|
HC ANTIGEN TYPING PATIENT
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
900904701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.09
|
| Rate for Payer: Heritage Provider Network Senior |
$224.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
|
|
HC ANTIGEN TYPING UNIT
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$685.59 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$176.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$227.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.66
|
| Rate for Payer: Blue Shield of California Commercial |
$30.99
|
| Rate for Payer: Blue Shield of California EPN |
$24.86
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Senior |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$457.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.89
|
| Rate for Payer: Heritage Provider Network Senior |
$204.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$157.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$575.90
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$457.06
|
| Rate for Payer: TriValley Medical Group Senior |
$457.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC ANTIGEN TYPING UNIT
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.09
|
| Rate for Payer: Heritage Provider Network Senior |
$224.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
|
|
HC ANTIMICROB SUSCEPTIBILITY TEST
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900911660
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$112.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.59
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$100.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC ANTIMICROB SUSCEPTIBILITY TEST
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900911660
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC ANTINUCLEAR ANTIBODIES (ANA)
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
900910969
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$167.25 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$150.97
|
| Rate for Payer: Heritage Provider Network Senior |
$150.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.75
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
|
|
HC ANTINUCLEAR ANTIBODIES (ANA)
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
900910969
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$167.25 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$119.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$153.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.33
|
| Rate for Payer: Blue Shield of California Commercial |
$97.29
|
| Rate for Payer: Blue Shield of California EPN |
$78.03
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$144.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.30
|
| Rate for Payer: Dignity Health Senior |
$12.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.04
|
| Rate for Payer: Heritage Provider Network Senior |
$138.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$106.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.23
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.09
|
| Rate for Payer: TriValley Medical Group Senior |
$12.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Vantage Medical Group Senior |
$12.09
|
|
|
HC ANTISTREPTOLYSIN O
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900910881
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$99.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.28
|
| Rate for Payer: Blue Shield of California Commercial |
$109.44
|
| Rate for Payer: Blue Shield of California EPN |
$87.78
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.96
|
| Rate for Payer: Dignity Health Senior |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.13
|
| Rate for Payer: Heritage Provider Network Senior |
$115.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$88.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.14
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.60
|
| Rate for Payer: TriValley Medical Group Senior |
$13.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
|
HC ANTISTREPTOLYSIN O
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900910881
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.92
|
| Rate for Payer: Heritage Provider Network Senior |
$125.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
|
|
HC ANTITHROMBIN III ACTIVITY
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
900912010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$129.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.17
|
| Rate for Payer: Blue Shield of California Commercial |
$95.33
|
| Rate for Payer: Blue Shield of California EPN |
$76.46
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$157.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.04
|
| Rate for Payer: Dignity Health Senior |
$11.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.80
|
| Rate for Payer: Heritage Provider Network Senior |
$149.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$115.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.93
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.85
|
| Rate for Payer: TriValley Medical Group Senior |
$11.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Vantage Medical Group Senior |
$11.85
|
|
|
HC ANTITHROMBIN III ACTIVITY
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
900912010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$163.83
|
| Rate for Payer: Heritage Provider Network Senior |
$163.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
|
|
HC ANTITHROMBIN III ANTIGEN
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
900912011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$122.25 |
| Rate for Payer: Adventist Health Commercial |
$32.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$87.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.71
|
| Rate for Payer: Blue Shield of California Commercial |
$87.03
|
| Rate for Payer: Blue Shield of California EPN |
$69.81
|
| Rate for Payer: Cash Price |
$89.65
|
| Rate for Payer: Cash Price |
$89.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.89
|
| Rate for Payer: Dignity Health Senior |
$10.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.90
|
| Rate for Payer: Heritage Provider Network Senior |
$100.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.62
|
| Rate for Payer: Multiplan Commercial |
$122.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.81
|
| Rate for Payer: TriValley Medical Group Senior |
$10.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Vantage Medical Group Senior |
$10.81
|
|
|
HC ANTITHROMBIN III ANTIGEN
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
900912011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$122.25 |
| Rate for Payer: Adventist Health Commercial |
$32.60
|
| Rate for Payer: Cash Price |
$89.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.35
|
| Rate for Payer: Heritage Provider Network Senior |
$110.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.75
|
| Rate for Payer: Multiplan Commercial |
$122.25
|
|
|
HC ANTI-XA APIXABAN
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$105.35 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.54
|
| Rate for Payer: Blue Shield of California Commercial |
$105.35
|
| Rate for Payer: Blue Shield of California EPN |
$84.50
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Senior |
$13.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.49
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.09
|
| Rate for Payer: TriValley Medical Group Senior |
$13.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC ANTI-XA APIXABAN
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
|
|
HC ANTI-XA UNFRACTIONATED HEPARIN
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.26 |
| Max. Negotiated Rate |
$92.25 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Cash Price |
$67.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.27
|
| Rate for Payer: Heritage Provider Network Senior |
$83.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.75
|
| Rate for Payer: Multiplan Commercial |
$92.25
|
|
|
HC ANTI-XA UNFRACTIONATED HEPARIN
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$105.35 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$65.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.54
|
| Rate for Payer: Blue Shield of California Commercial |
$105.35
|
| Rate for Payer: Blue Shield of California EPN |
$84.50
|
| Rate for Payer: Cash Price |
$67.65
|
| Rate for Payer: Cash Price |
$67.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$79.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Senior |
$13.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.14
|
| Rate for Payer: Heritage Provider Network Senior |
$76.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$58.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.49
|
| Rate for Payer: Multiplan Commercial |
$92.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.09
|
| Rate for Payer: TriValley Medical Group Senior |
$13.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
IP
|
$1,384.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
909081318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.50 |
| Max. Negotiated Rate |
$1,038.00 |
| Rate for Payer: Adventist Health Commercial |
$276.80
|
| Rate for Payer: Cash Price |
$761.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$936.97
|
| Rate for Payer: Heritage Provider Network Senior |
$936.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.00
|
| Rate for Payer: Multiplan Commercial |
$1,038.00
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
OP
|
$1,384.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
909081318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$276.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$950.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,176.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$761.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,038.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| 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 |
$761.20
|
| Rate for Payer: Cash Price |
$761.20
|
| Rate for Payer: Cash Price |
$761.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$899.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,176.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,176.40
|
| Rate for Payer: Dignity Health Senior |
$1,176.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$856.70
|
| Rate for Payer: Heritage Provider Network Senior |
$856.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$660.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$968.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$968.80
|
| Rate for Payer: Multiplan Commercial |
$1,038.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,176.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,176.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,176.40
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
IP
|
$1,345.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
906820175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$243.44 |
| Max. Negotiated Rate |
$1,008.75 |
| Rate for Payer: Adventist Health Commercial |
$269.00
|
| Rate for Payer: Cash Price |
$739.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$910.57
|
| Rate for Payer: Heritage Provider Network Senior |
$910.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.25
|
| Rate for Payer: Multiplan Commercial |
$1,008.75
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
OP
|
$1,345.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
906820175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$269.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$924.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,143.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$739.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| 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 |
$739.75
|
| Rate for Payer: Cash Price |
$739.75
|
| Rate for Payer: Cash Price |
$739.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$874.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,143.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,143.25
|
| Rate for Payer: Dignity Health Senior |
$1,143.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.55
|
| Rate for Payer: Heritage Provider Network Senior |
$832.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$641.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$941.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$941.50
|
| Rate for Payer: Multiplan Commercial |
$1,008.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,143.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,143.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,143.25
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
OP
|
$2,404.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906820073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$150.98 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$480.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,651.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,043.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,322.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,803.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,322.20
|
| Rate for Payer: Cash Price |
$1,322.20
|
| Rate for Payer: Cash Price |
$1,322.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,043.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,043.40
|
| Rate for Payer: Dignity Health Senior |
$2,043.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,562.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,488.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,488.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$150.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,146.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$435.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,682.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,682.80
|
| Rate for Payer: Multiplan Commercial |
$1,803.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,043.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,043.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,043.40
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
OP
|
$2,160.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906811416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$150.98 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$432.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,483.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,836.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,188.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,620.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,836.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,836.00
|
| Rate for Payer: Dignity Health Senior |
$1,836.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,337.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,337.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$150.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,030.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$390.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,512.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,512.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,836.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,836.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,836.00
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
IP
|
$2,404.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906820073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$435.12 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$480.80
|
| Rate for Payer: Cash Price |
$1,322.20
|
| Rate for Payer: Cash Price |
$1,322.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$435.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.00
|
| Rate for Payer: Multiplan Commercial |
$1,803.00
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
IP
|
$2,160.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906811416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$390.96 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$432.00
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$390.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
|
