|
HC POTASSIUM URINE
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.85
|
| Rate for Payer: Blue Shield of California Commercial |
$34.62
|
| Rate for Payer: Blue Shield of California Commercial |
$34.62
|
| Rate for Payer: Blue Shield of California EPN |
$27.77
|
| Rate for Payer: Blue Shield of California EPN |
$27.77
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$72.42
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$55.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.34
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.73
|
| Rate for Payer: TriValley Medical Group Senior |
$4.73
|
| Rate for Payer: TriValley Medical Group Senior |
$4.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
|
|
HC POTASSIUM URINE 24 HOURS
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900912217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.35
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.21
|
| Rate for Payer: Heritage Provider Network Senior |
$79.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.25
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
|
|
HC POTASSIUM URINE 24 HOURS
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900912217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.85
|
| Rate for Payer: Blue Shield of California Commercial |
$34.62
|
| Rate for Payer: Blue Shield of California Commercial |
$34.62
|
| Rate for Payer: Blue Shield of California EPN |
$27.77
|
| Rate for Payer: Blue Shield of California EPN |
$27.77
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$72.42
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$55.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.34
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.73
|
| Rate for Payer: TriValley Medical Group Senior |
$4.73
|
| Rate for Payer: TriValley Medical Group Senior |
$4.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
|
|
HC POTASSIUM URINE RANDOM
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900912216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.35
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.21
|
| Rate for Payer: Heritage Provider Network Senior |
$79.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.25
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
|
|
HC POTASSIUM URINE RANDOM
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900912216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.85
|
| Rate for Payer: Blue Shield of California Commercial |
$34.62
|
| Rate for Payer: Blue Shield of California Commercial |
$34.62
|
| Rate for Payer: Blue Shield of California EPN |
$27.77
|
| Rate for Payer: Blue Shield of California EPN |
$27.77
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$72.42
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$55.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.34
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.73
|
| Rate for Payer: TriValley Medical Group Senior |
$4.73
|
| Rate for Payer: TriValley Medical Group Senior |
$4.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
|
|
HC POWDER HYPAQUE CAN
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT Q9964
|
| Hospital Charge Code |
909001018
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$40.91 |
| Max. Negotiated Rate |
$192.10 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.05
|
| Rate for Payer: Blue Shield of California Commercial |
$137.86
|
| Rate for Payer: Blue Shield of California EPN |
$110.29
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$192.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.89
|
| Rate for Payer: Heritage Provider Network Senior |
$139.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$107.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$158.20
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$90.40
|
| Rate for Payer: TriValley Medical Group Senior |
$90.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$113.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$113.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$192.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.10
|
| Rate for Payer: Vantage Medical Group Senior |
$192.10
|
|
|
HC POWDER HYPAQUE CAN
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT Q9964
|
| Hospital Charge Code |
909001018
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$40.91 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.54
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$153.00
|
| Rate for Payer: Heritage Provider Network Senior |
$153.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.50
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
|
|
HC PRCD DRG GT 6YR W/O CGN CRDC ANM
|
Facility
|
OP
|
$1,328.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
900503017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$240.37 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$820.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$730.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$996.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$863.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,128.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$822.03
|
| Rate for Payer: Heritage Provider Network Senior |
$822.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$633.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,128.80
|
|
|
HC PRCD DRG GT 6YR W/O CGN CRDC ANM
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
900503017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$240.37 |
| Max. Negotiated Rate |
$996.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$855.23
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$899.06
|
| Rate for Payer: Heritage Provider Network Senior |
$899.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
|
|
HC PRCRD DRG LT 6YR/ANY AGE W/ANMLY
|
Facility
|
OP
|
$1,328.00
|
|
|
Service Code
|
CPT 33018
|
| Hospital Charge Code |
900503018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$240.37 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$820.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$730.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$996.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$863.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,128.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$822.03
|
| Rate for Payer: Heritage Provider Network Senior |
$822.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$633.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,128.80
|
|
|
HC PRCRD DRG LT 6YR/ANY AGE W/ANMLY
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 33018
|
| Hospital Charge Code |
900503018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$240.37 |
| Max. Negotiated Rate |
$996.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$855.23
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$899.06
|
| Rate for Payer: Heritage Provider Network Senior |
$899.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
|
|
HC PREGNANCY TEST URINE
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
910400131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.62 |
| Max. Negotiated Rate |
$180.75 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.20
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$163.16
|
| Rate for Payer: Heritage Provider Network Senior |
$163.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.25
|
| Rate for Payer: Multiplan Commercial |
$180.75
|
|
|
HC PREGNANCY TEST URINE
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
910400131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$180.75 |
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: Blue Shield of California Commercial |
$44.35
|
| Rate for Payer: Blue Shield of California EPN |
$35.57
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$156.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.18
|
| Rate for Payer: Heritage Provider Network Senior |
$149.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$114.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.54
|
| Rate for Payer: Multiplan Commercial |
$180.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.61
|
| Rate for Payer: TriValley Medical Group Senior |
$8.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.47
|
| Rate for Payer: Vantage Medical Group Senior |
$8.61
|
|
|
HC PREPARE FACE/ORAL PROSTHESIS
|
Facility
|
IP
|
$3,766.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
900501350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$681.65 |
| Max. Negotiated Rate |
$2,824.50 |
| Rate for Payer: Adventist Health Commercial |
$753.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,425.30
|
| Rate for Payer: Cash Price |
$1,694.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,549.58
|
| Rate for Payer: Heritage Provider Network Senior |
$2,549.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$681.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$941.50
|
| Rate for Payer: Multiplan Commercial |
$2,824.50
|
|
|
HC PREPARE FACE/ORAL PROSTHESIS
|
Facility
|
OP
|
$3,766.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
900501350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$753.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,327.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,788.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,423.55
|
| Rate for Payer: Cash Price |
$1,694.70
|
| Rate for Payer: Cash Price |
$1,694.70
|
| Rate for Payer: Cash Price |
$1,694.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,447.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,549.58
|
| Rate for Payer: Heritage Provider Network Senior |
$2,549.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,796.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$681.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$941.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$2,824.50
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,259.60
|
| Rate for Payer: TriValley Medical Group Senior |
$2,259.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC PREPARE OF FECAL MICROBIOTA
|
Facility
|
IP
|
$1,595.00
|
|
|
Service Code
|
CPT 44705
|
| Hospital Charge Code |
906700705
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$288.69 |
| Max. Negotiated Rate |
$1,196.25 |
| Rate for Payer: Adventist Health Commercial |
$319.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,027.18
|
| Rate for Payer: Cash Price |
$717.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,079.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,079.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.75
|
| Rate for Payer: Multiplan Commercial |
$1,196.25
|
|
|
HC PREPARE OF FECAL MICROBIOTA
|
Facility
|
OP
|
$1,595.00
|
|
|
Service Code
|
CPT 44705
|
| Hospital Charge Code |
906700705
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$288.69 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$319.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$985.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,355.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$877.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$717.75
|
| Rate for Payer: Cash Price |
$717.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,036.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,355.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,355.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,355.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$987.30
|
| Rate for Payer: Heritage Provider Network Senior |
$987.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$760.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,116.50
|
| Rate for Payer: Multiplan Commercial |
$1,196.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$797.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$797.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,355.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,355.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,355.75
|
|
|
HC PRE POST CHALLENGE SPIROMETRY
|
Facility
|
IP
|
$953.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
900801002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$172.49 |
| Max. Negotiated Rate |
$714.75 |
| Rate for Payer: Adventist Health Commercial |
$190.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$613.73
|
| Rate for Payer: Cash Price |
$428.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$645.18
|
| Rate for Payer: Heritage Provider Network Senior |
$645.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$172.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.25
|
| Rate for Payer: Multiplan Commercial |
$714.75
|
|
|
HC PRE POST CHALLENGE SPIROMETRY
|
Facility
|
OP
|
$953.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
900801002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$172.49 |
| Max. Negotiated Rate |
$719.91 |
| Rate for Payer: Adventist Health Commercial |
$190.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$588.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$476.69
|
| Rate for Payer: Blue Shield of California Commercial |
$214.70
|
| Rate for Payer: Blue Shield of California EPN |
$172.66
|
| Rate for Payer: Cash Price |
$428.85
|
| Rate for Payer: Cash Price |
$428.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$619.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$562.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$479.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$589.91
|
| Rate for Payer: Heritage Provider Network Senior |
$589.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$454.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$172.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$551.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$714.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$527.93
|
| Rate for Payer: TriValley Medical Group Senior |
$479.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$476.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$476.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC PREP SPLIT UNIT
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
900904439
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$107.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$331.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.79
|
| Rate for Payer: Blue Shield of California Commercial |
$327.57
|
| Rate for Payer: Blue Shield of California EPN |
$262.06
|
| Rate for Payer: Cash Price |
$241.65
|
| Rate for Payer: Cash Price |
$241.65
|
| Rate for Payer: Cash Price |
$241.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$349.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.83
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$332.40
|
| Rate for Payer: Heritage Provider Network Senior |
$332.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$256.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$402.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$241.03
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| 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 |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC PREP SPLIT UNIT
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
900904439
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$402.75 |
| Rate for Payer: Adventist Health Commercial |
$107.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$345.83
|
| Rate for Payer: Cash Price |
$241.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$363.55
|
| Rate for Payer: Heritage Provider Network Senior |
$363.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.25
|
| Rate for Payer: Multiplan Commercial |
$402.75
|
|
|
HC PREVIEW TRT PLANNING
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201982
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$112.58 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$342.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$466.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$311.12
|
| Rate for Payer: Blue Shield of California Commercial |
$737.66
|
| Rate for Payer: Blue Shield of California EPN |
$593.20
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$528.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$528.70
|
| 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 |
$296.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$435.40
|
| Rate for Payer: Multiplan Commercial |
$466.50
|
| 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 |
$311.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$311.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.70
|
| Rate for Payer: Vantage Medical Group Senior |
$528.70
|
|
|
HC PREVIEW TRT PLANNING
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201982
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$112.58 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$400.57
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$421.09
|
| Rate for Payer: Heritage Provider Network Senior |
$421.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.50
|
| Rate for Payer: Multiplan Commercial |
$466.50
|
|
|
HC PRGRMG DEV EVAL IMPLTBL SYS
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
900293260
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.89
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.96
|
| Rate for Payer: Heritage Provider Network Senior |
$62.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
|
|
HC PRGRMG DEV EVAL IMPLTBL SYS
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
900293260
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.52
|
| Rate for Payer: Blue Shield of California Commercial |
$56.73
|
| Rate for Payer: Blue Shield of California EPN |
$45.38
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.57
|
| Rate for Payer: Heritage Provider Network Senior |
$57.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Senior |
$48.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Vantage Medical Group Senior |
$48.00
|
|
