|
HC TUBE TRACH BIVONA FLEXTEND PED
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
900800710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.07
|
| Rate for Payer: Blue Shield of California Commercial |
$213.50
|
| Rate for Payer: Blue Shield of California EPN |
$170.80
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$166.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$175.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TUBE TRACH BIVONA FLEXTEND PED
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
900800710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$225.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC TUBE TRACH PORTEX DIC
|
Facility
|
IP
|
$178.00
|
|
| Hospital Charge Code |
900800712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.63
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.51
|
| Rate for Payer: Heritage Provider Network Senior |
$120.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
|
|
HC TUBE TRACH PORTEX DIC
|
Facility
|
OP
|
$178.00
|
|
| Hospital Charge Code |
900800712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.04
|
| Rate for Payer: Blue Shield of California Commercial |
$108.58
|
| Rate for Payer: Blue Shield of California EPN |
$86.86
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.18
|
| Rate for Payer: Heritage Provider Network Senior |
$110.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$84.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$89.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$89.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC TUMOR LOCAL I-111 ZEVALIN DIAGNOSTIC
|
Facility
|
OP
|
$3,199.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
909301340
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$579.02 |
| Max. Negotiated Rate |
$2,399.25 |
| Rate for Payer: Adventist Health Commercial |
$639.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,976.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,600.14
|
| Rate for Payer: Blue Shield of California Commercial |
$909.89
|
| Rate for Payer: Blue Shield of California EPN |
$731.70
|
| Rate for Payer: Cash Price |
$1,439.55
|
| Rate for Payer: Cash Price |
$1,439.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,079.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,079.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$698.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,980.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,980.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,525.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$579.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$803.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$799.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$2,399.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$768.18
|
| Rate for Payer: TriValley Medical Group Senior |
$698.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,599.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,599.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC TUMOR LOCAL I-111 ZEVALIN DIAGNOSTIC
|
Facility
|
IP
|
$3,199.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
909301340
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$579.02 |
| Max. Negotiated Rate |
$2,399.25 |
| Rate for Payer: Adventist Health Commercial |
$639.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,060.16
|
| Rate for Payer: Cash Price |
$1,439.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,165.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,165.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$579.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$799.75
|
| Rate for Payer: Multiplan Commercial |
$2,399.25
|
|
|
HC TUMOR LOCLIZATN SPECT SNGL DAY
|
Facility
|
IP
|
$3,020.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
909301254
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$546.62 |
| Max. Negotiated Rate |
$2,265.00 |
| Rate for Payer: Adventist Health Commercial |
$604.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,944.88
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,044.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,044.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$546.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$755.00
|
| Rate for Payer: Multiplan Commercial |
$2,265.00
|
|
|
HC TUMOR LOCLIZATN SPECT SNGL DAY
|
Facility
|
OP
|
$3,020.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
909301254
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$546.62 |
| Max. Negotiated Rate |
$2,265.00 |
| Rate for Payer: Adventist Health Commercial |
$604.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,866.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,510.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,379.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,109.52
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,963.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,963.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$698.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,869.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,869.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,440.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$546.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$803.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$755.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$2,265.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$768.18
|
| Rate for Payer: TriValley Medical Group Senior |
$698.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,510.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,510.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC TURBO TRACKER 2-TIP
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.77 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$753.48
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$792.09
|
| Rate for Payer: Heritage Provider Network Senior |
$792.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
|
|
HC TURBO TRACKER 2-TIP
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.77 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$643.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$877.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.23
|
| Rate for Payer: Blue Shield of California Commercial |
$713.70
|
| Rate for Payer: Blue Shield of California EPN |
$570.96
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$760.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$994.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$994.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$994.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.23
|
| Rate for Payer: Heritage Provider Network Senior |
$724.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$558.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$819.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$585.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$585.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$994.50
|
| Rate for Payer: Vantage Medical Group Senior |
$994.50
|
|
|
HC TVSWG VARIABLESTIFFNESS(TAD/II
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$79.05 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.52
|
| Rate for Payer: Blue Shield of California Commercial |
$56.73
|
| Rate for Payer: Blue Shield of California EPN |
$45.38
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$79.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.57
|
| Rate for Payer: Heritage Provider Network Senior |
$57.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$65.10
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.05
|
| Rate for Payer: Vantage Medical Group Senior |
$79.05
|
|
|
HC TVSWG VARIABLESTIFFNESS(TAD/II
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.89
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.96
|
| Rate for Payer: Heritage Provider Network Senior |
$62.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
|
|
HC T-WAVE ALTERNANS
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
CPT 93025
|
| Hospital Charge Code |
900200153
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$323.99 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$358.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,152.76
|
| Rate for Payer: Cash Price |
$805.50
|
| Rate for Payer: Cash Price |
$805.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$323.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.50
|
| Rate for Payer: Multiplan Commercial |
$1,342.50
|
|
|
HC T-WAVE ALTERNANS
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
CPT 93025
|
| Hospital Charge Code |
900200153
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$358.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,106.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$895.36
|
| 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 |
$805.50
|
| Rate for Payer: Cash Price |
$805.50
|
| Rate for Payer: Cash Price |
$805.50
|
| Rate for Payer: Cash Price |
$805.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,163.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,056.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,108.01
|
| Rate for Payer: Heritage Provider Network Senior |
$203.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$314.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$323.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$1,342.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$182.04
|
| Rate for Payer: TriValley Medical Group Senior |
$165.49
|
| 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 |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC U1RNP AUTO AB
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913524
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.12
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.77
|
| Rate for Payer: Heritage Provider Network Senior |
$115.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
|
|
HC U1RNP AUTO AB
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913524
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$105.85
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$81.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC UGI AIR CONTRAST WITH SMB
|
Facility
|
OP
|
$1,778.00
|
|
|
Service Code
|
CPT 74249
|
| Hospital Charge Code |
909001792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$321.82 |
| Max. Negotiated Rate |
$1,511.30 |
| Rate for Payer: Adventist Health Commercial |
$355.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,098.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,511.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$977.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,333.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$699.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,084.58
|
| Rate for Payer: Blue Shield of California EPN |
$867.66
|
| Rate for Payer: Cash Price |
$800.10
|
| Rate for Payer: Cash Price |
$800.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,155.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,511.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,511.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,511.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,100.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,100.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$848.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$321.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,244.60
|
| Rate for Payer: Multiplan Commercial |
$1,333.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$889.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$889.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,511.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,511.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,511.30
|
|
|
HC UGI AIR CONTRAST WITH SMB
|
Facility
|
IP
|
$1,778.00
|
|
|
Service Code
|
CPT 74249
|
| Hospital Charge Code |
909001792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$321.82 |
| Max. Negotiated Rate |
$1,333.50 |
| Rate for Payer: Adventist Health Commercial |
$355.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,145.03
|
| Rate for Payer: Cash Price |
$800.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,203.71
|
| Rate for Payer: Heritage Provider Network Senior |
$1,203.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$321.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.50
|
| Rate for Payer: Multiplan Commercial |
$1,333.50
|
|
|
HC UGI AIR CONTRAST W KUB
|
Facility
|
IP
|
$1,495.00
|
|
|
Service Code
|
CPT 74247
|
| Hospital Charge Code |
909001791
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$1,121.25 |
| Rate for Payer: Adventist Health Commercial |
$299.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$962.78
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,012.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1,012.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.75
|
| Rate for Payer: Multiplan Commercial |
$1,121.25
|
|
|
HC UGI AIR CONTRAST W KUB
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
CPT 74247
|
| Hospital Charge Code |
909001791
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$1,270.75 |
| Rate for Payer: Adventist Health Commercial |
$299.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$923.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$822.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,121.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$459.34
|
| Rate for Payer: Blue Shield of California Commercial |
$911.95
|
| Rate for Payer: Blue Shield of California EPN |
$729.56
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$971.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,270.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,270.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$882.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$925.40
|
| Rate for Payer: Heritage Provider Network Senior |
$925.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$713.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,046.50
|
| Rate for Payer: Multiplan Commercial |
$1,121.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$747.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$747.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,270.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,270.75
|
|
|
HC UGI AIR DBL CONTRAST
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$202.90 |
| Max. Negotiated Rate |
$840.75 |
| Rate for Payer: Adventist Health Commercial |
$224.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$721.92
|
| Rate for Payer: Cash Price |
$504.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$758.92
|
| Rate for Payer: Heritage Provider Network Senior |
$758.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.25
|
| Rate for Payer: Multiplan Commercial |
$840.75
|
|
|
HC UGI AIR DBL CONTRAST
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.33 |
| Max. Negotiated Rate |
$840.75 |
| Rate for Payer: Adventist Health Commercial |
$224.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$692.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.24
|
| Rate for Payer: Blue Shield of California Commercial |
$347.76
|
| Rate for Payer: Blue Shield of California EPN |
$279.66
|
| Rate for Payer: Cash Price |
$504.45
|
| Rate for Payer: Cash Price |
$504.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$728.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$661.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.90
|
| Rate for Payer: Heritage Provider Network Senior |
$693.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$534.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$840.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.59
|
| Rate for Payer: TriValley Medical Group Senior |
$225.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$885.70 |
| Rate for Payer: Adventist Health Commercial |
$208.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$643.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$885.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$573.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$781.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$521.21
|
| Rate for Payer: Blue Shield of California Commercial |
$231.46
|
| Rate for Payer: Blue Shield of California EPN |
$186.13
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$677.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$885.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$885.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$885.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$614.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$645.00
|
| Rate for Payer: Heritage Provider Network Senior |
$645.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$497.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$729.40
|
| Rate for Payer: Multiplan Commercial |
$781.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$885.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$885.70
|
| Rate for Payer: Vantage Medical Group Senior |
$885.70
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$781.50 |
| Rate for Payer: Adventist Health Commercial |
$208.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$671.05
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$705.43
|
| Rate for Payer: Heritage Provider Network Senior |
$705.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.50
|
| Rate for Payer: Multiplan Commercial |
$781.50
|
|
|
HC ULTRASND OB LT 14 WK SNGL FETUS
|
Facility
|
IP
|
$1,883.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
906601314
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$340.82 |
| Max. Negotiated Rate |
$1,412.25 |
| Rate for Payer: Adventist Health Commercial |
$376.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,212.65
|
| Rate for Payer: Cash Price |
$847.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,274.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,274.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$340.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.75
|
| Rate for Payer: Multiplan Commercial |
$1,412.25
|
|
