|
HC RUBEOLA ANTIBODY
|
Facility
|
IP
|
$144.06
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$108.05 |
| Rate for Payer: Adventist Health Commercial |
$28.81
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.53
|
| Rate for Payer: Heritage Provider Network Senior |
$97.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.02
|
| Rate for Payer: Multiplan Commercial |
$108.05
|
|
|
HC RUBEOLA ANTIBODY
|
Facility
|
OP
|
$144.06
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$117.64 |
| Rate for Payer: Adventist Health Commercial |
$28.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.64
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$93.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.17
|
| Rate for Payer: Heritage Provider Network Senior |
$89.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$68.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$108.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC RVSN PACEMAKER POCKET
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
906811999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$395.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| 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 |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$373.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$355.93
|
| Rate for Payer: Heritage Provider Network Senior |
$310.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$479.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$277.72
|
| Rate for Payer: TriValley Medical Group Senior |
$277.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC RVSN PACEMAKER POCKET
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
906811999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.08 |
| Max. Negotiated Rate |
$431.25 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Cash Price |
$316.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$389.27
|
| Rate for Payer: Heritage Provider Network Senior |
$389.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.75
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
|
|
HC RYE IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913639
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.32 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.32
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.85
|
| Rate for Payer: Heritage Provider Network Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC RYE IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913639
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
|
|
HC SACRAL AUGMENTATION BILAT
|
Facility
|
IP
|
$27,796.00
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
909020153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,031.08 |
| Max. Negotiated Rate |
$20,847.00 |
| Rate for Payer: Adventist Health Commercial |
$5,559.20
|
| Rate for Payer: Cash Price |
$15,287.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,817.89
|
| Rate for Payer: Heritage Provider Network Senior |
$18,817.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,031.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,949.00
|
| Rate for Payer: Multiplan Commercial |
$20,847.00
|
|
|
HC SACRAL AUGMENTATION BILAT
|
Facility
|
OP
|
$27,796.00
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
909020153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,031.08 |
| Max. Negotiated Rate |
$20,847.00 |
| Rate for Payer: Adventist Health Commercial |
$5,559.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,095.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$15,287.80
|
| Rate for Payer: Cash Price |
$15,287.80
|
| Rate for Payer: Cash Price |
$15,287.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,067.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Senior |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,677.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,076.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,205.72
|
| Rate for Payer: Heritage Provider Network Senior |
$11,164.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,031.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,438.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,949.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,436.79
|
| Rate for Payer: Multiplan Commercial |
$20,847.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,984.50
|
| Rate for Payer: TriValley Medical Group Senior |
$9,984.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC SACRAL AUGMENTATION UNILAT
|
Facility
|
OP
|
$22,450.00
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
909020152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,063.45 |
| Max. Negotiated Rate |
$17,245.96 |
| Rate for Payer: Adventist Health Commercial |
$4,490.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,423.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$12,347.50
|
| Rate for Payer: Cash Price |
$12,347.50
|
| Rate for Payer: Cash Price |
$12,347.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,592.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Senior |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,470.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,076.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,896.55
|
| Rate for Payer: Heritage Provider Network Senior |
$11,164.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,063.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,438.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,612.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,436.79
|
| Rate for Payer: Multiplan Commercial |
$16,837.50
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,984.50
|
| Rate for Payer: TriValley Medical Group Senior |
$9,984.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC SACRAL AUGMENTATION UNILAT
|
Facility
|
IP
|
$22,450.00
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
909020152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,063.45 |
| Max. Negotiated Rate |
$16,837.50 |
| Rate for Payer: Adventist Health Commercial |
$4,490.00
|
| Rate for Payer: Cash Price |
$12,347.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,198.65
|
| Rate for Payer: Heritage Provider Network Senior |
$15,198.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,063.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,612.50
|
| Rate for Payer: Multiplan Commercial |
$16,837.50
|
|
|
HC SACROILIAC ARTHROGRAPHY
|
Facility
|
IP
|
$1,515.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
909000223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$274.21 |
| Max. Negotiated Rate |
$1,136.25 |
| Rate for Payer: Adventist Health Commercial |
$303.00
|
| Rate for Payer: Cash Price |
$833.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,025.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,025.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.75
|
| Rate for Payer: Multiplan Commercial |
$1,136.25
|
|
|
HC SACROILIAC ARTHROGRAPHY
|
Facility
|
OP
|
$1,515.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
909000223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$303.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,040.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,287.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$833.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,136.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$833.25
|
| Rate for Payer: Cash Price |
$833.25
|
| Rate for Payer: Cash Price |
$833.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$984.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,287.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,287.75
|
| Rate for Payer: Dignity Health Senior |
$1,287.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$937.78
|
| Rate for Payer: Heritage Provider Network Senior |
$937.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$475.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$722.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,060.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,060.50
|
| Rate for Payer: Multiplan Commercial |
$1,136.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,287.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,287.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,287.75
|
|
|
HC SACRO ILIAC JOINTS
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
909001344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$478.50 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Cash Price |
$350.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$431.93
|
| Rate for Payer: Heritage Provider Network Senior |
$431.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
|
|
HC SACRO ILIAC JOINTS
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
909001344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$478.50 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$341.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.71
|
| Rate for Payer: Blue Shield of California Commercial |
$131.04
|
| Rate for Payer: Blue Shield of California EPN |
$105.38
|
| Rate for Payer: Cash Price |
$350.90
|
| Rate for Payer: Cash Price |
$350.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$394.92
|
| Rate for Payer: Heritage Provider Network Senior |
$394.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$304.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SACRUM AND COCCYX
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
909001343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.53 |
| Max. Negotiated Rate |
$508.50 |
| Rate for Payer: Adventist Health Commercial |
$135.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$362.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$465.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.99
|
| Rate for Payer: Blue Shield of California Commercial |
$120.91
|
| Rate for Payer: Blue Shield of California EPN |
$97.23
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$440.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.68
|
| Rate for Payer: Heritage Provider Network Senior |
$419.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$323.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$508.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC SACRUM AND COCCYX
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
909001343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.72 |
| Max. Negotiated Rate |
$508.50 |
| Rate for Payer: Adventist Health Commercial |
$135.60
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$459.01
|
| Rate for Payer: Heritage Provider Network Senior |
$459.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.50
|
| Rate for Payer: Multiplan Commercial |
$508.50
|
|
|
HC SALICYLATES
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910366
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$562.57 |
| Rate for Payer: Adventist Health Commercial |
$101.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$271.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.57
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Cash Price |
$279.40
|
| Rate for Payer: Cash Price |
$279.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$314.45
|
| Rate for Payer: Heritage Provider Network Senior |
$314.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$242.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.30
|
| Rate for Payer: Multiplan Commercial |
$381.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SALICYLATES
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910366
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.95 |
| Max. Negotiated Rate |
$381.00 |
| Rate for Payer: Adventist Health Commercial |
$101.60
|
| Rate for Payer: Cash Price |
$279.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$343.92
|
| Rate for Payer: Heritage Provider Network Senior |
$343.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.00
|
| Rate for Payer: Multiplan Commercial |
$381.00
|
|
|
HC SALIVARY DUCT DILATOR
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
909081730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| Rate for Payer: Blue Shield of California Commercial |
$48.19
|
| Rate for Payer: Blue Shield of California EPN |
$38.55
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Senior |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$39.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$39.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC SALIVARY DUCT DILATOR
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
909081730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
|
HC SALIVARY GLAND
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
909001145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.87 |
| Max. Negotiated Rate |
$196.50 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$140.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.25
|
| Rate for Payer: Blue Shield of California Commercial |
$141.12
|
| Rate for Payer: Blue Shield of California EPN |
$113.48
|
| Rate for Payer: Cash Price |
$144.10
|
| Rate for Payer: Cash Price |
$144.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$170.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.18
|
| Rate for Payer: Heritage Provider Network Senior |
$162.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$124.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC SALIVARY GLAND
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
909001145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.42 |
| Max. Negotiated Rate |
$196.50 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Cash Price |
$144.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$177.37
|
| Rate for Payer: Heritage Provider Network Senior |
$177.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.50
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
|
|
HC SALIV (PAROTID) SCAN
|
Facility
|
IP
|
$1,113.00
|
|
|
Service Code
|
CPT 78230
|
| Hospital Charge Code |
909301355
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$201.45 |
| Max. Negotiated Rate |
$834.75 |
| Rate for Payer: Adventist Health Commercial |
$222.60
|
| Rate for Payer: Cash Price |
$612.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$753.50
|
| Rate for Payer: Heritage Provider Network Senior |
$753.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.25
|
| Rate for Payer: Multiplan Commercial |
$834.75
|
|
|
HC SALIV (PAROTID) SCAN
|
Facility
|
OP
|
$1,113.00
|
|
|
Service Code
|
CPT 78230
|
| Hospital Charge Code |
909301355
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$98.16 |
| Max. Negotiated Rate |
$834.75 |
| Rate for Payer: Adventist Health Commercial |
$222.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$594.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$764.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$459.12
|
| Rate for Payer: Blue Shield of California EPN |
$369.21
|
| Rate for Payer: Cash Price |
$612.15
|
| Rate for Payer: Cash Price |
$612.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$723.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$688.95
|
| Rate for Payer: Heritage Provider Network Senior |
$688.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$98.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$530.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$834.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$556.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$556.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC SARS-COV2-2 RNA POC
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900912260
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.51
|
| Rate for Payer: Heritage Provider Network Senior |
$120.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
|
