|
HC PET SCAN WHOLE BODY
|
Facility
|
OP
|
$10,105.00
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
909301482
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$8,317.15 |
| Rate for Payer: Adventist Health Commercial |
$2,021.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,401.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,942.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Blue Shield of California Commercial |
$8,317.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,688.38
|
| Rate for Payer: Cash Price |
$5,557.75
|
| Rate for Payer: Cash Price |
$5,557.75
|
| Rate for Payer: Cash Price |
$5,557.75
|
| Rate for Payer: Cash Price |
$5,557.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,100.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Senior |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,169.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,853.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,465.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,332.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,283.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,820.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,829.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,131.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,526.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,335.13
|
| Rate for Payer: Multiplan Commercial |
$7,578.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,659.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,659.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC PET SCAN WHOLE BODY
|
Facility
|
IP
|
$10,105.00
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
909301482
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,829.01 |
| Max. Negotiated Rate |
$7,578.75 |
| Rate for Payer: Adventist Health Commercial |
$2,021.00
|
| Rate for Payer: Cash Price |
$5,557.75
|
| Rate for Payer: Cash Price |
$5,557.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,841.09
|
| Rate for Payer: Heritage Provider Network Senior |
$6,841.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,829.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,526.25
|
| Rate for Payer: Multiplan Commercial |
$7,578.75
|
|
|
HC PET TUMOR LIMITED
|
Facility
|
IP
|
$7,638.00
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
909301480
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,382.48 |
| Max. Negotiated Rate |
$5,728.50 |
| Rate for Payer: Adventist Health Commercial |
$1,527.60
|
| Rate for Payer: Cash Price |
$4,200.90
|
| Rate for Payer: Cash Price |
$4,200.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,170.93
|
| Rate for Payer: Heritage Provider Network Senior |
$5,170.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,382.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,909.50
|
| Rate for Payer: Multiplan Commercial |
$5,728.50
|
|
|
HC PET TUMOR LIMITED
|
Facility
|
OP
|
$7,638.00
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
909301480
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$7,337.71 |
| Rate for Payer: Adventist Health Commercial |
$1,527.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,082.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,247.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Blue Shield of California Commercial |
$7,337.71
|
| Rate for Payer: Blue Shield of California EPN |
$5,900.74
|
| Rate for Payer: Cash Price |
$4,200.90
|
| Rate for Payer: Cash Price |
$4,200.90
|
| Rate for Payer: Cash Price |
$4,200.90
|
| Rate for Payer: Cash Price |
$4,200.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,100.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Senior |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,169.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,658.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,465.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,332.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,283.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,643.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,382.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,907.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,909.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,090.01
|
| Rate for Payer: Multiplan Commercial |
$5,728.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,659.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,659.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
OP
|
$1,543.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906811410
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$308.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$824.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,060.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,311.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$848.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,157.25
|
| 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 |
$848.65
|
| Rate for Payer: Cash Price |
$848.65
|
| Rate for Payer: Cash Price |
$848.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,311.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,311.55
|
| Rate for Payer: Dignity Health Senior |
$1,311.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,002.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.12
|
| Rate for Payer: Heritage Provider Network Senior |
$955.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$142.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$736.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,080.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,080.10
|
| Rate for Payer: Multiplan Commercial |
$1,157.25
|
| 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 |
$1,311.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,311.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,311.55
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
IP
|
$1,543.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906811410
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$279.28 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$308.60
|
| Rate for Payer: Cash Price |
$848.65
|
| Rate for Payer: Cash Price |
$848.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.75
|
| Rate for Payer: Multiplan Commercial |
$1,157.25
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
IP
|
$2,465.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906820068
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$446.17 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$493.00
|
| Rate for Payer: Cash Price |
$1,355.75
|
| Rate for Payer: Cash Price |
$1,355.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$616.25
|
| Rate for Payer: Multiplan Commercial |
$1,848.75
|
|
|
HC PHARMACOLOGIC AGENT ADMIN
|
Facility
|
OP
|
$2,465.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
906820068
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$493.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,317.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,693.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,095.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,355.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,848.75
|
| 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 |
$1,355.75
|
| Rate for Payer: Cash Price |
$1,355.75
|
| Rate for Payer: Cash Price |
$1,355.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,095.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.25
|
| Rate for Payer: Dignity Health Senior |
$2,095.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,602.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,525.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,525.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$142.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,175.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$616.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,725.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,725.50
|
| Rate for Payer: Multiplan Commercial |
$1,848.75
|
| 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 |
$2,095.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,095.25
|
|
|
HC PHARM-CHLORIDE IV SOLUTION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
900912107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14.64
|
| Rate for Payer: Blue Shield of California EPN |
$11.71
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Senior |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC PHARM-CHLORIDE IV SOLUTION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
900912107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
|
|
HC PHARM-GLUCOSE IV SOLUTION
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 81099
|
| Hospital Charge Code |
900912109
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14.64
|
| Rate for Payer: Blue Shield of California EPN |
$11.71
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Senior |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC PHARM-GLUCOSE IV SOLUTION
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 81099
|
| Hospital Charge Code |
900912109
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
|
|
HC PHARM-PHOSPHORUS IV SOLUTION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
900912108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
|
|
HC PHARM-PHOSPHORUS IV SOLUTION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
900912108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14.64
|
| Rate for Payer: Blue Shield of California EPN |
$11.71
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Senior |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC PHARM-POTASSIUM IV SOLUTION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
900912106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14.64
|
| Rate for Payer: Blue Shield of California EPN |
$11.71
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Senior |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC PHARM-POTASSIUM IV SOLUTION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
900912106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
|
|
HC PHARM-SODIUM IV SOLUTION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
900912105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
|
|
HC PHARM-SODIUM IV SOLUTION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
900912105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14.64
|
| Rate for Payer: Blue Shield of California EPN |
$11.71
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Senior |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC PH BODY FLUID
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
900910261
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Cash Price |
$91.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.38
|
| Rate for Payer: Heritage Provider Network Senior |
$112.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
|
|
HC PH BODY FLUID
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
900910261
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$88.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.64
|
| Rate for Payer: Blue Shield of California Commercial |
$28.80
|
| Rate for Payer: Blue Shield of California EPN |
$23.10
|
| Rate for Payer: Cash Price |
$91.30
|
| Rate for Payer: Cash Price |
$91.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.94
|
| Rate for Payer: Dignity Health Senior |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.75
|
| Rate for Payer: Heritage Provider Network Senior |
$102.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$79.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.51
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.58
|
| Rate for Payer: TriValley Medical Group Senior |
$3.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.94
|
| Rate for Payer: Vantage Medical Group Senior |
$3.58
|
|
|
HC PHENCYCLIDINE CONF
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900910517
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$166.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$214.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.82
|
| Rate for Payer: Blue Shield of California Commercial |
$112.26
|
| Rate for Payer: Blue Shield of California EPN |
$90.04
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$202.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$265.20
|
| Rate for Payer: Dignity Health Senior |
$265.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.13
|
| Rate for Payer: Heritage Provider Network Senior |
$193.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$148.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$265.20
|
| Rate for Payer: Vantage Medical Group Senior |
$265.20
|
|
|
HC PHENCYCLIDINE CONF
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900910517
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.47 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.22
|
| Rate for Payer: Heritage Provider Network Senior |
$211.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
|
|
HC PHENOBARBITAL (LUMINAL)
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
900910409
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.36
|
| Rate for Payer: Blue Shield of California Commercial |
$92.22
|
| Rate for Payer: Blue Shield of California EPN |
$73.97
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Senior |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$88.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.30
|
| Rate for Payer: TriValley Medical Group Senior |
$15.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC PHENOBARBITAL (LUMINAL)
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
900910409
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.25
|
| Rate for Payer: Heritage Provider Network Senior |
$125.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
|
|
HC PHENYTOIN (DILANTN)
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
900910400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$170.25 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$121.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.02
|
| Rate for Payer: Blue Shield of California Commercial |
$106.68
|
| Rate for Payer: Blue Shield of California EPN |
$85.56
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$147.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Senior |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.51
|
| Rate for Payer: Heritage Provider Network Senior |
$140.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$108.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.25
|
| Rate for Payer: TriValley Medical Group Senior |
$13.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
