|
HC ANGIO RV/OR RA
|
Facility
IP
|
$1,956.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906820072
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$354.04 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$391.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,343.77
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| 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 |
$354.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$1,467.00
|
|
|
HC ANKLE ARTHROGRAPHY INJECTION
|
Facility
IP
|
$790.00
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
909000118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$142.99 |
| Max. Negotiated Rate |
$592.50 |
| Rate for Payer: Adventist Health Commercial |
$158.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$542.73
|
| Rate for Payer: Blue Shield of California Commercial |
$333.38
|
| Rate for Payer: Blue Shield of California EPN |
$317.58
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$534.83
|
| Rate for Payer: Heritage Provider Network Senior |
$534.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.50
|
| Rate for Payer: Multiplan Commercial |
$592.50
|
|
|
HC ANKLE ARTHROGRAPHY INJECTION
|
Facility
OP
|
$790.00
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
909000118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$142.99 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$158.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$542.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$671.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$434.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$592.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$513.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$671.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$671.50
|
| Rate for Payer: Dignity Health Senior |
$671.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$489.01
|
| Rate for Payer: Heritage Provider Network Senior |
$489.01
|
| Rate for Payer: IEHP Medi-Cal |
$249.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$380.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.50
|
| Rate for Payer: Multiplan Commercial |
$592.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$671.50
|
| Rate for Payer: Vantage Medical Group Senior |
$671.50
|
|
|
HC ANKLE COMPLETE
|
Facility
IP
|
$646.00
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
909001648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$443.80
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.34
|
| Rate for Payer: Heritage Provider Network Senior |
$437.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
|
|
HC ANKLE COMPLETE
|
Facility
OP
|
$646.00
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
909001648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.22 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$443.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.02
|
| Rate for Payer: Blue Shield of California Commercial |
$106.76
|
| Rate for Payer: Blue Shield of California EPN |
$60.71
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$419.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$399.87
|
| Rate for Payer: Heritage Provider Network Senior |
$399.87
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$39.22
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC ANKLE LIMITED
|
Facility
OP
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
909001642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.67 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.11
|
| Rate for Payer: Blue Shield of California Commercial |
$98.89
|
| Rate for Payer: Blue Shield of California EPN |
$56.23
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$312.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$297.12
|
| Rate for Payer: Heritage Provider Network Senior |
$297.12
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$29.67
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC ANKLE LIMITED
|
Facility
IP
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
909001642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.76
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.96
|
| Rate for Payer: Heritage Provider Network Senior |
$324.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
|
|
HC ANORECTAL MANOMETRY
|
Facility
OP
|
$1,842.00
|
|
|
Service Code
|
CPT 91122
|
| Hospital Charge Code |
906791122
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$94.18 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$368.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$334.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,265.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,197.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,105.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,140.20
|
| Rate for Payer: Heritage Provider Network Senior |
$482.37
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: IEHP Medi-Cal |
$94.18
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$745.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$1,381.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC ANORECTAL MANOMETRY
|
Facility
IP
|
$2,534.00
|
|
|
Service Code
|
CPT 91122
|
| Hospital Charge Code |
906791122
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$458.65 |
| Max. Negotiated Rate |
$1,900.50 |
| Rate for Payer: Adventist Health Commercial |
$506.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,740.86
|
| Rate for Payer: Cash Price |
$1,140.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,715.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,715.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$458.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.50
|
| Rate for Payer: Multiplan Commercial |
$1,900.50
|
|
|
HC ANOSCOPY DIAGNOSTIC W WO SPEC COLLECT
|
Facility
OP
|
$298.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
900501159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.75
|
| Rate for Payer: Heritage Provider Network Senior |
$201.75
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$143.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$108.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC ANOSCOPY DIAGNOSTIC W WO SPEC COLLECT
|
Facility
IP
|
$298.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
900501159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$223.50 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.73
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.75
|
| Rate for Payer: Heritage Provider Network Senior |
$201.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
|
|
HC ANOSCOPY DIAG W/RMVL FB
|
Facility
OP
|
$2,974.00
|
|
|
Service Code
|
CPT 46608
|
| Hospital Charge Code |
900501160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$538.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$594.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,043.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,338.30
|
| Rate for Payer: Cash Price |
$1,338.30
|
| Rate for Payer: Cash Price |
$1,338.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,933.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,013.40
|
| Rate for Payer: Heritage Provider Network Senior |
$2,013.40
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,433.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$538.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$2,230.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,079.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$993.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC ANOSCOPY DIAG W/RMVL FB
|
Facility
IP
|
$2,974.00
|
|
|
Service Code
|
CPT 46608
|
| Hospital Charge Code |
900501160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$538.29 |
| Max. Negotiated Rate |
$2,230.50 |
| Rate for Payer: Adventist Health Commercial |
$594.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,043.14
|
| Rate for Payer: Cash Price |
$1,338.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,013.40
|
| Rate for Payer: Heritage Provider Network Senior |
$2,013.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$538.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.50
|
| Rate for Payer: Multiplan Commercial |
$2,230.50
|
|
|
HC ANTIBODY IDENTIFICATION
|
Facility
OP
|
$814.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
900904444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$853.31 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$559.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.33
|
| Rate for Payer: Blue Shield of California Commercial |
$505.49
|
| Rate for Payer: Blue Shield of California EPN |
$477.82
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$529.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.02
|
| Rate for Payer: Dignity Health Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$449.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.87
|
| Rate for Payer: Heritage Provider Network Senior |
$503.87
|
| Rate for Payer: Humana Medicare |
$449.11
|
| Rate for Payer: IEHP Medi-Cal |
$25.77
|
| Rate for Payer: IEHP Medicare Advantage |
$449.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$853.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$529.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$565.88
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$449.11
|
| Rate for Payer: TriValley Medical Group Senior |
$449.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC ANTIBODY IDENTIFICATION
|
Facility
IP
|
$814.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
900904444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.33 |
| Max. Negotiated Rate |
$610.50 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$559.22
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$551.08
|
| Rate for Payer: Heritage Provider Network Senior |
$551.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.50
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
|
|
HC ANTIBODY SCREEN
|
Facility
OP
|
$429.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
900904542
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$321.75 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$294.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.39
|
| Rate for Payer: Blue Shield of California Commercial |
$266.41
|
| Rate for Payer: Blue Shield of California EPN |
$251.82
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$278.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: Dignity Health Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$265.55
|
| Rate for Payer: Heritage Provider Network Senior |
$265.55
|
| Rate for Payer: Humana Medicare |
$67.70
|
| Rate for Payer: IEHP Medi-Cal |
$4.06
|
| Rate for Payer: IEHP Medicare Advantage |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.30
|
| Rate for Payer: Multiplan Commercial |
$321.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.70
|
| Rate for Payer: TriValley Medical Group Senior |
$67.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC ANTIBODY SCREEN
|
Facility
IP
|
$429.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
900904542
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.65 |
| Max. Negotiated Rate |
$321.75 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$294.72
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$290.43
|
| Rate for Payer: Heritage Provider Network Senior |
$290.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.25
|
| Rate for Payer: Multiplan Commercial |
$321.75
|
|
|
HC ANTIBODY TITRATION
|
Facility
OP
|
$611.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
900904500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$419.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.28
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$397.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$378.21
|
| Rate for Payer: Heritage Provider Network Senior |
$378.21
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: IEHP Medi-Cal |
$6.58
|
| Rate for Payer: IEHP Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$458.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$213.41
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC ANTIBODY TITRATION
|
Facility
IP
|
$611.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
900904500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.59 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$419.76
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$413.65
|
| Rate for Payer: Heritage Provider Network Senior |
$413.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.75
|
| Rate for Payer: Multiplan Commercial |
$458.25
|
|
|
HC ANTIGEN TYPING PATIENT
|
Facility
OP
|
$354.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
900904701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$853.31 |
| Rate for Payer: Adventist Health Commercial |
$70.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$243.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.01
|
| Rate for Payer: Blue Shield of California Commercial |
$29.85
|
| Rate for Payer: Blue Shield of California EPN |
$23.34
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$230.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.02
|
| Rate for Payer: Dignity Health Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$449.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$219.13
|
| Rate for Payer: Heritage Provider Network Senior |
$219.13
|
| Rate for Payer: Humana Medicare |
$449.11
|
| Rate for Payer: IEHP Medi-Cal |
$5.23
|
| Rate for Payer: IEHP Medicare Advantage |
$449.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$853.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$529.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$565.88
|
| Rate for Payer: Multiplan Commercial |
$265.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$449.11
|
| Rate for Payer: TriValley Medical Group Senior |
$449.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC ANTIGEN TYPING PATIENT
|
Facility
IP
|
$354.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
900904701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.07 |
| Max. Negotiated Rate |
$265.50 |
| Rate for Payer: Adventist Health Commercial |
$70.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$243.20
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$239.66
|
| Rate for Payer: Heritage Provider Network Senior |
$239.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.50
|
| Rate for Payer: Multiplan Commercial |
$265.50
|
|
|
HC ANTIGEN TYPING UNIT
|
Facility
IP
|
$354.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.07 |
| Max. Negotiated Rate |
$265.50 |
| Rate for Payer: Adventist Health Commercial |
$70.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$243.20
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$239.66
|
| Rate for Payer: Heritage Provider Network Senior |
$239.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.50
|
| Rate for Payer: Multiplan Commercial |
$265.50
|
|
|
HC ANTIGEN TYPING UNIT
|
Facility
OP
|
$354.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$853.31 |
| Rate for Payer: Adventist Health Commercial |
$70.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$243.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.36
|
| Rate for Payer: Blue Shield of California Commercial |
$30.07
|
| Rate for Payer: Blue Shield of California EPN |
$23.51
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$230.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.02
|
| Rate for Payer: Dignity Health Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$449.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$219.13
|
| Rate for Payer: Heritage Provider Network Senior |
$219.13
|
| Rate for Payer: Humana Medicare |
$449.11
|
| Rate for Payer: IEHP Medi-Cal |
$5.12
|
| Rate for Payer: IEHP Medicare Advantage |
$449.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$853.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$529.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$565.88
|
| Rate for Payer: Multiplan Commercial |
$265.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$449.11
|
| Rate for Payer: TriValley Medical Group Senior |
$449.11
|
| 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 |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC ANTIMICROB SUSCEPTIBILITY TEST
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900911660
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$147.70
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.56
|
| Rate for Payer: Heritage Provider Network Senior |
$145.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
|
|
HC ANTIMICROB SUSCEPTIBILITY TEST
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900911660
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.88
|
| Rate for Payer: Blue Shield of California Commercial |
$22.47
|
| Rate for Payer: Blue Shield of California EPN |
$17.57
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| 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 |
$11.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Humana Medicare |
$4.75
|
| Rate for Payer: IEHP Medi-Cal |
$1.81
|
| Rate for Payer: IEHP Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| 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
|
|
