|
HC RESPIRATORY PANEL, NUCLEIC ACID
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
900913642
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$83.98 |
| Max. Negotiated Rate |
$3,299.96 |
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Adventist Health Commercial |
$308.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$951.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$286.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,132.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,132.56
|
| Rate for Payer: Blue Shield of California Commercial |
$3,299.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3,299.96
|
| Rate for Payer: Blue Shield of California EPN |
$2,646.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,646.84
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,001.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$301.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$908.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$416.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$416.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$953.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$287.22
|
| Rate for Payer: Heritage Provider Network Senior |
$953.26
|
| Rate for Payer: Heritage Provider Network Senior |
$287.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$734.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$221.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$278.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$479.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$479.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$558.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$558.49
|
| Rate for Payer: Multiplan Commercial |
$1,155.00
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$416.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$416.78
|
| Rate for Payer: TriValley Medical Group Senior |
$416.78
|
| Rate for Payer: TriValley Medical Group Senior |
$416.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$450.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$450.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$450.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$450.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC RESP VIRUS PANEL NUCLEIC ACID
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
900912337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$83.98 |
| Max. Negotiated Rate |
$3,299.96 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Adventist Health Commercial |
$308.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$951.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$286.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,132.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,132.56
|
| Rate for Payer: Blue Shield of California Commercial |
$3,299.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3,299.96
|
| Rate for Payer: Blue Shield of California EPN |
$2,646.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,646.84
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,001.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$301.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$908.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$416.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$416.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$953.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$287.22
|
| Rate for Payer: Heritage Provider Network Senior |
$953.26
|
| Rate for Payer: Heritage Provider Network Senior |
$287.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$734.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$221.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$278.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$479.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$479.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$558.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$558.49
|
| Rate for Payer: Multiplan Commercial |
$1,155.00
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$416.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$416.78
|
| Rate for Payer: TriValley Medical Group Senior |
$416.78
|
| Rate for Payer: TriValley Medical Group Senior |
$416.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$450.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$450.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$450.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$450.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC RESP VIRUS PANEL NUCLEIC ACID
|
Facility
|
IP
|
$1,540.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
900912337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$278.74 |
| Max. Negotiated Rate |
$1,155.00 |
| Rate for Payer: Adventist Health Commercial |
$308.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$991.76
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,042.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,042.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$278.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.00
|
| Rate for Payer: Multiplan Commercial |
$1,155.00
|
|
|
HC RESTING THALLIUM
|
Facility
|
OP
|
$2,853.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301384
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$516.39 |
| Max. Negotiated Rate |
$2,497.70 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,763.15
|
| Rate for Payer: Adventist Health Commercial |
$570.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,665.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,427.07
|
| Rate for Payer: Blue Shield of California Commercial |
$811.44
|
| Rate for Payer: Blue Shield of California EPN |
$652.53
|
| Rate for Payer: Cash Price |
$1,283.85
|
| Rate for Payer: Cash Price |
$1,283.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,854.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,831.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,665.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,854.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,665.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,766.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,766.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,665.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,360.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$516.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,914.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,231.27
|
| Rate for Payer: Multiplan Commercial |
$2,139.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,831.64
|
| Rate for Payer: TriValley Medical Group Senior |
$1,665.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,426.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,426.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1,665.13
|
|
|
HC RESTING THALLIUM
|
Facility
|
IP
|
$2,853.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301384
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$516.39 |
| Max. Negotiated Rate |
$2,139.75 |
| Rate for Payer: Adventist Health Commercial |
$570.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,837.33
|
| Rate for Payer: Cash Price |
$1,283.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,931.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,931.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$516.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.25
|
| Rate for Payer: Multiplan Commercial |
$2,139.75
|
|
|
HC RETICULOCYTE COUNT, AUTO
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
900910088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.98
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.41
|
| Rate for Payer: Heritage Provider Network Senior |
$70.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
|
|
HC RETICULOCYTE COUNT, AUTO
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
900910088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.80
|
| Rate for Payer: Blue Shield of California Commercial |
$44.93
|
| Rate for Payer: Blue Shield of California Commercial |
$44.93
|
| Rate for Payer: Blue Shield of California EPN |
$36.04
|
| Rate for Payer: Blue Shield of California EPN |
$36.04
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$64.38
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$49.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Senior |
$5.57
|
| Rate for Payer: TriValley Medical Group Senior |
$5.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
|
|
HC RETICULOCYTE COUNT, MANUAL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 85044
|
| Hospital Charge Code |
900910063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| 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 |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.24
|
| Rate for Payer: Heritage Provider Network Senior |
$76.76
|
| Rate for Payer: Heritage Provider Network Senior |
$14.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$59.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.31
|
| Rate for Payer: TriValley Medical Group Senior |
$4.31
|
| Rate for Payer: TriValley Medical Group Senior |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
|
|
HC RETICULOCYTE COUNT, MANUAL
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 85044
|
| Hospital Charge Code |
900910063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.86
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.62 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$702.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$539.60
|
| Rate for Payer: Blue Shield of California EPN |
$429.41
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$738.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$738.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$408.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$769.07
|
| Rate for Payer: Heritage Provider Network Senior |
$769.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$541.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$681.60
|
| Rate for Payer: TriValley Medical Group Senior |
$681.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.62 |
| Max. Negotiated Rate |
$852.00 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$731.58
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$769.07
|
| Rate for Payer: Heritage Provider Network Senior |
$769.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
|
|
HC RETROGRADE DBL BLLN ENTSCPY
|
Facility
|
IP
|
$9,256.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,675.34 |
| Max. Negotiated Rate |
$6,942.00 |
| Rate for Payer: Adventist Health Commercial |
$1,851.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,960.86
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,266.31
|
| Rate for Payer: Heritage Provider Network Senior |
$6,266.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,675.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,314.00
|
| Rate for Payer: Multiplan Commercial |
$6,942.00
|
|
|
HC RETROGRADE DBL BLLN ENTSCPY
|
Facility
|
OP
|
$9,256.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,851.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,720.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,629.85
|
| 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 |
$4,165.20
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,016.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,729.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,415.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,675.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,314.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$6,942.00
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
|
IP
|
$9,256.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,675.34 |
| Max. Negotiated Rate |
$6,942.00 |
| Rate for Payer: Adventist Health Commercial |
$1,851.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,960.86
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,266.31
|
| Rate for Payer: Heritage Provider Network Senior |
$6,266.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,675.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,314.00
|
| Rate for Payer: Multiplan Commercial |
$6,942.00
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
|
OP
|
$9,256.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,851.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,720.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,629.85
|
| 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 |
$4,165.20
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,016.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,729.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,415.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,675.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,314.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$6,942.00
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC RETROGRAD URETHROGRAM
|
Facility
|
IP
|
$1,264.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$228.78 |
| Max. Negotiated Rate |
$948.00 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$814.02
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$855.73
|
| Rate for Payer: Heritage Provider Network Senior |
$855.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$228.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.00
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
|
|
HC RETROGRAD URETHROGRAM
|
Facility
|
OP
|
$1,264.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$228.78 |
| Max. Negotiated Rate |
$948.00 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$781.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$394.72
|
| 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 |
$568.80
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$821.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$745.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$782.42
|
| Rate for Payer: Heritage Provider Network Senior |
$782.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$602.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$228.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.88
|
| Rate for Payer: TriValley Medical Group Senior |
$306.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
OP
|
$1,678.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$294.18 |
| Max. Negotiated Rate |
$1,258.50 |
| Rate for Payer: Adventist Health Commercial |
$335.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,037.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$625.09
|
| Rate for Payer: Blue Shield of California Commercial |
$549.46
|
| Rate for Payer: Blue Shield of California EPN |
$441.85
|
| Rate for Payer: Cash Price |
$755.10
|
| Rate for Payer: Cash Price |
$755.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,090.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$990.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,038.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,038.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$800.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$303.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$1,258.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$448.71
|
| Rate for Payer: TriValley Medical Group Senior |
$448.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
IP
|
$1,678.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.72 |
| Max. Negotiated Rate |
$1,258.50 |
| Rate for Payer: Adventist Health Commercial |
$335.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,080.63
|
| Rate for Payer: Cash Price |
$755.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,136.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,136.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$303.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.50
|
| Rate for Payer: Multiplan Commercial |
$1,258.50
|
|
|
HC REVERSE KNUCKLE BENDER
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309138
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$79.60
|
| Rate for Payer: Blue Shield of California EPN |
$79.60
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.67
|
| Rate for Payer: Heritage Provider Network Senior |
$91.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$65.56
|
|
|
HC REVERSE KNUCKLE BENDER
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309138
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$81.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$79.60
|
| Rate for Payer: Blue Shield of California EPN |
$79.60
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$168.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$168.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.67
|
| Rate for Payer: Heritage Provider Network Senior |
$91.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$138.60
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$65.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Vantage Medical Group Senior |
$168.30
|
|
|
HC REV INCL RPLCMT SPNL NEURO ELEC
|
Facility
|
OP
|
$30,068.00
|
|
|
Service Code
|
CPT 63663
|
| Hospital Charge Code |
900100645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,158.00 |
| Max. Negotiated Rate |
$22,551.00 |
| Rate for Payer: Adventist Health Commercial |
$6,013.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,582.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,295.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,016.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,196.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$13,530.60
|
| Rate for Payer: Cash Price |
$13,530.60
|
| Rate for Payer: Cash Price |
$13,530.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,544.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,295.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,016.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,196.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,040.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,196.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,612.09
|
| Rate for Payer: Heritage Provider Network Senior |
$10,081.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,196.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15,573.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,442.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,426.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,517.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,983.63
|
| Rate for Payer: Multiplan Commercial |
$22,551.00
|
| Rate for Payer: Multiplan WC |
$13,286.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,016.41
|
| Rate for Payer: TriValley Medical Group Senior |
$9,016.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,295.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,016.41
|
| Rate for Payer: Vantage Medical Group Senior |
$8,196.74
|
|
|
HC REV INCL RPLCMT SPNL NEURO ELEC
|
Facility
|
IP
|
$30,068.00
|
|
|
Service Code
|
CPT 63663
|
| Hospital Charge Code |
900100645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,442.31 |
| Max. Negotiated Rate |
$22,551.00 |
| Rate for Payer: Adventist Health Commercial |
$6,013.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,363.79
|
| Rate for Payer: Cash Price |
$13,530.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,356.04
|
| Rate for Payer: Heritage Provider Network Senior |
$20,356.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,442.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,517.00
|
| Rate for Payer: Multiplan Commercial |
$22,551.00
|
|
|
HC REVISE REMOVE NEURORECEIVER
|
Facility
|
IP
|
$14,480.00
|
|
|
Service Code
|
CPT 63688
|
| Hospital Charge Code |
909000688
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,620.88 |
| Max. Negotiated Rate |
$10,860.00 |
| Rate for Payer: Adventist Health Commercial |
$2,896.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,325.12
|
| Rate for Payer: Cash Price |
$6,516.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,802.96
|
| Rate for Payer: Heritage Provider Network Senior |
$9,802.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,620.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,620.00
|
| Rate for Payer: Multiplan Commercial |
$10,860.00
|
|
|
HC REVISE REMOVE NEURORECEIVER
|
Facility
|
OP
|
$14,480.00
|
|
|
Service Code
|
CPT 63688
|
| Hospital Charge Code |
909000688
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,620.88 |
| Max. Negotiated Rate |
$10,860.00 |
| Rate for Payer: Adventist Health Commercial |
$2,896.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,948.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,744.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,946.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,496.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$6,516.00
|
| Rate for Payer: Cash Price |
$6,516.00
|
| Rate for Payer: Cash Price |
$6,516.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,412.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,744.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,946.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,496.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,688.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,496.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,963.12
|
| Rate for Payer: Heritage Provider Network Senior |
$5,530.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,496.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,543.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,620.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,171.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,620.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,025.42
|
| Rate for Payer: Multiplan Commercial |
$10,860.00
|
| Rate for Payer: Multiplan WC |
$6,962.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,946.24
|
| Rate for Payer: TriValley Medical Group Senior |
$4,946.24
|
| 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 |
$6,744.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,946.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4,496.58
|
|
