|
HC THRPTC INTVN EA ADD 15MIN OT
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107133
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Cash Price |
$24.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.79
|
| Rate for Payer: Heritage Provider Network Senior |
$29.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
|
|
HC THRPTC INTVN EA ADD 15MIN ST
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107134
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$18.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$24.20
|
| Rate for Payer: Cash Price |
$24.20
|
| Rate for Payer: Cash Price |
$24.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.40
|
| Rate for Payer: Dignity Health Senior |
$37.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.80
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.40
|
| Rate for Payer: Vantage Medical Group Senior |
$37.40
|
|
|
HC THRPTC INTVN EA ADD 15MIN ST
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107134
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Cash Price |
$24.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.79
|
| Rate for Payer: Heritage Provider Network Senior |
$29.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
|
|
HC THRPTC SPNL PNCTR CSF FLUOR/CT
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
CPT 62329
|
| Hospital Charge Code |
909002329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Adventist Health Commercial |
$380.00
|
| Rate for Payer: Cash Price |
$1,045.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,286.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,286.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.00
|
| Rate for Payer: Multiplan Commercial |
$1,425.00
|
|
|
HC THRPTC SPNL PNCTR CSF FLUOR/CT
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 62329
|
| Hospital Charge Code |
909002329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$380.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,305.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,045.00
|
| Rate for Payer: Cash Price |
$1,045.00
|
| Rate for Payer: Cash Price |
$1,045.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,235.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Senior |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,176.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,082.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$476.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,671.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,108.70
|
| Rate for Payer: Multiplan Commercial |
$1,425.00
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$967.91
|
| Rate for Payer: TriValley Medical Group Senior |
$967.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC THYROGEN 1.1MG
|
Facility
|
IP
|
$5,235.00
|
|
|
Service Code
|
CPT J3240
|
| Hospital Charge Code |
909301498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$947.53 |
| Max. Negotiated Rate |
$3,926.25 |
| Rate for Payer: Adventist Health Commercial |
$1,047.00
|
| Rate for Payer: Cash Price |
$2,879.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,408.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,826.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,423.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2,423.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$947.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,308.75
|
| Rate for Payer: Multiplan Commercial |
$3,926.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,891.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,733.31
|
|
|
HC THYROGEN 1.1MG
|
Facility
|
OP
|
$5,235.00
|
|
|
Service Code
|
CPT J3240
|
| Hospital Charge Code |
909301498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$947.53 |
| Max. Negotiated Rate |
$5,237.22 |
| Rate for Payer: Adventist Health Commercial |
$1,047.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,798.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,596.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,641.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,324.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,237.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,016.79
|
| Rate for Payer: Blue Shield of California EPN |
$2,016.79
|
| Rate for Payer: Cash Price |
$2,879.25
|
| Rate for Payer: Cash Price |
$2,879.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,408.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,641.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,324.56
|
| Rate for Payer: Dignity Health Senior |
$2,324.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,350.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,113.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,423.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2,423.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,078.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,113.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,497.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$947.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,430.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,308.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,662.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,662.68
|
| Rate for Payer: Multiplan Commercial |
$3,926.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,094.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,094.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,891.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,733.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,641.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,324.56
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.56
|
|
|
HC THYROID BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$1,311.00
|
|
|
Service Code
|
CPT 60100
|
| Hospital Charge Code |
909000178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$262.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$900.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$721.05
|
| Rate for Payer: Cash Price |
$721.05
|
| Rate for Payer: Cash Price |
$721.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$852.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$786.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$811.51
|
| Rate for Payer: Heritage Provider Network Senior |
$1,099.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,698.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$983.25
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$983.38
|
| Rate for Payer: TriValley Medical Group Senior |
$983.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC THYROID BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$1,311.00
|
|
|
Service Code
|
CPT 60100
|
| Hospital Charge Code |
909000178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$237.29 |
| Max. Negotiated Rate |
$983.25 |
| Rate for Payer: Adventist Health Commercial |
$262.20
|
| Rate for Payer: Cash Price |
$721.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$887.55
|
| Rate for Payer: Heritage Provider Network Senior |
$887.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.75
|
| Rate for Payer: Multiplan Commercial |
$983.25
|
|
|
HC THYROID HORMONE T3
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
900910827
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.98
|
| Rate for Payer: Heritage Provider Network Senior |
$194.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
|
|
HC THYROID HORMONE T3
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
900910827
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$153.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.38
|
| Rate for Payer: Blue Shield of California Commercial |
$114.11
|
| Rate for Payer: Blue Shield of California EPN |
$91.52
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.60
|
| Rate for Payer: Dignity Health Senior |
$14.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.27
|
| Rate for Payer: Heritage Provider Network Senior |
$178.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$137.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.87
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.18
|
| Rate for Payer: TriValley Medical Group Senior |
$14.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.60
|
| Rate for Payer: Vantage Medical Group Senior |
$14.18
|
|
|
HC THYROID SCAN
|
Facility
|
OP
|
$1,151.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
909301316
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,143.55 |
| Rate for Payer: Adventist Health Commercial |
$230.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$615.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$790.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,143.55
|
| Rate for Payer: Blue Shield of California EPN |
$919.61
|
| Rate for Payer: Cash Price |
$633.05
|
| Rate for Payer: Cash Price |
$633.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$748.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$712.47
|
| Rate for Payer: Heritage Provider Network Senior |
$712.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$281.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$549.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$863.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$575.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC THYROID SCAN
|
Facility
|
IP
|
$1,151.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
909301316
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$863.25 |
| Rate for Payer: Adventist Health Commercial |
$230.20
|
| Rate for Payer: Cash Price |
$633.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$779.23
|
| Rate for Payer: Heritage Provider Network Senior |
$779.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.75
|
| Rate for Payer: Multiplan Commercial |
$863.25
|
|
|
HC THYROID UPTAKE MULT
|
Facility
|
IP
|
$769.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
909301311
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$139.19 |
| Max. Negotiated Rate |
$576.75 |
| Rate for Payer: Adventist Health Commercial |
$153.80
|
| Rate for Payer: Cash Price |
$422.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$520.61
|
| Rate for Payer: Heritage Provider Network Senior |
$520.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.25
|
| Rate for Payer: Multiplan Commercial |
$576.75
|
|
|
HC THYROID UPTAKE MULT
|
Facility
|
OP
|
$769.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
909301311
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$139.19 |
| Max. Negotiated Rate |
$765.86 |
| Rate for Payer: Adventist Health Commercial |
$153.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$411.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$528.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$439.78
|
| Rate for Payer: Blue Shield of California EPN |
$353.65
|
| Rate for Payer: Cash Price |
$422.95
|
| Rate for Payer: Cash Price |
$422.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$499.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$476.01
|
| Rate for Payer: Heritage Provider Network Senior |
$476.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$366.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$576.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$384.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$384.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC THYROID UPTAKE/SCAN
|
Facility
|
IP
|
$1,896.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
909301315
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$343.18 |
| Max. Negotiated Rate |
$1,422.00 |
| Rate for Payer: Adventist Health Commercial |
$379.20
|
| Rate for Payer: Cash Price |
$1,042.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,283.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,283.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$474.00
|
| Rate for Payer: Multiplan Commercial |
$1,422.00
|
|
|
HC THYROID UPTAKE/SCAN
|
Facility
|
OP
|
$1,896.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
909301315
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$343.18 |
| Max. Negotiated Rate |
$1,422.00 |
| Rate for Payer: Adventist Health Commercial |
$379.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,013.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,302.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,305.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,049.57
|
| Rate for Payer: Cash Price |
$1,042.80
|
| Rate for Payer: Cash Price |
$1,042.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,232.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,232.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,173.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,173.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$345.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$904.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$474.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$1,422.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$948.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$948.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC THYROXIN T4
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
900910835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$81.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.75
|
| Rate for Payer: Blue Shield of California Commercial |
$55.35
|
| Rate for Payer: Blue Shield of California EPN |
$44.40
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$99.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.56
|
| Rate for Payer: Dignity Health Senior |
$6.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.71
|
| Rate for Payer: Heritage Provider Network Senior |
$94.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$72.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.66
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.87
|
| Rate for Payer: TriValley Medical Group Senior |
$6.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.56
|
| Rate for Payer: Vantage Medical Group Senior |
$6.87
|
|
|
HC THYROXIN T4
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
900910835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.58
|
| Rate for Payer: Heritage Provider Network Senior |
$103.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
|
|
HC TIBIA FIBULA
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
909001638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Cash Price |
$332.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.91
|
| Rate for Payer: Heritage Provider Network Senior |
$408.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
|
|
HC TIBIA FIBULA
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
909001638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$322.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$414.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.32
|
| Rate for Payer: Blue Shield of California Commercial |
$107.90
|
| Rate for Payer: Blue Shield of California EPN |
$86.77
|
| Rate for Payer: Cash Price |
$332.20
|
| Rate for Payer: Cash Price |
$332.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$392.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$373.88
|
| Rate for Payer: Heritage Provider Network Senior |
$373.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$288.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC TILT TABLE TEST
|
Facility
|
IP
|
$2,448.00
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
900200144
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$443.09 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$489.60
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.00
|
| Rate for Payer: Multiplan Commercial |
$1,836.00
|
|
|
HC TILT TABLE TEST
|
Facility
|
OP
|
$2,448.00
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
900200144
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$443.09 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$489.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,308.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,681.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| 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 |
$1,346.40
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,591.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Senior |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,591.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$674.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,515.31
|
| Rate for Payer: Heritage Provider Network Senior |
$829.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,280.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$775.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$849.47
|
| Rate for Payer: Multiplan Commercial |
$1,836.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$741.60
|
| Rate for Payer: TriValley Medical Group Senior |
$674.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC TIP DEFLECTING WIRE
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$105.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$136.03
|
| 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: Blue Shield of California Commercial |
$120.78
|
| Rate for Payer: Blue Shield of California EPN |
$96.62
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$168.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$168.30
|
| Rate for Payer: Dignity Health Senior |
$168.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.56
|
| Rate for Payer: Heritage Provider Network Senior |
$122.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$94.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$138.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$138.60
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$99.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.00
|
| 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 TIP DEFLECTING WIRE
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.05
|
| Rate for Payer: Heritage Provider Network Senior |
$134.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
|
