|
HC VALPROIC ACID (DEPAKENE)
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
900910927
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| 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 |
$134.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.61
|
| Rate for Payer: Blue Shield of California Commercial |
$109.04
|
| Rate for Payer: Blue Shield of California Commercial |
$109.04
|
| Rate for Payer: Blue Shield of California EPN |
$87.46
|
| Rate for Payer: Blue Shield of California EPN |
$87.46
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| 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 |
$141.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.44
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.94
|
| Rate for Payer: Heritage Provider Network Senior |
$71.80
|
| Rate for Payer: Heritage Provider Network Senior |
$134.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$55.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$103.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.54
|
| Rate for Payer: TriValley Medical Group Senior |
$13.54
|
| Rate for Payer: TriValley Medical Group Senior |
$13.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
|
|
HC VALVULOPLASTY, AORTIC
|
Facility
|
OP
|
$15,457.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906811113
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,797.72 |
| Max. Negotiated Rate |
$14,574.13 |
| Rate for Payer: Adventist Health Commercial |
$3,091.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,552.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,320.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,728.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$6,955.65
|
| Rate for Payer: Cash Price |
$6,955.65
|
| Rate for Payer: Cash Price |
$6,955.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,052.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,320.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,320.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,567.88
|
| Rate for Payer: Heritage Provider Network Senior |
$9,003.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,908.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,797.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,418.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,864.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,809.20
|
| Rate for Payer: Multiplan Commercial |
$11,592.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,052.33
|
| Rate for Payer: TriValley Medical Group Senior |
$7,320.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7,320.30
|
|
|
HC VALVULOPLASTY, AORTIC
|
Facility
|
IP
|
$15,457.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906811113
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,797.72 |
| Max. Negotiated Rate |
$11,592.75 |
| Rate for Payer: Adventist Health Commercial |
$3,091.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,954.31
|
| Rate for Payer: Cash Price |
$6,955.65
|
| Rate for Payer: Cash Price |
$6,955.65
|
| 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 |
$2,797.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,864.25
|
| Rate for Payer: Multiplan Commercial |
$11,592.75
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
|
IP
|
$10,305.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906811138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,865.20 |
| Max. Negotiated Rate |
$7,728.75 |
| Rate for Payer: Adventist Health Commercial |
$2,061.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,636.42
|
| Rate for Payer: Cash Price |
$4,637.25
|
| Rate for Payer: Cash Price |
$4,637.25
|
| 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 |
$1,865.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,576.25
|
| Rate for Payer: Multiplan Commercial |
$7,728.75
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
|
OP
|
$10,305.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906811138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,865.20 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Adventist Health Commercial |
$2,061.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,368.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,728.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$4,637.25
|
| Rate for Payer: Cash Price |
$4,637.25
|
| Rate for Payer: Cash Price |
$4,637.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,378.80
|
| Rate for Payer: Heritage Provider Network Senior |
$18,262.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,210.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,865.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,576.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$7,728.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$14,847.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
OP
|
$11,391.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906811137
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,061.77 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Adventist Health Commercial |
$2,278.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,039.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,185.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$5,125.95
|
| Rate for Payer: Cash Price |
$5,125.95
|
| Rate for Payer: Cash Price |
$5,125.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,051.03
|
| Rate for Payer: Heritage Provider Network Senior |
$18,262.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,210.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,061.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,847.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$8,543.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$14,847.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
IP
|
$11,391.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906811137
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,061.77 |
| Max. Negotiated Rate |
$8,543.25 |
| Rate for Payer: Adventist Health Commercial |
$2,278.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,335.80
|
| Rate for Payer: Cash Price |
$5,125.95
|
| Rate for Payer: Cash Price |
$5,125.95
|
| 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 |
$2,061.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,847.75
|
| Rate for Payer: Multiplan Commercial |
$8,543.25
|
|
|
HC VANCOMYCIN
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900910934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$183.75 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.78
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.87
|
| Rate for Payer: Heritage Provider Network Senior |
$165.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.25
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
|
|
HC VANCOMYCIN
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900910934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$128.61 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$151.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.61
|
| Rate for Payer: Blue Shield of California Commercial |
$109.04
|
| Rate for Payer: Blue Shield of California Commercial |
$109.04
|
| Rate for Payer: Blue Shield of California EPN |
$87.46
|
| Rate for Payer: Blue Shield of California EPN |
$87.46
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$159.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$151.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.57
|
| Rate for Payer: Heritage Provider Network Senior |
$151.66
|
| Rate for Payer: Heritage Provider Network Senior |
$31.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$116.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.54
|
| Rate for Payer: TriValley Medical Group Senior |
$13.54
|
| Rate for Payer: TriValley Medical Group Senior |
$13.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
|
|
HC VANCOMYCIN PEAK
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900912232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$183.75 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.78
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.87
|
| Rate for Payer: Heritage Provider Network Senior |
$165.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.25
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
|
|
HC VANCOMYCIN PEAK
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900912232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$128.61 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$151.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.61
|
| Rate for Payer: Blue Shield of California Commercial |
$109.04
|
| Rate for Payer: Blue Shield of California Commercial |
$109.04
|
| Rate for Payer: Blue Shield of California EPN |
$87.46
|
| Rate for Payer: Blue Shield of California EPN |
$87.46
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$159.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$151.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.57
|
| Rate for Payer: Heritage Provider Network Senior |
$151.66
|
| Rate for Payer: Heritage Provider Network Senior |
$31.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$116.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.54
|
| Rate for Payer: TriValley Medical Group Senior |
$13.54
|
| Rate for Payer: TriValley Medical Group Senior |
$13.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
|
|
HC VANILLYLMANDELIC ACID 24 HR UR
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900914082
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.81
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.57
|
| Rate for Payer: Heritage Provider Network Senior |
$15.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
|
|
HC VANILLYLMANDELIC ACID 24 HR UR
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900914082
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$147.21 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.21
|
| Rate for Payer: Blue Shield of California Commercial |
$124.76
|
| Rate for Payer: Blue Shield of California EPN |
$100.07
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.24
|
| Rate for Payer: Heritage Provider Network Senior |
$14.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.50
|
| Rate for Payer: TriValley Medical Group Senior |
$15.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
|
|
HC VANILLYLMANDELIC ACID URINE 24 HOURS
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900912225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$147.21 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.21
|
| Rate for Payer: Blue Shield of California Commercial |
$124.76
|
| Rate for Payer: Blue Shield of California Commercial |
$124.76
|
| Rate for Payer: Blue Shield of California EPN |
$100.07
|
| Rate for Payer: Blue Shield of California EPN |
$100.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.50
|
| Rate for Payer: TriValley Medical Group Senior |
$15.50
|
| Rate for Payer: TriValley Medical Group Senior |
$15.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
|
|
HC VANILLYLMANDELIC ACID URINE 24 HOURS
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900912225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.76
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC VANILLYLMANDELIC ACID URINE RANDOM
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900912224
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$147.21 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.21
|
| Rate for Payer: Blue Shield of California Commercial |
$124.76
|
| Rate for Payer: Blue Shield of California Commercial |
$124.76
|
| Rate for Payer: Blue Shield of California EPN |
$100.07
|
| Rate for Payer: Blue Shield of California EPN |
$100.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.50
|
| Rate for Payer: TriValley Medical Group Senior |
$15.50
|
| Rate for Payer: TriValley Medical Group Senior |
$15.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
|
|
HC VANILLYLMANDELIC ACID URINE RANDOM
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900912224
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.76
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC VANILMANDELIC ACID
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900910531
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$147.21 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.21
|
| Rate for Payer: Blue Shield of California Commercial |
$124.76
|
| Rate for Payer: Blue Shield of California Commercial |
$124.76
|
| Rate for Payer: Blue Shield of California EPN |
$100.07
|
| Rate for Payer: Blue Shield of California EPN |
$100.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.50
|
| Rate for Payer: TriValley Medical Group Senior |
$15.50
|
| Rate for Payer: TriValley Medical Group Senior |
$15.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
|
|
HC VANILMANDELIC ACID
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900910531
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.76
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC VAN SONNENBERG SUMP (COOK)
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$292.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$182.51
|
| Rate for Payer: Blue Shield of California EPN |
$182.51
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$208.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$210.20
|
| Rate for Payer: Heritage Provider Network Senior |
$210.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$227.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.50
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$150.32
|
|
|
HC VAN SONNENBERG SUMP (COOK)
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$280.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$249.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$340.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$182.51
|
| Rate for Payer: Blue Shield of California EPN |
$182.51
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$208.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$385.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$385.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$210.20
|
| Rate for Payer: Heritage Provider Network Senior |
$210.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$227.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$317.80
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$150.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$385.90
|
| Rate for Payer: Vantage Medical Group Senior |
$385.90
|
|
|
HC VARICELLA ZOSTER ANTIBODY
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913671
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$106.50 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$91.45
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.13
|
| Rate for Payer: Heritage Provider Network Senior |
$96.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.50
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
|
|
HC VARICELLA ZOSTER ANTIBODY
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913671
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$122.35 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.76
|
| 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 |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$83.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92.30
|
| 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 |
$83.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.11
|
| 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 |
$79.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.90
|
| Rate for Payer: Heritage Provider Network Senior |
$79.85
|
| Rate for Payer: Heritage Provider Network Senior |
$87.90
|
| 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 |
$61.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$67.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.70
|
| 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 |
$35.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.25
|
| 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 |
$96.75
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| 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 VASC EMBOLIZATION, VENOUS, TUMORS, ORG ISCHEM, INFARC
|
Facility
|
IP
|
$44,324.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
900100013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,022.64 |
| Max. Negotiated Rate |
$33,243.00 |
| Rate for Payer: Adventist Health Commercial |
$8,864.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,544.66
|
| Rate for Payer: Cash Price |
$19,945.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,007.35
|
| Rate for Payer: Heritage Provider Network Senior |
$30,007.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,022.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,081.00
|
| Rate for Payer: Multiplan Commercial |
$33,243.00
|
|
|
HC VASC EMBOLIZATION, VENOUS, TUMORS, ORG ISCHEM, INFARC
|
Facility
|
OP
|
$44,324.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
900100013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$33,243.00 |
| Rate for Payer: Adventist Health Commercial |
$8,864.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27,392.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,136.00
|
| 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 |
$19,945.80
|
| Rate for Payer: Cash Price |
$19,945.80
|
| Rate for Payer: Cash Price |
$19,945.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28,810.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$27,436.56
|
| Rate for Payer: Heritage Provider Network Senior |
$18,262.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,210.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,022.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,081.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$33,243.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$16,332.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
