|
HC SOA 837 CEL MODY8 MUT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914773
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$515.25
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.75
|
| Rate for Payer: Heritage Provider Network Senior |
$507.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.50
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
|
|
HC SOA 837 CEL MODY8 MUT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914773
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$1,252.63 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$145.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$515.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,252.63
|
| Rate for Payer: Blue Shield of California Commercial |
$465.75
|
| Rate for Payer: Blue Shield of California EPN |
$440.25
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$487.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Senior |
$185.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$487.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$185.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$464.25
|
| Rate for Payer: Heritage Provider Network Senior |
$464.25
|
| Rate for Payer: Humana Medicare |
$185.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$288.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$351.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$218.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$233.35
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$185.20
|
| Rate for Payer: TriValley Medical Group Senior |
$185.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$200.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$200.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOA 885 MONOGEN EVL 81405
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914774
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$190.73 |
| Max. Negotiated Rate |
$1,972.62 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$255.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$301.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,972.62
|
| Rate for Payer: Blue Shield of California Commercial |
$654.38
|
| Rate for Payer: Blue Shield of California EPN |
$618.55
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$684.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$331.48
|
| Rate for Payer: Dignity Health Senior |
$301.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$301.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$652.27
|
| Rate for Payer: Heritage Provider Network Senior |
$652.27
|
| Rate for Payer: Humana Medicare |
$301.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$470.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$301.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$572.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$379.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$379.70
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$301.35
|
| Rate for Payer: TriValley Medical Group Senior |
$301.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$325.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$325.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$331.48
|
| Rate for Payer: Vantage Medical Group Senior |
$301.35
|
|
|
HC SOA 885 MONOGEN EVL 81405
|
Facility
|
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914774
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$190.73 |
| Max. Negotiated Rate |
$790.31 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.93
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$713.39
|
| Rate for Payer: Heritage Provider Network Senior |
$713.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
|
|
HC SOA 885 MONOGEN EVL 81406
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914775
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$145.45 |
| Max. Negotiated Rate |
$2,012.18 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$145.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,012.18
|
| Rate for Payer: Blue Shield of California Commercial |
$654.38
|
| Rate for Payer: Blue Shield of California EPN |
$618.55
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$684.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.17
|
| Rate for Payer: Dignity Health Senior |
$282.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$282.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$652.27
|
| Rate for Payer: Heritage Provider Network Senior |
$652.27
|
| Rate for Payer: Humana Medicare |
$282.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$441.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$282.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$537.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$333.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$356.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$356.43
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$282.88
|
| Rate for Payer: TriValley Medical Group Senior |
$282.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$305.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$305.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Vantage Medical Group Senior |
$282.88
|
|
|
HC SOA 885 MONOGEN EVL 81406
|
Facility
|
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914775
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$190.73 |
| Max. Negotiated Rate |
$790.31 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.93
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$713.39
|
| Rate for Payer: Heritage Provider Network Senior |
$713.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
|
|
HC SOA 885 MONOGEN EVL 81479
|
Facility
|
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914776
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$190.73 |
| Max. Negotiated Rate |
$790.31 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.93
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$713.39
|
| Rate for Payer: Heritage Provider Network Senior |
$713.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
|
|
HC SOA 885 MONOGEN EVL 81479
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914776
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$109.45 |
| Max. Negotiated Rate |
$895.69 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$895.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$579.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$790.31
|
| Rate for Payer: Blue Shield of California Commercial |
$654.38
|
| Rate for Payer: Blue Shield of California EPN |
$618.55
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$684.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$895.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$895.69
|
| Rate for Payer: Dignity Health Senior |
$895.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$652.27
|
| Rate for Payer: Heritage Provider Network Senior |
$652.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$507.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$895.69
|
| Rate for Payer: Vantage Medical Group Senior |
$895.69
|
|
|
HC SO ACROMIO/CLAVICULAR
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
901309109
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$119.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$114.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.57
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$124.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$124.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$90.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$83.19
|
|
|
HC SO ACROMIO/CLAVICULAR
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
901309109
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$119.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$154.63
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$114.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Senior |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.29
|
| Rate for Payer: Heritage Provider Network Senior |
$115.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$138.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$124.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$124.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$90.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$83.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC SOCC FANCONI COMPLEM ASSAY
|
Facility
|
OP
|
$1,699.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914675
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$109.45 |
| Max. Negotiated Rate |
$1,444.15 |
| Rate for Payer: Adventist Health Commercial |
$339.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,167.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,444.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$934.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,274.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,055.08
|
| Rate for Payer: Blue Shield of California EPN |
$997.31
|
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,104.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,444.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,444.15
|
| Rate for Payer: Dignity Health Senior |
$1,444.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,104.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,051.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,051.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$818.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.75
|
| Rate for Payer: Multiplan Commercial |
$1,274.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,444.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,444.15
|
|
|
HC SOCC FANCONI COMPLEM ASSAY
|
Facility
|
IP
|
$1,699.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914675
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$307.52 |
| Max. Negotiated Rate |
$1,274.25 |
| Rate for Payer: Adventist Health Commercial |
$339.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,167.21
|
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,150.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,150.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.75
|
| Rate for Payer: Multiplan Commercial |
$1,274.25
|
|
|
HC SOCDX ALLOSURE COLLECTION
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900915321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC SOCDX ALLOSURE COLLECTION
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900915321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$82.10 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.10
|
| Rate for Payer: Blue Shield of California Commercial |
$18.63
|
| Rate for Payer: Blue Shield of California EPN |
$17.61
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Senior |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC SOCIDEM PDC 82657
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900915254
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$150.51 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Senior |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| Rate for Payer: Humana Medicare |
$22.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.93
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.17
|
| Rate for Payer: TriValley Medical Group Senior |
$22.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOCIDEM PDC 82657
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900915254
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC SOCIDEM PDC 82658
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 82658
|
| Hospital Charge Code |
900915255
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC SOCIDEM PDC 82658
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 82658
|
| Hospital Charge Code |
900915255
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$150.51 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.43
|
| Rate for Payer: Dignity Health Senior |
$44.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$44.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$44.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.48
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$44.03
|
| Rate for Payer: TriValley Medical Group Senior |
$44.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$47.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.43
|
| Rate for Payer: Vantage Medical Group Senior |
$44.03
|
|
|
HC SOCIDEM PDC 84157
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900915256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.77
|
| Rate for Payer: Blue Shield of California Commercial |
$28.62
|
| Rate for Payer: Blue Shield of California EPN |
$22.37
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.40
|
| Rate for Payer: Dignity Health Senior |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.00
|
| Rate for Payer: TriValley Medical Group Senior |
$4.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4.00
|
|
|
HC SOCIDEM PDC 84157
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900915256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC SOCIDEM PDC 84999
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900915253
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
|
HC SOCIDEM PDC 84999
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900915253
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Blue Shield of California Commercial |
$74.52
|
| Rate for Payer: Blue Shield of California EPN |
$70.44
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Senior |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC SOCINN 558 PRF1 GENE
|
Facility
|
IP
|
$2,371.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914743
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$429.15 |
| Max. Negotiated Rate |
$1,778.25 |
| Rate for Payer: Adventist Health Commercial |
$474.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,628.88
|
| Rate for Payer: Cash Price |
$1,066.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,605.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,605.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.75
|
| Rate for Payer: Multiplan Commercial |
$1,778.25
|
|
|
HC SOCINN 558 PRF1 GENE
|
Facility
|
OP
|
$2,371.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914743
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$109.45 |
| Max. Negotiated Rate |
$2,015.35 |
| Rate for Payer: Adventist Health Commercial |
$474.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,628.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,015.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,304.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,778.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,472.39
|
| Rate for Payer: Blue Shield of California EPN |
$1,391.78
|
| Rate for Payer: Cash Price |
$1,066.95
|
| Rate for Payer: Cash Price |
$1,066.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,541.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,015.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,015.35
|
| Rate for Payer: Dignity Health Senior |
$2,015.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,467.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,467.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,142.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.75
|
| Rate for Payer: Multiplan Commercial |
$1,778.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,015.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,015.35
|
|
|
HC SODIUM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900910269
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$40.12 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.12
|
| Rate for Payer: Blue Shield of California Commercial |
$37.56
|
| Rate for Payer: Blue Shield of California EPN |
$29.37
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: Dignity Health Senior |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.81
|
| Rate for Payer: TriValley Medical Group Senior |
$4.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
