|
HC CBC W DIFFERENTIAL
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910093
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.64
|
| Rate for Payer: Heritage Provider Network Senior |
$63.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
|
|
HC CBC WITHOUT DIFFERENTIAL
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912020
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.07
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.38
|
| Rate for Payer: Heritage Provider Network Senior |
$64.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC WITHOUT DIFFERENTIAL
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912020
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.41
|
| Rate for Payer: Heritage Provider Network Senior |
$70.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
|
|
HC CBC WO DIFFERENTIAL
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.41
|
| Rate for Payer: Heritage Provider Network Senior |
$70.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
|
|
HC CBC WO DIFFERENTIAL
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.07
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.38
|
| Rate for Payer: Heritage Provider Network Senior |
$64.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC W WBC AUTO DIFF
|
Facility
|
IP
|
$145.80
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900910092
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$26.39 |
| Max. Negotiated Rate |
$109.35 |
| Rate for Payer: Adventist Health Commercial |
$29.16
|
| Rate for Payer: Cash Price |
$80.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.71
|
| Rate for Payer: Heritage Provider Network Senior |
$98.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.45
|
| Rate for Payer: Multiplan Commercial |
$109.35
|
|
|
HC CBC W WBC AUTO DIFF
|
Facility
|
OP
|
$145.80
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900910092
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$109.35 |
| Rate for Payer: Adventist Health Commercial |
$29.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.99
|
| Rate for Payer: Blue Shield of California Commercial |
$62.55
|
| Rate for Payer: Blue Shield of California EPN |
$50.17
|
| Rate for Payer: Cash Price |
$80.19
|
| Rate for Payer: Cash Price |
$80.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$94.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.55
|
| Rate for Payer: Dignity Health Senior |
$7.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.25
|
| Rate for Payer: Heritage Provider Network Senior |
$90.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$69.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.79
|
| Rate for Payer: Multiplan Commercial |
$109.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.77
|
| Rate for Payer: TriValley Medical Group Senior |
$7.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7.77
|
|
|
HC CBC W WBC AUTO DIFFERENTIAL INDIV
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900912018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.17
|
| Rate for Payer: Heritage Provider Network Senior |
$98.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.25
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
|
|
HC CBC W WBC AUTO DIFFERENTIAL INDIV
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900912018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$99.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.99
|
| Rate for Payer: Blue Shield of California Commercial |
$62.55
|
| Rate for Payer: Blue Shield of California EPN |
$50.17
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$94.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.55
|
| Rate for Payer: Dignity Health Senior |
$7.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.75
|
| Rate for Payer: Heritage Provider Network Senior |
$89.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$69.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.79
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.77
|
| Rate for Payer: TriValley Medical Group Senior |
$7.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7.77
|
|
|
HC CBC W WO DIFFERENTIAL INDIVIDUAL
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.07
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC W WO DIFFERENTIAL INDIVIDUAL
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.64
|
| Rate for Payer: Heritage Provider Network Senior |
$63.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
|
|
HC CCPD TRAINING
|
Facility
|
IP
|
$2,149.00
|
|
|
Service Code
|
CPT 90989
|
| Hospital Charge Code |
943000202
|
|
Hospital Revenue Code
|
851
|
| Min. Negotiated Rate |
$388.97 |
| Max. Negotiated Rate |
$1,611.75 |
| Rate for Payer: Adventist Health Commercial |
$429.80
|
| Rate for Payer: Cash Price |
$1,181.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,454.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,454.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.25
|
| Rate for Payer: Multiplan Commercial |
$1,611.75
|
|
|
HC CCPD TRAINING
|
Facility
|
OP
|
$2,149.00
|
|
|
Service Code
|
CPT 90989
|
| Hospital Charge Code |
943000202
|
|
Hospital Revenue Code
|
851
|
| Min. Negotiated Rate |
$388.97 |
| Max. Negotiated Rate |
$1,826.65 |
| Rate for Payer: Adventist Health Commercial |
$429.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,148.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,476.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,826.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,611.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,310.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,048.71
|
| Rate for Payer: Cash Price |
$1,181.95
|
| Rate for Payer: Cash Price |
$1,181.95
|
| Rate for Payer: Cash Price |
$1,181.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,396.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,826.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,826.65
|
| Rate for Payer: Dignity Health Senior |
$1,826.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,396.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,330.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,330.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,081.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,025.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,504.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,504.30
|
| Rate for Payer: Multiplan Commercial |
$1,611.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$471.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$394.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,826.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,826.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,826.65
|
|
|
HC C DIFFICILE TOXIN A/B ASSAY
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900911750
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.98
|
| Rate for Payer: Heritage Provider Network Senior |
$194.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
|
|
HC C DIFFICILE TOXIN A/B ASSAY
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900911750
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$153.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.05
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.27
|
| Rate for Payer: Heritage Provider Network Senior |
$178.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$137.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC CDIFF NUCLEIC ACID TEST
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
900912489
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$392.99 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$103.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$392.99
|
| Rate for Payer: Blue Shield of California Commercial |
$289.56
|
| Rate for Payer: Blue Shield of California EPN |
$232.25
|
| Rate for Payer: Cash Price |
$106.70
|
| Rate for Payer: Cash Price |
$106.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.00
|
| Rate for Payer: Dignity Health Senior |
$37.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.09
|
| Rate for Payer: Heritage Provider Network Senior |
$120.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$92.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.96
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.27
|
| Rate for Payer: TriValley Medical Group Senior |
$37.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: Vantage Medical Group Senior |
$37.27
|
|
|
HC CDIFF NUCLEIC ACID TEST
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
900912489
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Cash Price |
$106.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.34
|
| Rate for Payer: Heritage Provider Network Senior |
$131.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
|
|
HC CEFINASE
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900912424
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Cash Price |
$56.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.73
|
| Rate for Payer: Heritage Provider Network Senior |
$69.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
|
|
HC CEFINASE
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900912424
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.31
|
| 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 |
$56.65
|
| Rate for Payer: Cash Price |
$56.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.95
|
| 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 |
$66.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.76
|
| Rate for Payer: Heritage Provider Network Senior |
$63.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC CELIAC BLOCK INJECTION
|
Facility
|
OP
|
$6,916.00
|
|
|
Service Code
|
CPT 64620
|
| Hospital Charge Code |
906764620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,383.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,751.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,803.80
|
| Rate for Payer: Cash Price |
$3,803.80
|
| Rate for Payer: Cash Price |
$3,803.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,495.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,149.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,281.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$161.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,149.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,729.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$5,187.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,244.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1,244.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC CELIAC BLOCK INJECTION
|
Facility
|
IP
|
$6,916.00
|
|
|
Service Code
|
CPT 64620
|
| Hospital Charge Code |
906764620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,251.80 |
| Max. Negotiated Rate |
$5,187.00 |
| Rate for Payer: Adventist Health Commercial |
$1,383.20
|
| Rate for Payer: Cash Price |
$3,803.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,682.13
|
| Rate for Payer: Heritage Provider Network Senior |
$4,682.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,729.00
|
| Rate for Payer: Multiplan Commercial |
$5,187.00
|
|
|
HC CELL COUNT & DIFF
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
900910124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.77 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Adventist Health Commercial |
$57.20
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.62
|
| Rate for Payer: Heritage Provider Network Senior |
$193.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.50
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
|
|
HC CELL COUNT & DIFF
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
900910124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Adventist Health Commercial |
$57.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$152.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$196.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.34
|
| Rate for Payer: Blue Shield of California Commercial |
$44.35
|
| Rate for Payer: Blue Shield of California EPN |
$35.57
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$185.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.16
|
| Rate for Payer: Dignity Health Senior |
$5.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$177.03
|
| Rate for Payer: Heritage Provider Network Senior |
$177.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$136.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.06
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Senior |
$5.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.16
|
| Rate for Payer: Vantage Medical Group Senior |
$5.60
|
|
|
HC CELL EXPANSION
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$69.50 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Adventist Health Commercial |
$76.80
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$259.97
|
| Rate for Payer: Heritage Provider Network Senior |
$259.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
|
|
HC CELL EXPANSION
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$69.50 |
| Max. Negotiated Rate |
$1,132.59 |
| Rate for Payer: Adventist Health Commercial |
$76.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$205.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$263.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,090.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,132.59
|
| Rate for Payer: Blue Shield of California EPN |
$908.43
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$249.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Senior |
$140.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$249.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$140.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$237.70
|
| Rate for Payer: Heritage Provider Network Senior |
$237.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$202.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$183.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$161.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$177.32
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$140.73
|
| Rate for Payer: TriValley Medical Group Senior |
$140.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$151.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$151.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
