|
HC BCEDP CASE MANAGEMENT FEE
|
Facility
|
IP
|
$39.00
|
|
| Hospital Charge Code |
909099998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.40
|
| Rate for Payer: Heritage Provider Network Senior |
$26.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
|
|
HC B-CELL LYMPH FISH DNA PROBE SO
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914114
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$1,420.05 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,420.05
|
| Rate for Payer: Blue Shield of California Commercial |
$167.31
|
| Rate for Payer: Blue Shield of California EPN |
$130.79
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Senior |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.28
|
| Rate for Payer: Heritage Provider Network Senior |
$61.28
|
| Rate for Payer: Humana Medicare |
$21.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.99
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.42
|
| Rate for Payer: TriValley Medical Group Senior |
$21.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC B-CELL LYMPH FISH DNA PROBE SO
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914114
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.01
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.02
|
| Rate for Payer: Heritage Provider Network Senior |
$67.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
|
|
HC B-CELL LYMPH FISH INTRPHAS IN
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914115
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.29
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.67
|
| Rate for Payer: Heritage Provider Network Senior |
$109.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
|
|
HC B-CELL LYMPH FISH INTRPHAS IN
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914115
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$2,190.93 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$116.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,190.93
|
| Rate for Payer: Blue Shield of California Commercial |
$313.65
|
| Rate for Payer: Blue Shield of California EPN |
$245.20
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Senior |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.28
|
| Rate for Payer: Heritage Provider Network Senior |
$100.28
|
| Rate for Payer: Humana Medicare |
$51.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$49.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$97.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.19
|
| Rate for Payer: TriValley Medical Group Senior |
$51.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC BC-GN NUCLEIC ACID ID CULTURE
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$167.70 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$58.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.70
|
| Rate for Payer: Blue Shield of California Commercial |
$156.63
|
| Rate for Payer: Blue Shield of California EPN |
$122.45
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.06
|
| Rate for Payer: Dignity Health Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$20.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.26
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.05
|
| Rate for Payer: TriValley Medical Group Senior |
$20.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC BC-GN NUCLEIC ACID ID CULTURE
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.91
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.15
|
| Rate for Payer: Heritage Provider Network Senior |
$119.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
|
|
HC BC-GP NUCLEIC ACID ID CULTURE
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$167.70 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$58.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.70
|
| Rate for Payer: Blue Shield of California Commercial |
$156.63
|
| Rate for Payer: Blue Shield of California EPN |
$122.45
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.06
|
| Rate for Payer: Dignity Health Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$20.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.26
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.05
|
| Rate for Payer: TriValley Medical Group Senior |
$20.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC BC-GP NUCLEIC ACID ID CULTURE
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.91
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.15
|
| Rate for Payer: Heritage Provider Network Senior |
$119.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
|
|
HC BCT LIMITED STUDY
|
Facility
|
OP
|
$1,045.00
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
909201971
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$1,024.00 |
| Rate for Payer: Adventist Health Commercial |
$209.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$717.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Blue Shield of California Commercial |
$713.59
|
| Rate for Payer: Blue Shield of California EPN |
$405.79
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$198.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$783.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$170.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$170.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC BCT LIMITED STUDY
|
Facility
|
IP
|
$2,339.00
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
909201971
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$423.36 |
| Max. Negotiated Rate |
$1,754.25 |
| Rate for Payer: Adventist Health Commercial |
$467.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,606.89
|
| Rate for Payer: Cash Price |
$1,052.55
|
| Rate for Payer: Cash Price |
$1,052.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,583.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1,583.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.75
|
| Rate for Payer: Multiplan Commercial |
$1,754.25
|
|
|
HC BEHAVIORAL & QUALITATIVE ANALYSIS VOICE & RESONANCE
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
900100021
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$620.25 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$559.88
|
| Rate for Payer: Heritage Provider Network Senior |
$559.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
|
|
HC BEHAVIORAL & QUALITATIVE ANALYSIS VOICE & RESONANCE
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
900100021
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$83.99 |
| Max. Negotiated Rate |
$702.95 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$224.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$620.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$537.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.95
|
| Rate for Payer: Dignity Health Senior |
$702.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$511.91
|
| Rate for Payer: Heritage Provider Network Senior |
$511.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$398.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.95
|
| Rate for Payer: Vantage Medical Group Senior |
$702.95
|
|
|
HC BENZODIAZPINES CONF
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900910515
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.48
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: Dignity Health Senior |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.28
|
| Rate for Payer: Heritage Provider Network Senior |
$139.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$108.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC BENZODIAZPINES CONF
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900910515
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$203.25 |
| Rate for Payer: Adventist Health Commercial |
$54.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.18
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.47
|
| Rate for Payer: Heritage Provider Network Senior |
$183.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.75
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
|
|
HC BETA HCG POC
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900912138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$62.89 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.89
|
| Rate for Payer: Blue Shield of California Commercial |
$58.64
|
| Rate for Payer: Blue Shield of California EPN |
$45.84
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.27
|
| Rate for Payer: Dignity Health Senior |
$7.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$7.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.48
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.52
|
| Rate for Payer: TriValley Medical Group Senior |
$7.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.27
|
| Rate for Payer: Vantage Medical Group Senior |
$7.52
|
|
|
HC BETA HCG POC
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900912138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.79
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.09
|
| Rate for Payer: Heritage Provider Network Senior |
$115.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.50
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
|
|
HC BETA HCG, QUAL
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900910840
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.79
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.09
|
| Rate for Payer: Heritage Provider Network Senior |
$115.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.50
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
|
|
HC BETA HCG, QUAL
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900910840
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$62.89 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.89
|
| Rate for Payer: Blue Shield of California Commercial |
$58.64
|
| Rate for Payer: Blue Shield of California EPN |
$45.84
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.27
|
| Rate for Payer: Dignity Health Senior |
$7.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Humana Medicare |
$7.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.48
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.52
|
| Rate for Payer: TriValley Medical Group Senior |
$7.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.27
|
| Rate for Payer: Vantage Medical Group Senior |
$7.52
|
|
|
HC BETA HCG, QUANT
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900910814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.49 |
| Max. Negotiated Rate |
$304.50 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$278.92
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$274.86
|
| Rate for Payer: Heritage Provider Network Senior |
$274.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.50
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
|
|
HC BETA HCG, QUANT
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900910814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$120.59 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.59
|
| Rate for Payer: Blue Shield of California Commercial |
$117.56
|
| Rate for Payer: Blue Shield of California EPN |
$91.90
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.56
|
| Rate for Payer: Dignity Health Senior |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.28
|
| Rate for Payer: Heritage Provider Network Senior |
$35.28
|
| Rate for Payer: Humana Medicare |
$15.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.05
|
| Rate for Payer: TriValley Medical Group Senior |
$15.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.56
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC BETA-HYDROXYBUTYRATE
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.54 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$161.44
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.10
|
| Rate for Payer: Heritage Provider Network Senior |
$159.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.75
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
|
|
HC BETA-HYDROXYBUTYRATE
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$68.02 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.02
|
| Rate for Payer: Blue Shield of California Commercial |
$63.84
|
| Rate for Payer: Blue Shield of California EPN |
$49.91
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.99
|
| Rate for Payer: Dignity Health Senior |
$8.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Humana Medicare |
$8.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.17
|
| Rate for Payer: TriValley Medical Group Senior |
$8.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Vantage Medical Group Senior |
$8.17
|
|
|
HC BETA STREP RAPID TEST
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
900911635
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.87
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.46
|
| Rate for Payer: Heritage Provider Network Senior |
$95.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
|
|
HC BETA STREP RAPID TEST
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
900911635
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$75.23 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.23
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| 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: Dignity Health Commercial/Exchange |
$25.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.49
|
| Rate for Payer: Dignity Health Senior |
$16.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Humana Medicare |
$16.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.18
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.81
|
| Rate for Payer: TriValley Medical Group Senior |
$16.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.49
|
| Rate for Payer: Vantage Medical Group Senior |
$16.81
|
|
