|
HC CAVERNOSGRAPHY INJECTION
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 54230
|
| Hospital Charge Code |
909080039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.25 |
| Max. Negotiated Rate |
$266.25 |
| Rate for Payer: Adventist Health Commercial |
$71.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.62
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$240.34
|
| Rate for Payer: Heritage Provider Network Senior |
$240.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.75
|
| Rate for Payer: Multiplan Commercial |
$266.25
|
|
|
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: Aetna of CA Non-Gatekeeper |
$60.54
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.64
|
| Rate for Payer: Heritage Provider Network Senior |
$63.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
|
|
HC CBC W DIFFERENTIAL
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910093
|
|
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: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| 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 Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.43
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$32.19
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
| 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: Aetna of CA Non-Gatekeeper |
$66.98
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.41
|
| Rate for Payer: Heritage Provider Network Senior |
$70.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
|
|
HC CBC WITHOUT DIFFERENTIAL
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912020
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$61.43 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| 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 Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.43
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Heritage Provider Network Senior |
$64.38
|
| Rate for Payer: Heritage Provider Network Senior |
$32.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$49.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
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: Aetna of CA Non-Gatekeeper |
$66.98
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.41
|
| Rate for Payer: Heritage Provider Network Senior |
$70.41
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$37.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$61.43 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| 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 Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.43
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.90
|
| Rate for Payer: Heritage Provider Network Senior |
$64.38
|
| Rate for Payer: Heritage Provider Network Senior |
$22.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$49.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC W WBC AUTO DIFF
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900910092
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$73.83 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.65
|
| 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 Medi-Cal |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.83
|
| Rate for Payer: Blue Shield of California Commercial |
$62.55
|
| Rate for Payer: Blue Shield of California Commercial |
$62.55
|
| Rate for Payer: Blue Shield of California EPN |
$50.17
|
| Rate for Payer: Blue Shield of California EPN |
$50.17
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$32.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$71.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.77
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$8.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$11.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7.77
|
| Rate for Payer: Vantage Medical Group Senior |
$7.77
|
|
|
HC CBC W WBC AUTO DIFF
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900910092
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
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: Aetna of CA Non-Gatekeeper |
$93.38
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.17
|
| Rate for Payer: Heritage Provider Network Senior |
$98.17
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$52.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900912018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$73.83 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$89.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.65
|
| 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 Medi-Cal |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.83
|
| Rate for Payer: Blue Shield of California Commercial |
$62.55
|
| Rate for Payer: Blue Shield of California Commercial |
$62.55
|
| Rate for Payer: Blue Shield of California EPN |
$50.17
|
| Rate for Payer: Blue Shield of California EPN |
$50.17
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$94.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Heritage Provider Network Senior |
$89.75
|
| Rate for Payer: Heritage Provider Network Senior |
$32.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$69.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.77
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$8.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$11.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7.77
|
| Rate for Payer: Vantage Medical Group Senior |
$7.77
|
|
|
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: Aetna of CA Non-Gatekeeper |
$60.54
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.64
|
| Rate for Payer: Heritage Provider Network Senior |
$63.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
|
|
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: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| 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 Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.43
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$32.19
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
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: Aetna of CA Non-Gatekeeper |
$1,383.96
|
| Rate for Payer: Cash Price |
$967.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,454.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,454.87
|
| Rate for Payer: Kaiser Foundation Hospitals 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 Non-Gatekeeper |
$1,328.08
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$1,074.93
|
| 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 |
$967.05
|
| Rate for Payer: Cash Price |
$967.05
|
| 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 Medicare Advantage |
$1,826.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,267.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,330.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,330.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,025.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$388.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900911750
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$85.34 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| 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 Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.42
|
| Rate for Payer: Heritage Provider Network Senior |
$178.27
|
| Rate for Payer: Heritage Provider Network Senior |
$59.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$137.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$45.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
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: Aetna of CA Non-Gatekeeper |
$185.47
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.98
|
| Rate for Payer: Heritage Provider Network Senior |
$194.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
|
|
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 |
$408.72 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.91
|
| 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 Medi-Cal |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.72
|
| Rate for Payer: Blue Shield of California Commercial |
$289.56
|
| Rate for Payer: Blue Shield of California Commercial |
$289.56
|
| Rate for Payer: Blue Shield of California EPN |
$232.25
|
| Rate for Payer: Blue Shield of California EPN |
$232.25
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$93.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.09
|
| Rate for Payer: Heritage Provider Network Senior |
$89.14
|
| Rate for Payer: Heritage Provider Network Senior |
$120.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$68.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$92.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.94
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.27
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$40.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$55.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: Vantage Medical Group Senior |
$37.27
|
| 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: Aetna of CA Non-Gatekeeper |
$124.94
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.34
|
| Rate for Payer: Heritage Provider Network Senior |
$131.34
|
| Rate for Payer: Kaiser Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$66.33
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.73
|
| Rate for Payer: Heritage Provider Network Senior |
$69.73
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$24.00
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900912424
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$27.36 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.83
|
| 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 |
$27.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.36
|
| 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: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.60
|
| 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 |
$14.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.77
|
| 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 |
$63.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$63.76
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| 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 |
$49.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.34
|
| 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 |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| 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 |
$77.25
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| 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 CELIAC BLOCK INJECTION
|
Facility
|
OP
|
$6,916.00
|
|
|
Service Code
|
CPT 64620
|
| Hospital Charge Code |
906764620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,137.58 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,383.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,274.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$3,112.20
|
| Rate for Payer: Cash Price |
$3,112.20
|
| Rate for Payer: Cash Price |
$3,112.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,495.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,149.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,281.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,161.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,251.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,729.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$5,187.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,251.34
|
| Rate for Payer: TriValley Medical Group Senior |
$1,251.34
|
| 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 |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
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: Aetna of CA Non-Gatekeeper |
$4,453.90
|
| Rate for Payer: Cash Price |
$3,112.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,682.13
|
| Rate for Payer: Heritage Provider Network Senior |
$4,682.13
|
| Rate for Payer: Kaiser Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$184.18
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.62
|
| Rate for Payer: Heritage Provider Network Senior |
$193.62
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$59.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
900910124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$52.35 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Adventist Health Commercial |
$57.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$176.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.40
|
| 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 Medi-Cal |
$6.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.35
|
| Rate for Payer: Blue Shield of California Commercial |
$44.35
|
| Rate for Payer: Blue Shield of California Commercial |
$44.35
|
| Rate for Payer: Blue Shield of California EPN |
$35.57
|
| Rate for Payer: Blue Shield of California EPN |
$35.57
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$185.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$177.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.52
|
| Rate for Payer: Heritage Provider Network Senior |
$177.03
|
| Rate for Payer: Heritage Provider Network Senior |
$36.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$136.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.60
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$6.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$8.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.16
|
| Rate for Payer: Vantage Medical Group Senior |
$5.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5.60
|
|
