|
HC ANOSCOPY DIAGNOSTIC W WO SPEC COLLECT
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
900501159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.83 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$200.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$154.38
|
| Rate for Payer: Blue Shield of California EPN |
$122.85
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$211.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.03
|
| Rate for Payer: Heritage Provider Network Senior |
$220.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$155.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$195.00
|
| Rate for Payer: TriValley Medical Group Senior |
$195.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC ANOSCOPY DIAGNOSTIC W WO SPEC COLLECT
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
900501159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.83 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$209.30
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.03
|
| Rate for Payer: Heritage Provider Network Senior |
$220.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.25
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
|
|
HC ANOSCOPY DIAG W/RMVL FB
|
Facility
|
IP
|
$3,249.00
|
|
|
Service Code
|
CPT 46608
|
| Hospital Charge Code |
900501160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$588.07 |
| Max. Negotiated Rate |
$2,436.75 |
| Rate for Payer: Adventist Health Commercial |
$649.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,092.36
|
| Rate for Payer: Cash Price |
$1,462.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,199.57
|
| Rate for Payer: Heritage Provider Network Senior |
$2,199.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$588.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.25
|
| Rate for Payer: Multiplan Commercial |
$2,436.75
|
|
|
HC ANOSCOPY DIAG W/RMVL FB
|
Facility
|
OP
|
$3,249.00
|
|
|
Service Code
|
CPT 46608
|
| Hospital Charge Code |
900501160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$588.07 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$649.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,007.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,543.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,228.12
|
| Rate for Payer: Cash Price |
$1,462.05
|
| Rate for Payer: Cash Price |
$1,462.05
|
| Rate for Payer: Cash Price |
$1,462.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,111.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,196.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,199.57
|
| Rate for Payer: Heritage Provider Network Senior |
$2,199.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,549.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$588.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,375.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$2,436.75
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,949.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1,949.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
HC ANTIBODY IDENTIFICATION
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
900904444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.83 |
| Max. Negotiated Rate |
$691.53 |
| Rate for Payer: Adventist Health Commercial |
$152.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.63
|
| Rate for Payer: Blue Shield of California Commercial |
$167.66
|
| Rate for Payer: Blue Shield of California EPN |
$134.83
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$494.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$494.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$461.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$471.06
|
| Rate for Payer: Heritage Provider Network Senior |
$471.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$363.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$530.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.77
|
| Rate for Payer: Multiplan Commercial |
$570.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$461.02
|
| Rate for Payer: TriValley Medical Group Senior |
$461.02
|
| 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 |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
HC ANTIBODY IDENTIFICATION
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
900904444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.74 |
| Max. Negotiated Rate |
$570.75 |
| Rate for Payer: Adventist Health Commercial |
$152.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$490.08
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$515.20
|
| Rate for Payer: Heritage Provider Network Senior |
$515.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.25
|
| Rate for Payer: Multiplan Commercial |
$570.75
|
|
|
HC ANTIBODY SCREEN
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
900904542
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$300.75 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$258.24
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$271.48
|
| Rate for Payer: Heritage Provider Network Senior |
$271.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.25
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
|
|
HC ANTIBODY SCREEN
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
900904542
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$300.75 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.53
|
| Rate for Payer: Blue Shield of California Commercial |
$94.94
|
| Rate for Payer: Blue Shield of California EPN |
$76.35
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$248.22
|
| Rate for Payer: Heritage Provider Network Senior |
$248.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$191.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.09
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.77
|
| Rate for Payer: TriValley Medical Group Senior |
$9.77
|
| 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 |
$14.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.75
|
| Rate for Payer: Vantage Medical Group Senior |
$9.77
|
|
|
HC ANTIBODY TITRATION
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
900904500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$428.25 |
| Rate for Payer: Adventist Health Commercial |
$114.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$352.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Cash Price |
$256.95
|
| Rate for Payer: Cash Price |
$256.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$371.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$371.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$353.45
|
| Rate for Payer: Heritage Provider Network Senior |
$353.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$272.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$428.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| 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 |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC ANTIBODY TITRATION
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
900904500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.35 |
| Max. Negotiated Rate |
$428.25 |
| Rate for Payer: Adventist Health Commercial |
$114.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$367.72
|
| Rate for Payer: Cash Price |
$256.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$386.57
|
| Rate for Payer: Heritage Provider Network Senior |
$386.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.75
|
| Rate for Payer: Multiplan Commercial |
$428.25
|
|
|
HC ANTIGEN TYPING PATIENT
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
900904701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.31
|
| Rate for Payer: Blue Shield of California Commercial |
$30.76
|
| Rate for Payer: Blue Shield of California EPN |
$24.67
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.89
|
| Rate for Payer: Heritage Provider Network Senior |
$204.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$157.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.13
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.83
|
| Rate for Payer: TriValley Medical Group Senior |
$3.83
|
| 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 |
$5.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.21
|
| Rate for Payer: Vantage Medical Group Senior |
$3.83
|
|
|
HC ANTIGEN TYPING PATIENT
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
900904701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.16
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.09
|
| Rate for Payer: Heritage Provider Network Senior |
$224.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
|
|
HC ANTIGEN TYPING UNIT
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.76
|
| Rate for Payer: Blue Shield of California Commercial |
$30.99
|
| Rate for Payer: Blue Shield of California EPN |
$24.86
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.89
|
| Rate for Payer: Heritage Provider Network Senior |
$204.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$157.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.35
|
| Rate for Payer: TriValley Medical Group Senior |
$6.35
|
| 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 |
$9.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Vantage Medical Group Senior |
$6.35
|
|
|
HC ANTIGEN TYPING UNIT
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.16
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.09
|
| Rate for Payer: Heritage Provider Network Senior |
$224.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
|
|
HC ANTIMICROB SUSCEPTIBILITY TEST
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900911660
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.41
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| 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: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$100.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC ANTIMICROB SUSCEPTIBILITY TEST
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900911660
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$135.24
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC ANTINUCLEAR ANTIBODIES (ANA)
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
900910969
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$114.74 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.74
|
| Rate for Payer: Blue Shield of California Commercial |
$97.29
|
| Rate for Payer: Blue Shield of California Commercial |
$97.29
|
| Rate for Payer: Blue Shield of California EPN |
$78.03
|
| Rate for Payer: Blue Shield of California EPN |
$78.03
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$144.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.81
|
| Rate for Payer: Heritage Provider Network Senior |
$138.04
|
| Rate for Payer: Heritage Provider Network Senior |
$32.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$106.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.09
|
| Rate for Payer: TriValley Medical Group Senior |
$12.09
|
| Rate for Payer: TriValley Medical Group Senior |
$12.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Vantage Medical Group Senior |
$12.09
|
| Rate for Payer: Vantage Medical Group Senior |
$12.09
|
|
|
HC ANTINUCLEAR ANTIBODIES (ANA)
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
900910969
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$167.25 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$143.61
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$150.97
|
| Rate for Payer: Heritage Provider Network Senior |
$150.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.75
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
|
|
HC ANTISTREPTOLYSIN O
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900910881
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.92
|
| Rate for Payer: Heritage Provider Network Senior |
$125.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
|
|
HC ANTISTREPTOLYSIN O
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900910881
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$129.25 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.25
|
| Rate for Payer: Blue Shield of California Commercial |
$109.44
|
| Rate for Payer: Blue Shield of California Commercial |
$109.44
|
| Rate for Payer: Blue Shield of California EPN |
$87.78
|
| Rate for Payer: Blue Shield of California EPN |
$87.78
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.42
|
| Rate for Payer: Heritage Provider Network Senior |
$115.13
|
| Rate for Payer: Heritage Provider Network Senior |
$46.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$88.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.60
|
| Rate for Payer: TriValley Medical Group Senior |
$13.60
|
| Rate for Payer: TriValley Medical Group Senior |
$13.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
|
HC ANTITHROMBIN III ACTIVITY
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
900912010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.85
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$163.83
|
| Rate for Payer: Heritage Provider Network Senior |
$163.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
|
|
HC ANTITHROMBIN III ACTIVITY
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
900912010
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.50
|
| Rate for Payer: Blue Shield of California Commercial |
$95.33
|
| Rate for Payer: Blue Shield of California Commercial |
$95.33
|
| Rate for Payer: Blue Shield of California EPN |
$76.46
|
| Rate for Payer: Blue Shield of California EPN |
$76.46
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$157.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.80
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$149.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$52.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$115.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.88
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.85
|
| Rate for Payer: TriValley Medical Group Senior |
$11.85
|
| Rate for Payer: TriValley Medical Group Senior |
$11.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Vantage Medical Group Senior |
$11.85
|
| Rate for Payer: Vantage Medical Group Senior |
$11.85
|
|
|
HC ANTITHROMBIN III ANTIGEN
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
900912011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$122.25 |
| Rate for Payer: Adventist Health Commercial |
$32.60
|
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.66
|
| Rate for Payer: Blue Shield of California Commercial |
$87.03
|
| Rate for Payer: Blue Shield of California Commercial |
$87.03
|
| Rate for Payer: Blue Shield of California EPN |
$69.81
|
| Rate for Payer: Blue Shield of California EPN |
$69.81
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.90
|
| Rate for Payer: Heritage Provider Network Senior |
$63.14
|
| Rate for Payer: Heritage Provider Network Senior |
$100.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$48.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$77.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.49
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
| Rate for Payer: Multiplan Commercial |
$122.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.81
|
| Rate for Payer: TriValley Medical Group Senior |
$10.81
|
| Rate for Payer: TriValley Medical Group Senior |
$10.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.89
|
| Rate for Payer: Vantage Medical Group Senior |
$10.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.81
|
|
|
HC ANTITHROMBIN III ANTIGEN
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
900912011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$122.25 |
| Rate for Payer: Adventist Health Commercial |
$32.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.97
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.35
|
| Rate for Payer: Heritage Provider Network Senior |
$110.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.75
|
| Rate for Payer: Multiplan Commercial |
$122.25
|
|
|
HC ANTI-XA APIXABAN
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$105.60 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.60
|
| Rate for Payer: Blue Shield of California Commercial |
$105.35
|
| Rate for Payer: Blue Shield of California Commercial |
$105.35
|
| Rate for Payer: Blue Shield of California EPN |
$84.50
|
| Rate for Payer: Blue Shield of California EPN |
$84.50
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$35.90
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$27.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$30.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.09
|
| Rate for Payer: TriValley Medical Group Senior |
$13.09
|
| Rate for Payer: TriValley Medical Group Senior |
$13.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
