|
HC BC-GP NUCLEIC ACID ID CULTURE
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.44
|
| Rate for Payer: Heritage Provider Network Senior |
$116.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
|
|
HC BCID2
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 87154
|
| Hospital Charge Code |
900913011
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.97 |
| Max. Negotiated Rate |
$198.75 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$179.41
|
| Rate for Payer: Heritage Provider Network Senior |
$179.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.25
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
|
|
HC BCID2
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 87154
|
| Hospital Charge Code |
900913011
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.82 |
| Max. Negotiated Rate |
$1,256.03 |
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$117.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$151.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$327.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$218.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$559.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,256.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,007.44
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$143.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$327.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.87
|
| Rate for Payer: Dignity Health Senior |
$218.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$218.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$136.18
|
| Rate for Payer: Heritage Provider Network Senior |
$136.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$353.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$218.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$104.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$274.76
|
| Rate for Payer: Multiplan Commercial |
$165.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$218.06
|
| Rate for Payer: TriValley Medical Group Senior |
$218.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$235.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$235.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$327.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.87
|
| Rate for Payer: Vantage Medical Group Senior |
$218.06
|
|
|
HC BCT LIMITED STUDY
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
909201971
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$1,024.00 |
| Rate for Payer: Adventist Health Commercial |
$177.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$610.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Blue Shield of California Commercial |
$735.02
|
| Rate for Payer: Blue Shield of California EPN |
$591.08
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$206.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$423.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$666.00
|
| 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 |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC BCT LIMITED STUDY
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
909201971
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$341.91 |
| Max. Negotiated Rate |
$1,416.75 |
| Rate for Payer: Adventist Health Commercial |
$377.80
|
| Rate for Payer: Cash Price |
$850.05
|
| Rate for Payer: Cash Price |
$850.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,278.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,278.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.25
|
| Rate for Payer: Multiplan Commercial |
$1,416.75
|
|
|
HC BEHAVIORAL & QUALITATIVE ANALYSIS VOICE & RESONANCE
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
900100021
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$120.91 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$452.24
|
| Rate for Payer: Heritage Provider Network Senior |
$452.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
|
|
HC BEHAVIORAL & QUALITATIVE ANALYSIS VOICE & RESONANCE
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
900100021
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$87.22 |
| Max. Negotiated Rate |
$567.80 |
| Rate for Payer: Adventist Health Commercial |
$273.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$357.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$458.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$501.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$434.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.80
|
| Rate for Payer: Dignity Health Senior |
$567.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$413.49
|
| Rate for Payer: Heritage Provider Network Senior |
$413.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$318.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.60
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$567.80
|
|
|
HC BENZODIAZPINES CONF
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900910515
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$220.15 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$138.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$194.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.96
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$168.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$220.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.15
|
| Rate for Payer: Dignity Health Senior |
$220.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$160.32
|
| Rate for Payer: Heritage Provider Network Senior |
$160.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$123.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.30
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$129.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$129.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.15
|
| Rate for Payer: Vantage Medical Group Senior |
$220.15
|
|
|
HC BENZODIAZPINES CONF
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900910515
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.47 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.22
|
| Rate for Payer: Heritage Provider Network Senior |
$211.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
|
|
HC BETA HCG POC
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900912138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.03 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Adventist Health Commercial |
$37.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.28
|
| Rate for Payer: Heritage Provider Network Senior |
$127.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
|
|
HC BETA HCG POC
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900912138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$68.59 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.10
|
| 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 |
$68.59
|
| Rate for Payer: Blue Shield of California Commercial |
$60.42
|
| Rate for Payer: Blue Shield of California EPN |
$48.46
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.10
|
| 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 |
$35.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.43
|
| Rate for Payer: Heritage Provider Network Senior |
$33.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| 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 |
$40.50
|
| 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, QUAL
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900910840
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.03 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Adventist Health Commercial |
$37.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.28
|
| Rate for Payer: Heritage Provider Network Senior |
$127.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
|
|
HC BETA HCG, QUAL
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
900910840
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$68.59 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.21
|
| 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 |
$68.59
|
| Rate for Payer: Blue Shield of California Commercial |
$60.42
|
| Rate for Payer: Blue Shield of California EPN |
$48.46
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.40
|
| 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 |
$49.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.04
|
| Rate for Payer: Heritage Provider Network Senior |
$47.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| 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 |
$57.00
|
| 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
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900910814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$131.53 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.53
|
| Rate for Payer: Blue Shield of California Commercial |
$121.13
|
| Rate for Payer: Blue Shield of California EPN |
$97.16
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.55
|
| Rate for Payer: Dignity Health Senior |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.99
|
| Rate for Payer: Heritage Provider Network Senior |
$77.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| 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 |
$94.50
|
| 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 |
$22.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC BETA HCG, QUANT
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900910814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.27 |
| Max. Negotiated Rate |
$336.75 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$303.97
|
| Rate for Payer: Heritage Provider Network Senior |
$303.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.25
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
|
|
HC BETA-HYDROXYBUTYRATE
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Adventist Health Commercial |
$52.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$176.02
|
| Rate for Payer: Heritage Provider Network Senior |
$176.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
|
|
HC BETA-HYDROXYBUTYRATE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$74.19 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.17
|
| 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 |
$74.19
|
| Rate for Payer: Blue Shield of California Commercial |
$65.78
|
| Rate for Payer: Blue Shield of California EPN |
$52.76
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.65
|
| 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 |
$26.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.38
|
| Rate for Payer: Heritage Provider Network Senior |
$25.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| 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 |
$30.75
|
| 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 BETAMETHASONE SOD PHOS ACET3MG
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
910400060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.85
|
| Rate for Payer: Blue Shield of California Commercial |
$8.21
|
| Rate for Payer: Blue Shield of California EPN |
$8.21
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Senior |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.89
|
| Rate for Payer: Heritage Provider Network Senior |
$13.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC BETAMETHASONE SOD PHOS ACET3MG
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
910400060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.89
|
| Rate for Payer: Heritage Provider Network Senior |
$13.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.93
|
|
|
HC BETA STREP RAPID TEST
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
900911635
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
|
HC BETA STREP RAPID TEST
|
Facility
|
OP
|
$91.77
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
900911635
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$82.05 |
| Rate for Payer: Adventist Health Commercial |
$18.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.21
|
| 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 |
$82.05
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.49
|
| Rate for Payer: Dignity Health Senior |
$16.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.81
|
| Rate for Payer: Heritage Provider Network Senior |
$56.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.94
|
| 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 |
$68.83
|
| 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 |
$25.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.49
|
| Rate for Payer: Vantage Medical Group Senior |
$16.81
|
|
|
HC BFLEX 2.8 BRONCHOSCOPE
|
Facility
|
OP
|
$808.00
|
|
| Hospital Charge Code |
900831711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$686.80 |
| Rate for Payer: Adventist Health Commercial |
$161.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$431.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$555.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$686.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$444.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$606.00
|
| Rate for Payer: Blue Shield of California Commercial |
$492.88
|
| Rate for Payer: Blue Shield of California EPN |
$394.30
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$525.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$686.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$686.80
|
| Rate for Payer: Dignity Health Senior |
$686.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$525.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.15
|
| Rate for Payer: Heritage Provider Network Senior |
$500.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$385.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$565.60
|
| Rate for Payer: Multiplan Commercial |
$606.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$404.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$404.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$686.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$686.80
|
| Rate for Payer: Vantage Medical Group Senior |
$686.80
|
|
|
HC BFLEX 2.8 BRONCHOSCOPE
|
Facility
|
IP
|
$808.00
|
|
| Hospital Charge Code |
900831711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$606.00 |
| Rate for Payer: Adventist Health Commercial |
$161.60
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$547.02
|
| Rate for Payer: Heritage Provider Network Senior |
$547.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$606.00
|
|
|
HC BFLEX 3.8 BRONCHOSCOPE
|
Facility
|
OP
|
$5,180.00
|
|
| Hospital Charge Code |
900831703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$937.58 |
| Max. Negotiated Rate |
$4,403.00 |
| Rate for Payer: Adventist Health Commercial |
$1,036.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,768.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,558.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,403.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,849.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,159.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,527.84
|
| Rate for Payer: Cash Price |
$2,331.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,367.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,403.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,403.00
|
| Rate for Payer: Dignity Health Senior |
$4,403.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,367.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,206.42
|
| Rate for Payer: Heritage Provider Network Senior |
$3,206.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,470.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$937.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,295.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,626.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,626.00
|
| Rate for Payer: Multiplan Commercial |
$3,885.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,590.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,590.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,403.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,403.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,403.00
|
|
|
HC BFLEX 3.8 BRONCHOSCOPE
|
Facility
|
IP
|
$5,180.00
|
|
| Hospital Charge Code |
900831703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$937.58 |
| Max. Negotiated Rate |
$3,885.00 |
| Rate for Payer: Adventist Health Commercial |
$1,036.00
|
| Rate for Payer: Cash Price |
$2,331.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,506.86
|
| Rate for Payer: Heritage Provider Network Senior |
$3,506.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$937.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,295.00
|
| Rate for Payer: Multiplan Commercial |
$3,885.00
|
|
