|
HC PHENYTOIN (DILANTN)
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
900910400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$170.25 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$153.68
|
| Rate for Payer: Heritage Provider Network Senior |
$153.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.75
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
|
|
HC PHENYTOIN (DILANTN)
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
900910400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$121.02 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.66
|
| 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 |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.85
|
| 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 |
$31.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.33
|
| Rate for Payer: Heritage Provider Network Senior |
$30.33
|
| 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 |
$23.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| 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 |
$36.75
|
| 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
|
|
|
HC PHERESFLOW TRIPLE LUMEN CATH
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$224.80 |
| Max. Negotiated Rate |
$1,055.70 |
| 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 |
$1,055.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$683.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$931.50
|
| 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 |
$558.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$807.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,055.70
|
| Rate for Payer: Dignity Health Senior |
$1,055.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$807.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$768.80
|
| Rate for Payer: Heritage Provider Network Senior |
$768.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$592.43
|
| 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: Molina Healthcare of CA Medi-Cal |
$869.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$869.40
|
| Rate for Payer: Multiplan Commercial |
$931.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$621.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$621.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,055.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,055.70
|
|
|
HC PHERESFLOW TRIPLE LUMEN CATH
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$224.80 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$248.40
|
| Rate for Payer: Cash Price |
$558.90
|
| 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 PHOSPHATIDYLGLYCEROL (PG)
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
900910939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.97 |
| Max. Negotiated Rate |
$190.50 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.96
|
| Rate for Payer: Heritage Provider Network Senior |
$171.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.50
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
|
|
HC PHOSPHATIDYLGLYCEROL (PG)
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
900910939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$145.97 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.97
|
| Rate for Payer: Blue Shield of California Commercial |
$133.00
|
| Rate for Payer: Blue Shield of California EPN |
$106.68
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.17
|
| Rate for Payer: Dignity Health Senior |
$16.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.82
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.52
|
| Rate for Payer: TriValley Medical Group Senior |
$16.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Vantage Medical Group Senior |
$16.52
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900910215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.12
|
| Rate for Payer: Heritage Provider Network Senior |
$73.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900910215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$47.20 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.20
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.78
|
| Rate for Payer: TriValley Medical Group Senior |
$5.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC PHOSPHORUS
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
900910252
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$129.75 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.12
|
| Rate for Payer: Heritage Provider Network Senior |
$117.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.25
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
|
|
HC PHOSPHORUS
|
Facility
|
OP
|
$31.04
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
900910252
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$43.21 |
| Rate for Payer: Adventist Health Commercial |
$6.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.21
|
| Rate for Payer: Blue Shield of California Commercial |
$38.19
|
| Rate for Payer: Blue Shield of California EPN |
$30.63
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.21
|
| Rate for Payer: Dignity Health Senior |
$4.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.21
|
| Rate for Payer: Heritage Provider Network Senior |
$19.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$23.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.74
|
| Rate for Payer: TriValley Medical Group Senior |
$4.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Vantage Medical Group Senior |
$4.74
|
|
|
HC PHOSPHORUS URINE 24 HOURS
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900912215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.12
|
| Rate for Payer: Heritage Provider Network Senior |
$73.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
|
|
HC PHOSPHORUS URINE 24 HOURS
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900912215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$47.20 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.20
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.78
|
| Rate for Payer: TriValley Medical Group Senior |
$5.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC PHOSPHORUS URINE RANDOM
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900912214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$47.20 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.20
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.78
|
| Rate for Payer: TriValley Medical Group Senior |
$5.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC PHOSPHORUS URINE RANDOM
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900912214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.12
|
| Rate for Payer: Heritage Provider Network Senior |
$73.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
|
|
HC PHOTOCOAGULATION
|
Facility
|
OP
|
$1,384.00
|
|
|
Service Code
|
CPT 67145
|
| Hospital Charge Code |
900501743
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$276.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$950.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$697.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$899.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.75
|
| Rate for Payer: Dignity Health Senior |
$697.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$899.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$697.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$936.97
|
| Rate for Payer: Heritage Provider Network Senior |
$936.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$697.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$660.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$801.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$878.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$878.28
|
| Rate for Payer: Multiplan Commercial |
$1,038.00
|
| Rate for Payer: Multiplan WC |
$1,110.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$497.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$458.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.75
|
| Rate for Payer: Vantage Medical Group Senior |
$697.05
|
|
|
HC PHOTOCOAGULATION
|
Facility
|
IP
|
$1,384.00
|
|
|
Service Code
|
CPT 67145
|
| Hospital Charge Code |
900501743
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.50 |
| Max. Negotiated Rate |
$1,038.00 |
| Rate for Payer: Adventist Health Commercial |
$276.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$936.97
|
| Rate for Payer: Heritage Provider Network Senior |
$936.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.00
|
| Rate for Payer: Multiplan Commercial |
$1,038.00
|
|
|
HC PHRNC NRV STIM RMVL GEN AND LEAD
|
Facility
|
IP
|
$7,969.00
|
|
|
Service Code
|
CPT 33278
|
| Hospital Charge Code |
906819772
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,442.39 |
| Max. Negotiated Rate |
$5,976.75 |
| Rate for Payer: Adventist Health Commercial |
$1,593.80
|
| Rate for Payer: Cash Price |
$3,586.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,395.01
|
| Rate for Payer: Heritage Provider Network Senior |
$5,395.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,442.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,992.25
|
| Rate for Payer: Multiplan Commercial |
$5,976.75
|
|
|
HC PHRNC NRV STIM RMVL GEN AND LEAD
|
Facility
|
OP
|
$7,969.00
|
|
|
Service Code
|
CPT 33278
|
| Hospital Charge Code |
906819772
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,593.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,474.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,554.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,806.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,369.61
|
| 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 |
$3,586.05
|
| Rate for Payer: Cash Price |
$3,586.05
|
| Rate for Payer: Cash Price |
$3,586.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,179.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,554.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,806.57
|
| Rate for Payer: Dignity Health Senior |
$4,369.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,369.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,932.81
|
| Rate for Payer: Heritage Provider Network Senior |
$5,374.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,369.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,302.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,442.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,025.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,992.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,505.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,505.71
|
| Rate for Payer: Multiplan Commercial |
$5,976.75
|
| Rate for Payer: Multiplan WC |
$6,962.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,806.57
|
| Rate for Payer: TriValley Medical Group Senior |
$4,806.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,984.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,984.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,554.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,806.57
|
| Rate for Payer: Vantage Medical Group Senior |
$4,369.61
|
|
|
HC PHY/QHP OP PULM RHB W/MNTR
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
900804626
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.30
|
| Rate for Payer: Heritage Provider Network Senior |
$85.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
|
|
HC PHY/QHP OP PULM RHB W/MNTR
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
900804626
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$113.20 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Blue Shield of California Commercial |
$76.86
|
| Rate for Payer: Blue Shield of California EPN |
$61.49
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.99
|
| Rate for Payer: Heritage Provider Network Senior |
$77.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$108.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.02
|
| Rate for Payer: TriValley Medical Group Senior |
$75.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$63.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$63.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC PHY/QHP OP PULM RHB W/O MNTR
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
900804625
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$113.20 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Blue Shield of California Commercial |
$76.86
|
| Rate for Payer: Blue Shield of California EPN |
$61.49
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.99
|
| Rate for Payer: Heritage Provider Network Senior |
$77.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.02
|
| Rate for Payer: TriValley Medical Group Senior |
$75.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$63.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$63.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC PHY/QHP OP PULM RHB W/O MNTR
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
900804625
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.30
|
| Rate for Payer: Heritage Provider Network Senior |
$85.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
|
|
HC PHYSICAL PERF TEST 15 MIN MC
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900400023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$31.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Senior |
$64.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.04
|
| Rate for Payer: Heritage Provider Network Senior |
$47.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC PHYSICAL PERF TEST 15 MIN MC
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900400023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.45
|
| Rate for Payer: Heritage Provider Network Senior |
$51.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
|
|
HC PHYSICAL PERF TEST 15 MIN MCAL
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
901300076
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.45
|
| Rate for Payer: Heritage Provider Network Senior |
$51.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
|
