|
HC RBC ANTIBODY ADSORPTION
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$265.38
|
| Rate for Payer: Heritage Provider Network Senior |
$265.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
|
|
HC RBC ANTIBODY ADSORPTION
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.35 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$209.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.30
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$164.29
|
| Rate for Payer: Blue Shield of California Commercial |
$105.02
|
| Rate for Payer: Blue Shield of California EPN |
$84.46
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$254.80
|
| 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 |
$254.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$242.65
|
| Rate for Payer: Heritage Provider Network Senior |
$242.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$186.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| 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 |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.47
|
| Rate for Payer: TriValley Medical Group Senior |
$75.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
| 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 RBC ANTIBODY ELUTION
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$320.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$411.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.47
|
| Rate for Payer: Blue Shield of California Commercial |
$94.94
|
| Rate for Payer: Blue Shield of California EPN |
$76.35
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$389.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Senior |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$217.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.78
|
| Rate for Payer: Heritage Provider Network Senior |
$370.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$285.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$274.34
|
| Rate for Payer: Multiplan Commercial |
$449.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$217.73
|
| Rate for Payer: TriValley Medical Group Senior |
$217.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC RBC ANTIBODY ELUTION
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$405.52
|
| Rate for Payer: Heritage Provider Network Senior |
$405.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.75
|
| Rate for Payer: Multiplan Commercial |
$449.25
|
|
|
HC RBC PED PAK ALIQUOT
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904531
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$434.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$557.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$460.73
|
| 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 |
$446.60
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$527.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.19
|
| Rate for Payer: Dignity Health Senior |
$180.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$180.17
|
| 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) Medi-Cal |
$241.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$180.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$387.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.01
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$198.19
|
| Rate for Payer: TriValley Medical Group Senior |
$180.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Vantage Medical Group Senior |
$180.17
|
|
|
HC RBC PED PAK ALIQUOT
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904531
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$549.72
|
| Rate for Payer: Heritage Provider Network Senior |
$549.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
|
|
HC RDLGC SM INT FLW THRGH STDY
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
909004248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.11 |
| Max. Negotiated Rate |
$832.15 |
| Rate for Payer: Adventist Health Commercial |
$195.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$523.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$672.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$832.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$538.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$734.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$332.51
|
| Rate for Payer: Blue Shield of California Commercial |
$268.66
|
| Rate for Payer: Blue Shield of California EPN |
$216.04
|
| Rate for Payer: Cash Price |
$538.45
|
| Rate for Payer: Cash Price |
$538.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$636.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$832.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$832.15
|
| Rate for Payer: Dignity Health Senior |
$832.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$636.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.00
|
| Rate for Payer: Heritage Provider Network Senior |
$606.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$466.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$685.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$685.30
|
| Rate for Payer: Multiplan Commercial |
$734.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$489.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$489.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$832.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$832.15
|
| Rate for Payer: Vantage Medical Group Senior |
$832.15
|
|
|
HC RDLGC SM INT FLW THRGH STDY
|
Facility
|
IP
|
$979.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
909004248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$177.20 |
| Max. Negotiated Rate |
$734.25 |
| Rate for Payer: Adventist Health Commercial |
$195.80
|
| Rate for Payer: Cash Price |
$538.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$662.78
|
| Rate for Payer: Heritage Provider Network Senior |
$662.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.75
|
| Rate for Payer: Multiplan Commercial |
$734.25
|
|
|
HC RDLGC XM ESPHGS DBL CNTST STY
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
909004221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.44 |
| Max. Negotiated Rate |
$432.75 |
| Rate for Payer: Adventist Health Commercial |
$115.40
|
| Rate for Payer: Cash Price |
$317.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$390.63
|
| Rate for Payer: Heritage Provider Network Senior |
$390.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.25
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
|
|
HC RDLGC XM ESPHGS DBL CNTST STY
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
909004221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.44 |
| Max. Negotiated Rate |
$516.66 |
| Rate for Payer: Adventist Health Commercial |
$115.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$308.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$396.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$516.66
|
| Rate for Payer: Blue Shield of California Commercial |
$417.55
|
| Rate for Payer: Blue Shield of California EPN |
$335.78
|
| Rate for Payer: Cash Price |
$317.35
|
| Rate for Payer: Cash Price |
$317.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$375.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.16
|
| Rate for Payer: Heritage Provider Network Senior |
$357.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$160.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$275.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$226.19
|
| Rate for Payer: TriValley Medical Group Senior |
$226.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$291.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$291.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC RDLGC XM ESPHGS SNGL CNTST STY
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909004220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.44 |
| Max. Negotiated Rate |
$432.75 |
| Rate for Payer: Adventist Health Commercial |
$115.40
|
| Rate for Payer: Cash Price |
$317.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$390.63
|
| Rate for Payer: Heritage Provider Network Senior |
$390.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.25
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
|
|
HC RDLGC XM ESPHGS SNGL CNTST STY
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909004220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.71 |
| Max. Negotiated Rate |
$432.75 |
| Rate for Payer: Adventist Health Commercial |
$115.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$308.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$396.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$249.02
|
| Rate for Payer: Blue Shield of California EPN |
$200.26
|
| Rate for Payer: Cash Price |
$317.35
|
| Rate for Payer: Cash Price |
$317.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$375.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.16
|
| Rate for Payer: Heritage Provider Network Senior |
$357.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$275.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$226.19
|
| Rate for Payer: TriValley Medical Group Senior |
$226.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC RDLGC XM UPR GI TRC DBL CNTST
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909004246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.44 |
| Max. Negotiated Rate |
$432.75 |
| Rate for Payer: Adventist Health Commercial |
$115.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$308.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$396.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$431.96
|
| Rate for Payer: Blue Shield of California Commercial |
$347.76
|
| Rate for Payer: Blue Shield of California EPN |
$279.66
|
| Rate for Payer: Cash Price |
$317.35
|
| Rate for Payer: Cash Price |
$317.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$375.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.16
|
| Rate for Payer: Heritage Provider Network Senior |
$357.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$186.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$275.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$226.19
|
| Rate for Payer: TriValley Medical Group Senior |
$226.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC RDLGC XM UPR GI TRC DBL CNTST
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909004246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.44 |
| Max. Negotiated Rate |
$432.75 |
| Rate for Payer: Adventist Health Commercial |
$115.40
|
| Rate for Payer: Cash Price |
$317.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$390.63
|
| Rate for Payer: Heritage Provider Network Senior |
$390.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.25
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
|
|
HC RDLGC XM UPR GI TRC SNGL CNTST
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909004240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.44 |
| Max. Negotiated Rate |
$432.75 |
| Rate for Payer: Adventist Health Commercial |
$115.40
|
| Rate for Payer: Cash Price |
$317.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$390.63
|
| Rate for Payer: Heritage Provider Network Senior |
$390.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.25
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
|
|
HC RDLGC XM UPR GI TRC SNGL CNTST
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909004240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.44 |
| Max. Negotiated Rate |
$432.75 |
| Rate for Payer: Adventist Health Commercial |
$115.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$308.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$396.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.85
|
| Rate for Payer: Blue Shield of California Commercial |
$306.48
|
| Rate for Payer: Blue Shield of California EPN |
$246.46
|
| Rate for Payer: Cash Price |
$317.35
|
| Rate for Payer: Cash Price |
$317.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$375.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.16
|
| Rate for Payer: Heritage Provider Network Senior |
$357.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$165.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$275.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$432.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$226.19
|
| Rate for Payer: TriValley Medical Group Senior |
$226.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC RECOVERY LEVEL I FIRST HR
|
Facility
|
IP
|
$1,422.00
|
|
| Hospital Charge Code |
907201701
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$257.38 |
| Max. Negotiated Rate |
$1,066.50 |
| Rate for Payer: Adventist Health Commercial |
$284.40
|
| Rate for Payer: Cash Price |
$782.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$962.69
|
| Rate for Payer: Heritage Provider Network Senior |
$962.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.50
|
| Rate for Payer: Multiplan Commercial |
$1,066.50
|
|
|
HC RECOVERY LEVEL I FIRST HR
|
Facility
|
OP
|
$1,422.00
|
|
| Hospital Charge Code |
907201701
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$257.38 |
| Max. Negotiated Rate |
$1,208.70 |
| Rate for Payer: Adventist Health Commercial |
$284.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$760.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$976.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,208.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$782.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,066.50
|
| Rate for Payer: Blue Shield of California Commercial |
$867.42
|
| Rate for Payer: Blue Shield of California EPN |
$693.94
|
| Rate for Payer: Cash Price |
$782.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$924.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,208.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,208.70
|
| Rate for Payer: Dignity Health Senior |
$1,208.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$880.22
|
| Rate for Payer: Heritage Provider Network Senior |
$880.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$678.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$995.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$995.40
|
| Rate for Payer: Multiplan Commercial |
$1,066.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$711.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$711.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,208.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,208.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,208.70
|
|
|
HC RECOVERY LEVEL II FIRST HOUR
|
Facility
|
OP
|
$1,883.00
|
|
| Hospital Charge Code |
907201703
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$340.82 |
| Max. Negotiated Rate |
$1,600.55 |
| Rate for Payer: Adventist Health Commercial |
$376.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,006.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,293.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,600.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,035.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,412.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,148.63
|
| Rate for Payer: Blue Shield of California EPN |
$918.90
|
| Rate for Payer: Cash Price |
$1,035.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,223.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,600.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,600.55
|
| Rate for Payer: Dignity Health Senior |
$1,600.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,223.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,165.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,165.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$898.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$340.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,318.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,318.10
|
| Rate for Payer: Multiplan Commercial |
$1,412.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$941.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$941.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,600.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,600.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,600.55
|
|
|
HC RECOVERY LEVEL II FIRST HOUR
|
Facility
|
IP
|
$1,883.00
|
|
| Hospital Charge Code |
907201703
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$340.82 |
| Max. Negotiated Rate |
$1,412.25 |
| Rate for Payer: Adventist Health Commercial |
$376.60
|
| Rate for Payer: Cash Price |
$1,035.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,274.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,274.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$340.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.75
|
| Rate for Payer: Multiplan Commercial |
$1,412.25
|
|
|
HC RECOVERY LEVEL III EA ADDL 30
|
Facility
|
OP
|
$1,340.00
|
|
| Hospital Charge Code |
907201706
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$242.54 |
| Max. Negotiated Rate |
$1,139.00 |
| Rate for Payer: Adventist Health Commercial |
$268.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$716.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$920.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,139.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$737.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,005.00
|
| Rate for Payer: Blue Shield of California Commercial |
$817.40
|
| Rate for Payer: Blue Shield of California EPN |
$653.92
|
| Rate for Payer: Cash Price |
$737.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$871.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,139.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.00
|
| Rate for Payer: Dignity Health Senior |
$1,139.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$829.46
|
| Rate for Payer: Heritage Provider Network Senior |
$829.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$639.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$938.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$938.00
|
| Rate for Payer: Multiplan Commercial |
$1,005.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$670.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$670.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,139.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,139.00
|
|
|
HC RECOVERY LEVEL III EA ADDL 30
|
Facility
|
IP
|
$1,340.00
|
|
| Hospital Charge Code |
907201706
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$242.54 |
| Max. Negotiated Rate |
$1,005.00 |
| Rate for Payer: Adventist Health Commercial |
$268.00
|
| Rate for Payer: Cash Price |
$737.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$907.18
|
| Rate for Payer: Heritage Provider Network Senior |
$907.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.00
|
| Rate for Payer: Multiplan Commercial |
$1,005.00
|
|
|
HC RECOVERY LEVEL III FIRST HOUR
|
Facility
|
IP
|
$2,422.00
|
|
| Hospital Charge Code |
907201705
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$438.38 |
| Max. Negotiated Rate |
$1,816.50 |
| Rate for Payer: Adventist Health Commercial |
$484.40
|
| Rate for Payer: Cash Price |
$1,332.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,639.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,639.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$605.50
|
| Rate for Payer: Multiplan Commercial |
$1,816.50
|
|
|
HC RECOVERY LEVEL III FIRST HOUR
|
Facility
|
OP
|
$2,422.00
|
|
| Hospital Charge Code |
907201705
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$438.38 |
| Max. Negotiated Rate |
$2,058.70 |
| Rate for Payer: Adventist Health Commercial |
$484.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,294.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,663.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,058.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,332.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,816.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,477.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,181.94
|
| Rate for Payer: Cash Price |
$1,332.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,574.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,058.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,058.70
|
| Rate for Payer: Dignity Health Senior |
$2,058.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,574.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,499.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,499.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,155.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$605.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,695.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,695.40
|
| Rate for Payer: Multiplan Commercial |
$1,816.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,211.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,211.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,058.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,058.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.70
|
|
|
HC RECOVERY LEVEL IV FIRST HOUR
|
Facility
|
OP
|
$2,692.00
|
|
| Hospital Charge Code |
907201707
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$487.25 |
| Max. Negotiated Rate |
$2,288.20 |
| Rate for Payer: Adventist Health Commercial |
$538.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,438.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,849.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,288.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,480.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,019.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,642.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,313.70
|
| Rate for Payer: Cash Price |
$1,480.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,288.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,288.20
|
| Rate for Payer: Dignity Health Senior |
$2,288.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,749.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,666.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,666.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,284.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$487.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,884.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,884.40
|
| Rate for Payer: Multiplan Commercial |
$2,019.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,346.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,346.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,288.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,288.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,288.20
|
|
