HC ALLERGEN SUNFLOWER SEED IGE
|
Facility
OP
|
$15.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913604
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.72 |
Max. Negotiated Rate |
$132.31 |
Rate for Payer: Adventist Health Commercial |
$3.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
Rate for Payer: Blue Shield of California Commercial |
$40.81
|
Rate for Payer: Blue Shield of California EPN |
$31.90
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
Rate for Payer: Dignity Health Senior |
$5.22
|
Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
Rate for Payer: Heritage Provider Network Senior |
$9.28
|
Rate for Payer: Humana Medicare |
$5.22
|
Rate for Payer: IEHP Medi-Cal |
$7.24
|
Rate for Payer: IEHP Medicare Advantage |
$5.22
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
Rate for Payer: Multiplan Commercial |
$11.25
|
Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
Rate for Payer: TriValley Medical Group Senior |
$5.22
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
HC ALLERGEN SWEET GUM IGE
|
Facility
IP
|
$64.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913605
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$11.58 |
Max. Negotiated Rate |
$48.00 |
Rate for Payer: Adventist Health Commercial |
$12.80
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
Rate for Payer: Cash Price |
$28.80
|
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 ALLERGEN SWEET GUM IGE
|
Facility
OP
|
$15.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913605
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.72 |
Max. Negotiated Rate |
$132.31 |
Rate for Payer: Adventist Health Commercial |
$3.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
Rate for Payer: Blue Shield of California Commercial |
$40.81
|
Rate for Payer: Blue Shield of California EPN |
$31.90
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
Rate for Payer: Dignity Health Senior |
$5.22
|
Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
Rate for Payer: Heritage Provider Network Senior |
$9.28
|
Rate for Payer: Humana Medicare |
$5.22
|
Rate for Payer: IEHP Medi-Cal |
$7.24
|
Rate for Payer: IEHP Medicare Advantage |
$5.22
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
Rate for Payer: Multiplan Commercial |
$11.25
|
Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
Rate for Payer: TriValley Medical Group Senior |
$5.22
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
HC ALLERGEN TEA IGE
|
Facility
IP
|
$68.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913606
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$12.31 |
Max. Negotiated Rate |
$51.00 |
Rate for Payer: Adventist Health Commercial |
$13.60
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
Rate for Payer: Cash Price |
$30.60
|
Rate for Payer: Heritage Provider Network Commercial |
$46.04
|
Rate for Payer: Heritage Provider Network Senior |
$46.04
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
Rate for Payer: Multiplan Commercial |
$51.00
|
|
HC ALLERGEN TEA IGE
|
Facility
OP
|
$15.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913606
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.72 |
Max. Negotiated Rate |
$132.31 |
Rate for Payer: Adventist Health Commercial |
$3.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
Rate for Payer: Blue Shield of California Commercial |
$40.81
|
Rate for Payer: Blue Shield of California EPN |
$31.90
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
Rate for Payer: Dignity Health Senior |
$5.22
|
Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
Rate for Payer: Heritage Provider Network Senior |
$9.28
|
Rate for Payer: Humana Medicare |
$5.22
|
Rate for Payer: IEHP Medi-Cal |
$7.24
|
Rate for Payer: IEHP Medicare Advantage |
$5.22
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
Rate for Payer: Multiplan Commercial |
$11.25
|
Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
Rate for Payer: TriValley Medical Group Senior |
$5.22
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
HC ALLERGEN TIMOTHY GRASS IGE
|
Facility
IP
|
$68.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913501
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$12.31 |
Max. Negotiated Rate |
$51.00 |
Rate for Payer: Adventist Health Commercial |
$13.60
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
Rate for Payer: Cash Price |
$30.60
|
Rate for Payer: Heritage Provider Network Commercial |
$46.04
|
Rate for Payer: Heritage Provider Network Senior |
$46.04
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
Rate for Payer: Multiplan Commercial |
$51.00
|
|
HC ALLERGEN TIMOTHY GRASS IGE
|
Facility
OP
|
$15.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913501
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.72 |
Max. Negotiated Rate |
$132.31 |
Rate for Payer: Adventist Health Commercial |
$3.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
Rate for Payer: Blue Shield of California Commercial |
$40.81
|
Rate for Payer: Blue Shield of California EPN |
$31.90
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
Rate for Payer: Dignity Health Senior |
$5.22
|
Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
Rate for Payer: Heritage Provider Network Senior |
$9.28
|
Rate for Payer: Humana Medicare |
$5.22
|
Rate for Payer: IEHP Medi-Cal |
$7.24
|
Rate for Payer: IEHP Medicare Advantage |
$5.22
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
Rate for Payer: Multiplan Commercial |
$11.25
|
Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
Rate for Payer: TriValley Medical Group Senior |
$5.22
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
HC ALLERGEN TOBACCO IGE
|
Facility
IP
|
$64.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913607
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$11.58 |
Max. Negotiated Rate |
$48.00 |
Rate for Payer: Adventist Health Commercial |
$12.80
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
Rate for Payer: Cash Price |
$28.80
|
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 ALLERGEN TOBACCO IGE
|
Facility
OP
|
$15.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913607
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.72 |
Max. Negotiated Rate |
$132.31 |
Rate for Payer: Adventist Health Commercial |
$3.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
Rate for Payer: Blue Shield of California Commercial |
$40.81
|
Rate for Payer: Blue Shield of California EPN |
$31.90
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
Rate for Payer: Dignity Health Senior |
$5.22
|
Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
Rate for Payer: Heritage Provider Network Senior |
$9.28
|
Rate for Payer: Humana Medicare |
$5.22
|
Rate for Payer: IEHP Medi-Cal |
$7.24
|
Rate for Payer: IEHP Medicare Advantage |
$5.22
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
Rate for Payer: Multiplan Commercial |
$11.25
|
Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
Rate for Payer: TriValley Medical Group Senior |
$5.22
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
HC ALLERGEN TOMATO IGE
|
Facility
OP
|
$15.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913502
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.72 |
Max. Negotiated Rate |
$132.31 |
Rate for Payer: Adventist Health Commercial |
$3.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
Rate for Payer: Blue Shield of California Commercial |
$40.81
|
Rate for Payer: Blue Shield of California EPN |
$31.90
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
Rate for Payer: Dignity Health Senior |
$5.22
|
Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
Rate for Payer: Heritage Provider Network Senior |
$9.28
|
Rate for Payer: Humana Medicare |
$5.22
|
Rate for Payer: IEHP Medi-Cal |
$7.24
|
Rate for Payer: IEHP Medicare Advantage |
$5.22
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
Rate for Payer: Multiplan Commercial |
$11.25
|
Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
Rate for Payer: TriValley Medical Group Senior |
$5.22
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
HC ALLERGEN TOMATO IGE
|
Facility
IP
|
$68.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913502
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$12.31 |
Max. Negotiated Rate |
$51.00 |
Rate for Payer: Adventist Health Commercial |
$13.60
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
Rate for Payer: Cash Price |
$30.60
|
Rate for Payer: Heritage Provider Network Commercial |
$46.04
|
Rate for Payer: Heritage Provider Network Senior |
$46.04
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
Rate for Payer: Multiplan Commercial |
$51.00
|
|
HC ALLERGEN TUNA IGE
|
Facility
IP
|
$68.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913503
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$12.31 |
Max. Negotiated Rate |
$51.00 |
Rate for Payer: Adventist Health Commercial |
$13.60
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
Rate for Payer: Cash Price |
$30.60
|
Rate for Payer: Heritage Provider Network Commercial |
$46.04
|
Rate for Payer: Heritage Provider Network Senior |
$46.04
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
Rate for Payer: Multiplan Commercial |
$51.00
|
|
HC ALLERGEN TUNA IGE
|
Facility
OP
|
$15.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913503
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.72 |
Max. Negotiated Rate |
$132.31 |
Rate for Payer: Adventist Health Commercial |
$3.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
Rate for Payer: Blue Shield of California Commercial |
$40.81
|
Rate for Payer: Blue Shield of California EPN |
$31.90
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
Rate for Payer: Dignity Health Senior |
$5.22
|
Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
Rate for Payer: Heritage Provider Network Senior |
$9.28
|
Rate for Payer: Humana Medicare |
$5.22
|
Rate for Payer: IEHP Medi-Cal |
$7.24
|
Rate for Payer: IEHP Medicare Advantage |
$5.22
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
Rate for Payer: Multiplan Commercial |
$11.25
|
Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
Rate for Payer: TriValley Medical Group Senior |
$5.22
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
HC ALLERGEN TURKEY IGE
|
Facility
OP
|
$15.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913608
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.72 |
Max. Negotiated Rate |
$132.31 |
Rate for Payer: Adventist Health Commercial |
$3.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
Rate for Payer: Blue Shield of California Commercial |
$40.81
|
Rate for Payer: Blue Shield of California EPN |
$31.90
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
Rate for Payer: Dignity Health Senior |
$5.22
|
Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
Rate for Payer: Heritage Provider Network Senior |
$9.28
|
Rate for Payer: Humana Medicare |
$5.22
|
Rate for Payer: IEHP Medi-Cal |
$7.24
|
Rate for Payer: IEHP Medicare Advantage |
$5.22
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
Rate for Payer: Multiplan Commercial |
$11.25
|
Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
Rate for Payer: TriValley Medical Group Senior |
$5.22
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
HC ALLERGEN TURKEY IGE
|
Facility
IP
|
$68.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913608
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$12.31 |
Max. Negotiated Rate |
$51.00 |
Rate for Payer: Adventist Health Commercial |
$13.60
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
Rate for Payer: Cash Price |
$30.60
|
Rate for Payer: Heritage Provider Network Commercial |
$46.04
|
Rate for Payer: Heritage Provider Network Senior |
$46.04
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
Rate for Payer: Multiplan Commercial |
$51.00
|
|
HC ALLERGEN VANILLA IGE
|
Facility
IP
|
$68.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913504
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$12.31 |
Max. Negotiated Rate |
$51.00 |
Rate for Payer: Adventist Health Commercial |
$13.60
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
Rate for Payer: Cash Price |
$30.60
|
Rate for Payer: Heritage Provider Network Commercial |
$46.04
|
Rate for Payer: Heritage Provider Network Senior |
$46.04
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
Rate for Payer: Multiplan Commercial |
$51.00
|
|
HC ALLERGEN VANILLA IGE
|
Facility
OP
|
$15.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913504
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.72 |
Max. Negotiated Rate |
$132.31 |
Rate for Payer: Adventist Health Commercial |
$3.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
Rate for Payer: Blue Shield of California Commercial |
$40.81
|
Rate for Payer: Blue Shield of California EPN |
$31.90
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
Rate for Payer: Dignity Health Senior |
$5.22
|
Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
Rate for Payer: Heritage Provider Network Senior |
$9.28
|
Rate for Payer: Humana Medicare |
$5.22
|
Rate for Payer: IEHP Medi-Cal |
$7.24
|
Rate for Payer: IEHP Medicare Advantage |
$5.22
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
Rate for Payer: Multiplan Commercial |
$11.25
|
Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
Rate for Payer: TriValley Medical Group Senior |
$5.22
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
HC ALLERGEN WALNUT IGE
|
Facility
OP
|
$15.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913505
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.72 |
Max. Negotiated Rate |
$132.31 |
Rate for Payer: Adventist Health Commercial |
$3.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
Rate for Payer: Blue Shield of California Commercial |
$40.81
|
Rate for Payer: Blue Shield of California EPN |
$31.90
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
Rate for Payer: Dignity Health Senior |
$5.22
|
Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
Rate for Payer: Heritage Provider Network Senior |
$9.28
|
Rate for Payer: Humana Medicare |
$5.22
|
Rate for Payer: IEHP Medi-Cal |
$7.24
|
Rate for Payer: IEHP Medicare Advantage |
$5.22
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
Rate for Payer: Multiplan Commercial |
$11.25
|
Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
Rate for Payer: TriValley Medical Group Senior |
$5.22
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
HC ALLERGEN WALNUT IGE
|
Facility
IP
|
$68.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913505
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$12.31 |
Max. Negotiated Rate |
$51.00 |
Rate for Payer: Adventist Health Commercial |
$13.60
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
Rate for Payer: Cash Price |
$30.60
|
Rate for Payer: Heritage Provider Network Commercial |
$46.04
|
Rate for Payer: Heritage Provider Network Senior |
$46.04
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
Rate for Payer: Multiplan Commercial |
$51.00
|
|
HC ALLERGEN WHEAT IGE
|
Facility
IP
|
$68.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913506
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$12.31 |
Max. Negotiated Rate |
$51.00 |
Rate for Payer: Adventist Health Commercial |
$13.60
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
Rate for Payer: Cash Price |
$30.60
|
Rate for Payer: Heritage Provider Network Commercial |
$46.04
|
Rate for Payer: Heritage Provider Network Senior |
$46.04
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
Rate for Payer: Multiplan Commercial |
$51.00
|
|
HC ALLERGEN WHEAT IGE
|
Facility
OP
|
$15.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913506
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.72 |
Max. Negotiated Rate |
$132.31 |
Rate for Payer: Adventist Health Commercial |
$3.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
Rate for Payer: Blue Shield of California Commercial |
$40.81
|
Rate for Payer: Blue Shield of California EPN |
$31.90
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
Rate for Payer: Dignity Health Senior |
$5.22
|
Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
Rate for Payer: Heritage Provider Network Senior |
$9.28
|
Rate for Payer: Humana Medicare |
$5.22
|
Rate for Payer: IEHP Medi-Cal |
$7.24
|
Rate for Payer: IEHP Medicare Advantage |
$5.22
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
Rate for Payer: Multiplan Commercial |
$11.25
|
Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
Rate for Payer: TriValley Medical Group Senior |
$5.22
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
HC ALLERGEN YELLOW JACKET VENOM IGE
|
Facility
IP
|
$64.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913609
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$11.58 |
Max. Negotiated Rate |
$48.00 |
Rate for Payer: Adventist Health Commercial |
$12.80
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
Rate for Payer: Cash Price |
$28.80
|
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 ALLERGEN YELLOW JACKET VENOM IGE
|
Facility
OP
|
$15.00
|
|
Service Code
|
CPT 86003
|
Hospital Charge Code |
900913609
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$2.72 |
Max. Negotiated Rate |
$132.31 |
Rate for Payer: Adventist Health Commercial |
$3.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
Rate for Payer: Blue Shield of California Commercial |
$40.81
|
Rate for Payer: Blue Shield of California EPN |
$31.90
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cash Price |
$6.75
|
Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
Rate for Payer: Dignity Health Senior |
$5.22
|
Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
Rate for Payer: Heritage Provider Network Senior |
$9.28
|
Rate for Payer: Humana Medicare |
$5.22
|
Rate for Payer: IEHP Medi-Cal |
$7.24
|
Rate for Payer: IEHP Medicare Advantage |
$5.22
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
Rate for Payer: Multiplan Commercial |
$11.25
|
Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
Rate for Payer: TriValley Medical Group Senior |
$5.22
|
Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
HC ALLIGATOR RETRIEVAL DEVICE
|
Facility
OP
|
$6,250.00
|
|
Hospital Charge Code |
909020108
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$1,131.25 |
Max. Negotiated Rate |
$5,312.50 |
Rate for Payer: Adventist Health Commercial |
$1,250.00
|
Rate for Payer: Aetna of CA Gatekeeper |
$3,340.62
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,293.75
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,312.50
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,437.50
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,687.50
|
Rate for Payer: Blue Shield of California Commercial |
$3,881.25
|
Rate for Payer: Blue Shield of California EPN |
$3,668.75
|
Rate for Payer: Cash Price |
$2,812.50
|
Rate for Payer: Cigna of CA HMO/PPO |
$4,062.50
|
Rate for Payer: Dignity Health Commercial/Exchange |
$5,312.50
|
Rate for Payer: Dignity Health Medi-Cal |
$5,312.50
|
Rate for Payer: Dignity Health Senior |
$5,312.50
|
Rate for Payer: EPIC Health Plan Commercial |
$4,062.50
|
Rate for Payer: Heritage Provider Network Commercial |
$3,868.75
|
Rate for Payer: Heritage Provider Network Senior |
$3,868.75
|
Rate for Payer: Kaiser Permanente of CA Commercial |
$3,012.50
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,131.25
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1,562.50
|
Rate for Payer: Multiplan Commercial |
$4,687.50
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5,312.50
|
Rate for Payer: Vantage Medical Group Senior |
$5,312.50
|
|
HC ALLIGATOR RETRIEVAL DEVICE
|
Facility
IP
|
$6,250.00
|
|
Hospital Charge Code |
909020108
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$1,131.25 |
Max. Negotiated Rate |
$4,687.50 |
Rate for Payer: Adventist Health Commercial |
$1,250.00
|
Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,293.75
|
Rate for Payer: Cash Price |
$2,812.50
|
Rate for Payer: Heritage Provider Network Commercial |
$4,231.25
|
Rate for Payer: Heritage Provider Network Senior |
$4,231.25
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,131.25
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1,562.50
|
Rate for Payer: Multiplan Commercial |
$4,687.50
|
|