|
HC PUNCTURE SHUNT TUBE
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$393.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,349.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,277.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Senior |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,330.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,330.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$937.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,108.70
|
| Rate for Payer: Multiplan Commercial |
$1,473.75
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$707.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$650.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$355.67 |
| Max. Negotiated Rate |
$1,473.75 |
| Rate for Payer: Adventist Health Commercial |
$393.00
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,330.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,330.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.25
|
| Rate for Payer: Multiplan Commercial |
$1,473.75
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$355.67 |
| Max. Negotiated Rate |
$1,473.75 |
| Rate for Payer: Adventist Health Commercial |
$393.00
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,330.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,330.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.25
|
| Rate for Payer: Multiplan Commercial |
$1,473.75
|
|
|
HC PVA PARTICLES
|
Facility
|
OP
|
$1,127.00
|
|
| Hospital Charge Code |
909081806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$225.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$540.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$774.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$957.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$619.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$845.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$453.05
|
| Rate for Payer: Blue Shield of California EPN |
$453.05
|
| Rate for Payer: Cash Price |
$507.15
|
| Rate for Payer: Cash Price |
$507.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$518.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$957.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$957.95
|
| Rate for Payer: Dignity Health Senior |
$957.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$721.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$521.80
|
| Rate for Payer: Heritage Provider Network Senior |
$521.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$563.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$563.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$563.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$788.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$788.90
|
| Rate for Payer: Multiplan Commercial |
$845.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$407.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$373.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$957.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$957.95
|
| Rate for Payer: Vantage Medical Group Senior |
$957.95
|
|
|
HC PVA PARTICLES
|
Facility
|
IP
|
$1,127.00
|
|
| Hospital Charge Code |
909081806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$225.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$540.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$453.05
|
| Rate for Payer: Blue Shield of California EPN |
$453.05
|
| Rate for Payer: Cash Price |
$507.15
|
| Rate for Payer: Cash Price |
$507.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$518.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$608.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$521.80
|
| Rate for Payer: Heritage Provider Network Senior |
$521.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$563.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$563.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$563.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.75
|
| Rate for Payer: Multiplan Commercial |
$845.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$407.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$373.15
|
|
|
HC PYRUVATE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC PYRUVATE
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.14
|
| Rate for Payer: Blue Shield of California Commercial |
$87.38
|
| Rate for Payer: Blue Shield of California EPN |
$70.09
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: Dignity Health Senior |
$14.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.57
|
| Rate for Payer: Heritage Provider Network Senior |
$31.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.24
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.48
|
| Rate for Payer: TriValley Medical Group Senior |
$14.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
|
|
HC PYRUVATE CSF
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910344
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.14
|
| Rate for Payer: Blue Shield of California Commercial |
$87.38
|
| Rate for Payer: Blue Shield of California EPN |
$70.09
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: Dignity Health Senior |
$14.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.57
|
| Rate for Payer: Heritage Provider Network Senior |
$31.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.24
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.48
|
| Rate for Payer: TriValley Medical Group Senior |
$14.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
|
|
HC PYRUVATE CSF
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910344
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC QUAN MRI ANLYS BRN W/DX MRI
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
CPT 0866T
|
| Hospital Charge Code |
908801866
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$160.91 |
| Max. Negotiated Rate |
$929.00 |
| Rate for Payer: Adventist Health Commercial |
$177.80
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$601.85
|
| Rate for Payer: Heritage Provider Network Senior |
$601.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.25
|
| Rate for Payer: Multiplan Commercial |
$666.75
|
|
|
HC QUAN MRI ANLYS BRN W/DX MRI
|
Facility
|
OP
|
$889.00
|
|
|
Service Code
|
CPT 0866T
|
| Hospital Charge Code |
908801866
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$160.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$177.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$475.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$610.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$542.29
|
| Rate for Payer: Blue Shield of California EPN |
$433.83
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$424.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$666.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$444.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$444.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC QUAN MRI ANLYS BRN W/O DX MRI
|
Facility
|
OP
|
$889.00
|
|
|
Service Code
|
CPT 0865T
|
| Hospital Charge Code |
908801865
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$160.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$177.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$475.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$610.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$542.29
|
| Rate for Payer: Blue Shield of California EPN |
$433.83
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$424.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$666.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$444.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$444.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC QUAN MRI ANLYS BRN W/O DX MRI
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
CPT 0865T
|
| Hospital Charge Code |
908801865
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$160.91 |
| Max. Negotiated Rate |
$929.00 |
| Rate for Payer: Adventist Health Commercial |
$177.80
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: Cash Price |
$400.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$601.85
|
| Rate for Payer: Heritage Provider Network Senior |
$601.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.25
|
| Rate for Payer: Multiplan Commercial |
$666.75
|
|
|
HC RA223 DICLORIDE INJECTION PER MICRO CURIE
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
909301550
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$250.49
|
| Rate for Payer: Heritage Provider Network Senior |
$250.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$122.51
|
|
|
HC RA223 DICLORIDE INJECTION PER MICRO CURIE
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT A9606
|
| Hospital Charge Code |
909301550
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$197.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$254.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.96
|
| Rate for Payer: Blue Shield of California Commercial |
$225.70
|
| Rate for Payer: Blue Shield of California EPN |
$180.56
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$240.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.96
|
| Rate for Payer: Dignity Health Senior |
$188.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$229.03
|
| Rate for Payer: Heritage Provider Network Senior |
$229.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$176.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$197.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$216.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$216.44
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.96
|
| Rate for Payer: TriValley Medical Group Senior |
$171.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$122.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$214.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.96
|
| Rate for Payer: Vantage Medical Group Senior |
$188.96
|
|
|
HC RADIATION TRT DEL COMPLEX
|
Facility
|
IP
|
$2,108.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
909100337
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$381.55 |
| Max. Negotiated Rate |
$1,581.00 |
| Rate for Payer: Adventist Health Commercial |
$421.60
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,427.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1,427.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.00
|
| Rate for Payer: Multiplan Commercial |
$1,581.00
|
|
|
HC RADIATION TRT DEL COMPLEX
|
Facility
|
OP
|
$2,108.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
909100337
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.98 |
| Max. Negotiated Rate |
$1,581.00 |
| Rate for Payer: Adventist Health Commercial |
$421.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,126.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,448.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$501.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$334.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$547.45
|
| Rate for Payer: Blue Shield of California Commercial |
$491.47
|
| Rate for Payer: Blue Shield of California EPN |
$395.23
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,370.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$501.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$367.55
|
| Rate for Payer: Dignity Health Senior |
$334.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,370.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$334.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,304.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,304.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$334.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,005.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$384.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$421.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$421.02
|
| Rate for Payer: Multiplan Commercial |
$1,581.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$284.02
|
| Rate for Payer: TriValley Medical Group Senior |
$284.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,054.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,054.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$501.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$367.55
|
| Rate for Payer: Vantage Medical Group Senior |
$334.14
|
|
|
HC RADIOELEMENT HANDLING/LOADING
|
Facility
|
IP
|
$1,670.00
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
909100409
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$302.27 |
| Max. Negotiated Rate |
$1,252.50 |
| Rate for Payer: Adventist Health Commercial |
$334.00
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,130.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,130.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.50
|
| Rate for Payer: Multiplan Commercial |
$1,252.50
|
|
|
HC RADIOELEMENT HANDLING/LOADING
|
Facility
|
OP
|
$1,670.00
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
909100409
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$1,419.50 |
| Rate for Payer: Adventist Health Commercial |
$334.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$892.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,147.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,419.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$918.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,252.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.79
|
| Rate for Payer: Blue Shield of California Commercial |
$103.87
|
| Rate for Payer: Blue Shield of California EPN |
$83.53
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,085.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,419.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,419.50
|
| Rate for Payer: Dignity Health Senior |
$1,419.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,085.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,033.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,033.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$796.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,169.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,169.00
|
| Rate for Payer: Multiplan Commercial |
$1,252.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$835.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$835.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,419.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,419.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,419.50
|
|
|
HC RADIOPHARM THERAPY IA ADMIN
|
Facility
|
OP
|
$3,505.00
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
909020038
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$284.78 |
| Max. Negotiated Rate |
$2,628.75 |
| Rate for Payer: Adventist Health Commercial |
$701.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,873.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,407.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$284.78
|
| Rate for Payer: Blue Shield of California Commercial |
$552.34
|
| Rate for Payer: Blue Shield of California EPN |
$444.17
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,278.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$313.26
|
| Rate for Payer: Dignity Health Senior |
$284.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,278.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$284.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,169.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2,169.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$324.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$284.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,671.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$634.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$327.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.82
|
| Rate for Payer: Multiplan Commercial |
$2,628.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$313.26
|
| Rate for Payer: TriValley Medical Group Senior |
$284.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,752.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,752.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Vantage Medical Group Senior |
$284.78
|
|
|
HC RADIOPHARM THERAPY IA ADMIN
|
Facility
|
IP
|
$3,505.00
|
|
|
Service Code
|
CPT 79445
|
| Hospital Charge Code |
909020038
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$634.40 |
| Max. Negotiated Rate |
$2,628.75 |
| Rate for Payer: Adventist Health Commercial |
$701.00
|
| Rate for Payer: Cash Price |
$1,577.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,372.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,372.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$634.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.25
|
| Rate for Payer: Multiplan Commercial |
$2,628.75
|
|
|
HC RADIOPHARM THERAPY INTRACAVITARY ADMIN
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
909301456
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$168.20 |
| Max. Negotiated Rate |
$792.75 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$564.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$726.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$284.78
|
| Rate for Payer: Blue Shield of California Commercial |
$549.46
|
| Rate for Payer: Blue Shield of California EPN |
$441.85
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$687.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$313.26
|
| Rate for Payer: Dignity Health Senior |
$284.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$284.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$654.28
|
| Rate for Payer: Heritage Provider Network Senior |
$654.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$284.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$504.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$327.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.82
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$313.26
|
| Rate for Payer: TriValley Medical Group Senior |
$284.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$528.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$528.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Vantage Medical Group Senior |
$284.78
|
|
|
HC RADIOPHARM THERAPY INTRACAVITARY ADMIN
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
909301456
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$191.32 |
| Max. Negotiated Rate |
$792.75 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$715.59
|
| Rate for Payer: Heritage Provider Network Senior |
$715.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.25
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
|
|
HC RADIOPHARM THERAPY INTRAVENOUS ADMIN
|
Facility
|
IP
|
$2,499.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301455
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$452.32 |
| Max. Negotiated Rate |
$1,874.25 |
| Rate for Payer: Adventist Health Commercial |
$499.80
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,691.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,691.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.75
|
| Rate for Payer: Multiplan Commercial |
$1,874.25
|
|
|
HC RADIOPHARM THERAPY INTRAVENOUS ADMIN
|
Facility
|
OP
|
$2,499.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301455
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$204.35 |
| Max. Negotiated Rate |
$1,874.25 |
| Rate for Payer: Adventist Health Commercial |
$499.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,716.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$284.78
|
| Rate for Payer: Blue Shield of California Commercial |
$549.46
|
| Rate for Payer: Blue Shield of California EPN |
$441.85
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,624.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$313.26
|
| Rate for Payer: Dignity Health Senior |
$284.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,624.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$284.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,546.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,546.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$204.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$284.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,192.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$327.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.82
|
| Rate for Payer: Multiplan Commercial |
$1,874.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$313.26
|
| Rate for Payer: TriValley Medical Group Senior |
$284.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,249.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,249.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$313.26
|
| Rate for Payer: Vantage Medical Group Senior |
$284.78
|
|
