903800318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$224.80 |
| Max. Negotiated Rate |
$1,509.29 |
| Rate for Payer: Adventist Health Commercial |
$248.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$663.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$853.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$522.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$348.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,509.29
|
| Rate for Payer: Blue Shield of California Commercial |
$757.62
|
| Rate for Payer: Blue Shield of California EPN |
$606.10
|
| Rate for Payer: Cash Price |
$683.10
|
| Rate for Payer: Cash Price |
$683.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$807.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$522.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$383.42
|
| Rate for Payer: Dignity Health Senior |
$348.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$807.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$348.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$768.80
|
| Rate for Payer: Heritage Provider Network Senior |
$768.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$415.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$348.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$592.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$439.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$439.19
|
| Rate for Payer: Multiplan Commercial |
$931.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$348.56
|
| Rate for Payer: TriValley Medical Group Senior |
$348.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$376.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$522.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$383.42
|
| Rate for Payer: Vantage Medical Group Senior |
$348.56
|
|
|
HC MULTIFETAL PREG REDUCTION MPR
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 59866
|
| Hospital Charge Code |
910400094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$549.72
|
| Rate for Payer: Heritage Provider Network Senior |
$549.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
|
|
HC MULTIFETAL PREG REDUCTION MPR
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 59866
|
| Hospital Charge Code |
910400094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$434.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$557.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$495.32
|
| Rate for Payer: Blue Shield of California EPN |
$396.26
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Senior |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$386.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.63
|
| Rate for Payer: Heritage Provider Network Senior |
$502.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$387.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.99
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$406.00
|
| Rate for Payer: TriValley Medical Group Senior |
$406.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$406.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$406.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC MULTIFETAL PREG REDUCTION MPR ADDL FETUS
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 59866
|
| Hospital Charge Code |
910400095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$549.72
|
| Rate for Payer: Heritage Provider Network Senior |
$549.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
|
|
HC MULTIFETAL PREG REDUCTION MPR ADDL FETUS
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 59866
|
| Hospital Charge Code |
910400095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$434.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$557.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$495.32
|
| Rate for Payer: Blue Shield of California EPN |
$396.26
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Senior |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$386.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.63
|
| Rate for Payer: Heritage Provider Network Senior |
$502.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$387.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.99
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$406.00
|
| Rate for Payer: TriValley Medical Group Senior |
$406.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$406.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$406.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC MULTIHANCE PER ML
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT A9577
|
| Hospital Charge Code |
900009577
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
|
|
HC MULTIHANCE PER ML
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT A9577
|
| Hospital Charge Code |
900009577
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.78
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Senior |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC MULTI-PLANAR RECON
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
909201350
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$110.77 |
| Max. Negotiated Rate |
$1,024.00 |
| Rate for Payer: Adventist Health Commercial |
$122.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$420.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$520.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$459.00
|
| Rate for Payer: Blue Shield of California Commercial |
$704.40
|
| Rate for Payer: Blue Shield of California EPN |
$566.46
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$520.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$520.20
|
| Rate for Payer: Dignity Health Senior |
$520.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$291.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$428.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$428.40
|
| Rate for Payer: Multiplan Commercial |
$459.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$306.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$306.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$520.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$520.20
|
| Rate for Payer: Vantage Medical Group Senior |
$520.20
|
|
|
HC MULTI-PLANAR RECON
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
909201350
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$110.77 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$122.40
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.32
|
| Rate for Payer: Heritage Provider Network Senior |
$414.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.00
|
| Rate for Payer: Multiplan Commercial |
$459.00
|
|
|
HC MUMPS AB
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900913533
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC MUMPS AB
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900913533
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$106.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.41
|
| Rate for Payer: Blue Shield of California Commercial |
$105.00
|
| Rate for Payer: Blue Shield of California EPN |
$84.22
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Senior |
$13.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.44
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.05
|
| Rate for Payer: TriValley Medical Group Senior |
$13.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
