|
HC MRI SPECTROSCOPY
|
Facility
|
OP
|
$3,474.00
|
|
|
Service Code
|
CPT 76390
|
| Hospital Charge Code |
908801255
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$2,605.50 |
| Rate for Payer: Adventist Health Commercial |
$694.80
|
| Rate for Payer: Adventist Health Commercial |
$835.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,581.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,146.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,089.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,737.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,309.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2,309.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,857.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,857.01
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Cash Price |
$1,563.30
|
| Rate for Payer: Cash Price |
$1,563.30
|
| Rate for Payer: Cash Price |
$1,563.30
|
| Rate for Payer: Cash Price |
$1,563.30
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,992.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,657.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$756.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$628.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$868.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$2,605.50
|
| Rate for Payer: Multiplan Commercial |
$3,132.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$666.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$666.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$666.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$666.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC MRI T-SPINE W & WO CONTRAST
|
Facility
|
OP
|
$5,667.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,235.12 |
| Rate for Payer: Adventist Health Commercial |
$1,133.40
|
| Rate for Payer: Adventist Health Commercial |
$1,213.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,749.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,502.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,034.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,834.63
|
| Rate for Payer: Blue Shield of California Commercial |
$5,235.12
|
| Rate for Payer: Blue Shield of California Commercial |
$5,235.12
|
| Rate for Payer: Blue Shield of California EPN |
$4,209.91
|
| Rate for Payer: Blue Shield of California EPN |
$4,209.91
|
| Rate for Payer: Cash Price |
$2,730.15
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$2,550.15
|
| Rate for Payer: Cash Price |
$2,730.15
|
| Rate for Payer: Cash Price |
$2,730.15
|
| Rate for Payer: Cash Price |
$2,730.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,893.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,703.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,098.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,025.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$4,250.25
|
| Rate for Payer: Multiplan Commercial |
$4,550.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$854.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$854.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$854.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$854.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC MRI T-SPINE W & WO CONTRAST
|
Facility
|
IP
|
$6,067.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
908801114
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,550.25 |
| Rate for Payer: Adventist Health Commercial |
$1,213.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,907.15
|
| Rate for Payer: Cash Price |
$2,730.15
|
| Rate for Payer: Cash Price |
$2,730.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,107.36
|
| Rate for Payer: Heritage Provider Network Senior |
$4,107.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,098.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.75
|
| Rate for Payer: Multiplan Commercial |
$4,550.25
|
|
|
HC MRI UPPER EXTREM W/O CONT
|
Facility
|
IP
|
$3,480.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
908801413
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$629.88 |
| Max. Negotiated Rate |
$2,610.00 |
| Rate for Payer: Adventist Health Commercial |
$696.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,241.12
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,355.96
|
| Rate for Payer: Heritage Provider Network Senior |
$2,355.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$629.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.00
|
| Rate for Payer: Multiplan Commercial |
$2,610.00
|
|
|
HC MRI UPPER EXTREM W/O CONT
|
Facility
|
OP
|
$3,480.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
908801413
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$2,610.00 |
| Rate for Payer: Adventist Health Commercial |
$696.00
|
| Rate for Payer: Adventist Health Commercial |
$770.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,380.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,150.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,926.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,740.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,326.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,326.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,871.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,871.10
|
| Rate for Payer: Cash Price |
$1,733.40
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,733.40
|
| Rate for Payer: Cash Price |
$1,733.40
|
| Rate for Payer: Cash Price |
$1,733.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,837.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,659.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$697.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$629.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$963.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$2,610.00
|
| Rate for Payer: Multiplan Commercial |
$2,889.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC MRI UPPER EXTREM W & WO CONT
|
Facility
|
IP
|
$4,727.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
908801411
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$855.59 |
| Max. Negotiated Rate |
$3,545.25 |
| Rate for Payer: Adventist Health Commercial |
$945.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,044.19
|
| Rate for Payer: Cash Price |
$2,127.15
|
| Rate for Payer: Cash Price |
$2,127.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,200.18
|
| Rate for Payer: Heritage Provider Network Senior |
$3,200.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$855.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,181.75
|
| Rate for Payer: Multiplan Commercial |
$3,545.25
|
|
|
HC MRI UPPER EXTREM W & WO CONT
|
Facility
|
OP
|
$4,533.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
908801411
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,167.15 |
| Rate for Payer: Adventist Health Commercial |
$906.60
|
| Rate for Payer: Adventist Health Commercial |
$945.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,921.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,801.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,364.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,267.41
|
| Rate for Payer: Blue Shield of California Commercial |
$5,167.15
|
| Rate for Payer: Blue Shield of California Commercial |
$5,167.15
|
| Rate for Payer: Blue Shield of California EPN |
$4,155.25
|
| Rate for Payer: Blue Shield of California EPN |
$4,155.25
|
| Rate for Payer: Cash Price |
$2,127.15
|
| Rate for Payer: Cash Price |
$2,039.85
|
| Rate for Payer: Cash Price |
$2,039.85
|
| Rate for Payer: Cash Price |
$2,039.85
|
| Rate for Payer: Cash Price |
$2,039.85
|
| Rate for Payer: Cash Price |
$2,127.15
|
| Rate for Payer: Cash Price |
$2,127.15
|
| Rate for Payer: Cash Price |
$2,127.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,254.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,162.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$855.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$820.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,133.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,181.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$3,399.75
|
| Rate for Payer: Multiplan Commercial |
$3,545.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$854.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$854.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$854.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$854.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC MRSA DNA
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
900912328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$326.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$326.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$326.00
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.90
|
| Rate for Payer: Heritage Provider Network Senior |
$61.90
|
| Rate for Payer: Heritage Provider Network Senior |
$113.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$87.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC MRSA DNA
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
900912328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.50
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.57
|
| Rate for Payer: Heritage Provider Network Senior |
$124.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
|
|
HC MR SAFETY IMPL AND FB ASSMT CLIN STAFF 1ST 15 MIN
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 76014
|
| Hospital Charge Code |
908801500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$83.48 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.48
|
| Rate for Payer: Blue Shield of California Commercial |
$66.10
|
| Rate for Payer: Blue Shield of California EPN |
$53.15
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.23
|
| Rate for Payer: Heritage Provider Network Senior |
$53.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC MR SAFETY IMPL AND FB ASSMT CLIN STAFF 1ST 15 MIN
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 76014
|
| Hospital Charge Code |
908801500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.38
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.22
|
| Rate for Payer: Heritage Provider Network Senior |
$58.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
|
|
HC MR SAFETY IMPL AND FB ASSMT CLIN STAFF EA ADD 30 MIN
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 76015
|
| Hospital Charge Code |
908801501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$402.13 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$402.13
|
| Rate for Payer: Blue Shield of California Commercial |
$318.29
|
| Rate for Payer: Blue Shield of California EPN |
$255.96
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.62
|
| Rate for Payer: Heritage Provider Network Senior |
$26.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.10
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.55
|
| Rate for Payer: Vantage Medical Group Senior |
$36.55
|
|
|
HC MR SAFETY IMPL AND FB ASSMT CLIN STAFF EA ADD 30 MIN
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 76015
|
| Hospital Charge Code |
908801501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.69
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.11
|
| Rate for Payer: Heritage Provider Network Senior |
$29.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
|
|
HC MSI
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
CPT 81301
|
| Hospital Charge Code |
903800318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$224.80 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$248.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$799.85
|
| 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 Foundation Hospitals Medi-Cal |
$224.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.50
|
| Rate for Payer: Multiplan Commercial |
$931.50
|
|
|
HC MSI
|
Facility
|
OP
|
$902.00
|
|
|
Service Code
|
CPT 81301
|
| Hospital Charge Code |
903800318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$163.26 |
| Max. Negotiated Rate |
$1,569.67 |
| Rate for Payer: Adventist Health Commercial |
$180.40
|
| Rate for Payer: Adventist Health Commercial |
$248.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$767.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$557.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$522.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$522.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$348.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$348.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,569.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,569.67
|
| Rate for Payer: Blue Shield of California Commercial |
$757.62
|
| Rate for Payer: Blue Shield of California Commercial |
$550.22
|
| Rate for Payer: Blue Shield of California EPN |
$440.18
|
| Rate for Payer: Blue Shield of California EPN |
$606.10
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$807.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$586.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$522.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$522.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$383.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$348.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$348.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$807.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$348.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$348.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$768.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$558.34
|
| Rate for Payer: Heritage Provider Network Senior |
$768.80
|
| Rate for Payer: Heritage Provider Network Senior |
$558.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$348.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$348.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$592.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$430.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$224.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$163.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$400.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$400.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$467.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$467.07
|
| Rate for Payer: Multiplan Commercial |
$931.50
|
| Rate for Payer: Multiplan Commercial |
$676.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$348.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$348.56
|
| Rate for Payer: TriValley Medical Group Senior |
$348.56
|
| Rate for Payer: TriValley Medical Group Senior |
$348.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$376.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$376.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$522.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$522.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$383.42
|
| Rate for Payer: Vantage Medical Group Senior |
$348.56
|
| Rate for Payer: Vantage Medical Group Senior |
$348.56
|
|
|
HC MULTIFETAL PREG REDUCTION MPR
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 59866
|
| Hospital Charge Code |
910400094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$522.93
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$549.72
|
| Rate for Payer: Heritage Provider Network Senior |
$549.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
|
|
HC MULTIFETAL PREG REDUCTION MPR
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 59866
|
| Hospital Charge Code |
910400094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$501.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$495.32
|
| Rate for Payer: Blue Shield of California EPN |
$396.26
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$391.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.63
|
| Rate for Payer: Heritage Provider Network Senior |
$502.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$387.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$406.00
|
| Rate for Payer: TriValley Medical Group Senior |
$406.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$406.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$406.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC MULTIFETAL PREG REDUCTION MPR ADDL FETUS
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 59866
|
| Hospital Charge Code |
910400095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$522.93
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$549.72
|
| Rate for Payer: Heritage Provider Network Senior |
$549.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
|
|
HC MULTIFETAL PREG REDUCTION MPR ADDL FETUS
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 59866
|
| Hospital Charge Code |
910400095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$501.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$495.32
|
| Rate for Payer: Blue Shield of California EPN |
$396.26
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$391.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.63
|
| Rate for Payer: Heritage Provider Network Senior |
$502.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$387.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$406.00
|
| Rate for Payer: TriValley Medical Group Senior |
$406.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$406.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$406.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC MULTIHANCE PER ML
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT A9577
|
| Hospital Charge Code |
900009577
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.78
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC MULTIHANCE PER ML
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT A9577
|
| Hospital Charge Code |
900009577
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.59
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
|
|
HC MULTI-PLANAR RECON
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
909201350
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$110.77 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$122.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$394.13
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.32
|
| Rate for Payer: Heritage Provider Network Senior |
$414.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.00
|
| Rate for Payer: Multiplan Commercial |
$459.00
|
|
|
HC MULTI-PLANAR RECON
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
909201350
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$110.77 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Adventist Health Commercial |
$122.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$378.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$520.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$459.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.12
|
| Rate for Payer: Blue Shield of California Commercial |
$704.40
|
| Rate for Payer: Blue Shield of California EPN |
$566.46
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$520.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$520.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$520.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$291.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$428.40
|
| Rate for Payer: Multiplan Commercial |
$459.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$306.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$306.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$520.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$520.20
|
| Rate for Payer: Vantage Medical Group Senior |
$520.20
|
|
|
HC MUMPS AB
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900913533
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$105.00
|
| Rate for Payer: Blue Shield of California Commercial |
$105.00
|
| Rate for Payer: Blue Shield of California EPN |
$84.22
|
| Rate for Payer: Blue Shield of California EPN |
$84.22
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.81
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$45.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.05
|
| Rate for Payer: TriValley Medical Group Senior |
$13.05
|
| Rate for Payer: TriValley Medical Group Senior |
$13.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC MUMPS AB
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900913533
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.80
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
