|
HC RPR LIP FLL THCK UP TO HLF VER
|
Facility
|
OP
|
$2,198.00
|
|
|
Service Code
|
CPT 40652
|
| Hospital Charge Code |
900540652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$397.84 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$439.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,358.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,044.05
|
| Rate for Payer: Blue Shield of California EPN |
$830.84
|
| Rate for Payer: Cash Price |
$989.10
|
| Rate for Payer: Cash Price |
$989.10
|
| Rate for Payer: Cash Price |
$989.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,428.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$693.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,488.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1,488.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,048.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$397.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$797.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$1,648.50
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,318.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,318.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC RPR PROS DEVICE PER 15 MIN
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
905357520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.43
|
| Rate for Payer: Blue Shield of California EPN |
$6.43
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.41
|
| Rate for Payer: Heritage Provider Network Senior |
$7.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.30
|
|
|
HC RPR PROS DEVICE PER 15 MIN
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
905357520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$6.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.43
|
| Rate for Payer: Blue Shield of California EPN |
$6.43
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.41
|
| Rate for Payer: Heritage Provider Network Senior |
$7.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.60
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
|
HC RPR TITER
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
900910929
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$41.80 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.80
|
| Rate for Payer: Blue Shield of California Commercial |
$35.48
|
| Rate for Payer: Blue Shield of California Commercial |
$35.48
|
| Rate for Payer: Blue Shield of California EPN |
$28.46
|
| Rate for Payer: Blue Shield of California EPN |
$28.46
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$118.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$112.66
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$86.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.40
|
| Rate for Payer: TriValley Medical Group Senior |
$4.40
|
| Rate for Payer: TriValley Medical Group Senior |
$4.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4.40
|
|
|
HC RPR TITER
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
900910929
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.21
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.21
|
| Rate for Payer: Heritage Provider Network Senior |
$123.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.50
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
|
|
HC RSV AG
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 87420
|
| Hospital Charge Code |
900911613
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$85.34 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$119.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.91
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$113.90
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$87.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.91
|
| Rate for Payer: TriValley Medical Group Senior |
$13.91
|
| Rate for Payer: TriValley Medical Group Senior |
$13.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$13.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13.91
|
|
|
HC RSV AG
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 87420
|
| Hospital Charge Code |
900911613
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.50
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$124.57
|
| Rate for Payer: Heritage Provider Network Senior |
$124.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
|
|
HC RSV DFA
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
900911537
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$85.34 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$158.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.98
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.42
|
| Rate for Payer: TriValley Medical Group Senior |
$13.42
|
| Rate for Payer: TriValley Medical Group Senior |
$13.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Vantage Medical Group Senior |
$13.42
|
| Rate for Payer: Vantage Medical Group Senior |
$13.42
|
|
|
HC RSV DFA
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
900911537
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.81
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC RT ATTENDANCE AT DELIVERY
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
CPT 99464
|
| Hospital Charge Code |
900800499
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$144.26 |
| Max. Negotiated Rate |
$677.45 |
| Rate for Payer: Adventist Health Commercial |
$159.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$492.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$677.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$438.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$597.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$398.66
|
| Rate for Payer: Blue Shield of California Commercial |
$486.17
|
| Rate for Payer: Blue Shield of California EPN |
$388.94
|
| Rate for Payer: Cash Price |
$358.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$518.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$677.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$677.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$677.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$493.34
|
| Rate for Payer: Heritage Provider Network Senior |
$493.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$380.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$557.90
|
| Rate for Payer: Multiplan Commercial |
$597.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$398.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$398.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$677.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$677.45
|
| Rate for Payer: Vantage Medical Group Senior |
$677.45
|
|
|
HC RT ATTENDANCE AT DELIVERY
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
CPT 99464
|
| Hospital Charge Code |
900800499
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$144.26 |
| Max. Negotiated Rate |
$597.75 |
| Rate for Payer: Adventist Health Commercial |
$159.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$513.27
|
| Rate for Payer: Cash Price |
$358.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$539.57
|
| Rate for Payer: Heritage Provider Network Senior |
$539.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.25
|
| Rate for Payer: Multiplan Commercial |
$597.75
|
|
|
HC RUBELLA ANTIBODY
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900913664
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
|
HC RUBELLA ANTIBODY
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900913664
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$136.22 |
| Rate for Payer: Blue Shield of California EPN |
$92.91
|
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.22
|
| Rate for Payer: Blue Shield of California Commercial |
$115.83
|
| Rate for Payer: Blue Shield of California Commercial |
$115.83
|
| Rate for Payer: Blue Shield of California EPN |
$92.91
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$75.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.44
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$71.80
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$55.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC RUBELLA ANTIBODY IGG QUANT
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900913665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
|
HC RUBELLA ANTIBODY IGG QUANT
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900913665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$136.22 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.22
|
| Rate for Payer: Blue Shield of California Commercial |
$115.83
|
| Rate for Payer: Blue Shield of California Commercial |
$115.83
|
| Rate for Payer: Blue Shield of California EPN |
$92.91
|
| Rate for Payer: Blue Shield of California EPN |
$92.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC RUBEOLA ANTIBODY
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$122.35 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| 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 |
$70.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| 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 Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.35
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| 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 |
$74.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.57
|
| Rate for Payer: Heritage Provider Network Senior |
$64.38
|
| Rate for Payer: Heritage Provider Network Senior |
$70.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$49.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$54.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC RUBEOLA ANTIBODY
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.63 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.42
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.18
|
| Rate for Payer: Heritage Provider Network Senior |
$77.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.50
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
|
|
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: Aetna of CA Non-Gatekeeper |
$370.30
|
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$389.27
|
| Rate for Payer: Heritage Provider Network Senior |
$389.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.75
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
|
|
HC RVSN PACEMAKER POCKET
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
906811999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.08 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$355.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.62
|
| 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 |
$258.75
|
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: Cash Price |
$258.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$373.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$355.93
|
| Rate for Payer: Heritage Provider Network Senior |
$317.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$490.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$283.86
|
| Rate for Payer: TriValley Medical Group Senior |
$283.86
|
| 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 |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
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: Aetna of CA Non-Gatekeeper |
$42.50
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
|
|
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 |
$150.09 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.79
|
| 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 |
$150.09
|
| 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 |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| 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 Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| 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) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| 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 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: Aetna of CA Non-Gatekeeper |
$17,900.62
|
| Rate for Payer: Cash Price |
$12,508.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,817.89
|
| Rate for Payer: Heritage Provider Network Senior |
$18,817.89
|
| Rate for Payer: Kaiser Foundation Hospitals 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 Non-Gatekeeper |
$17,177.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$12,508.20
|
| Rate for Payer: Cash Price |
$12,508.20
|
| Rate for Payer: Cash Price |
$12,508.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,067.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,677.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,205.72
|
| Rate for Payer: Heritage Provider Network Senior |
$11,479.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,732.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,031.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,949.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$20,847.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,265.97
|
| Rate for Payer: TriValley Medical Group Senior |
$10,265.97
|
| 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 |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
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: Aetna of CA Non-Gatekeeper |
$14,457.80
|
| Rate for Payer: Cash Price |
$10,102.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,198.65
|
| Rate for Payer: Heritage Provider Network Senior |
$15,198.65
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 |
$17,732.13 |
| Rate for Payer: Adventist Health Commercial |
$4,490.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,874.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$10,102.50
|
| Rate for Payer: Cash Price |
$10,102.50
|
| Rate for Payer: Cash Price |
$10,102.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,592.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,470.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,896.55
|
| Rate for Payer: Heritage Provider Network Senior |
$11,479.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,732.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,063.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,612.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$16,837.50
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,265.97
|
| Rate for Payer: TriValley Medical Group Senior |
$10,265.97
|
| 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 |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
