|
HC CULTURE ANAEROBIC
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
900911501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$62.81 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$234.92
|
| Rate for Payer: Heritage Provider Network Senior |
$234.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.75
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
|
|
HC CULTURE ANAEROBIC IDS RAPID
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900911553
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$106.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.00
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC CULTURE ANAEROBIC IDS RAPID
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900911553
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC CULTURE BACTERIAL AG H INFLU
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911711
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$70.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.68
|
| 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 |
$42.72
|
| 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 |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$85.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.71
|
| Rate for Payer: Heritage Provider Network Senior |
$81.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$62.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| 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 CULTURE BACTERIAL AG H INFLU
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911711
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.89 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.36
|
| Rate for Payer: Heritage Provider Network Senior |
$89.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
|
|
HC CULTURE BACTERIAL AG N MENING
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911713
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$70.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.68
|
| 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 |
$42.72
|
| 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 |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$85.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.71
|
| Rate for Payer: Heritage Provider Network Senior |
$81.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$62.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| 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 CULTURE BACTERIAL AG N MENING
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911713
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.89 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.36
|
| Rate for Payer: Heritage Provider Network Senior |
$89.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
|
|
HC CULTURE BACTERIAL AG S PNEUM
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911712
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.89 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.36
|
| Rate for Payer: Heritage Provider Network Senior |
$89.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
|
|
HC CULTURE BACTERIAL AG S PNEUM
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911712
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$70.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.68
|
| 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 |
$42.72
|
| 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 |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$85.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.71
|
| Rate for Payer: Heritage Provider Network Senior |
$81.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$62.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| 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 CULTURE BACTERIAL AG STREP B
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911710
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$70.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.68
|
| 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 |
$42.72
|
| 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 |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$85.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.71
|
| Rate for Payer: Heritage Provider Network Senior |
$81.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$62.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| 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 CULTURE BACTERIAL AG STREP B
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911710
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.89 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.36
|
| Rate for Payer: Heritage Provider Network Senior |
$89.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
|
|
HC CULTURE BLOOD
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
900911502
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$264.03
|
| Rate for Payer: Heritage Provider Network Senior |
$264.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.50
|
| Rate for Payer: Multiplan Commercial |
$292.50
|
|
|
HC CULTURE BLOOD
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
900911502
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$208.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$267.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.22
|
| Rate for Payer: Blue Shield of California Commercial |
$83.06
|
| Rate for Payer: Blue Shield of California EPN |
$66.62
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$253.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.35
|
| Rate for Payer: Dignity Health Senior |
$10.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.41
|
| Rate for Payer: Heritage Provider Network Senior |
$241.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$186.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$292.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.32
|
| Rate for Payer: TriValley Medical Group Senior |
$10.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10.32
|
|
|
HC CULTURE BODY FLUID
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911503
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$208.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$267.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.55
|
| Rate for Payer: Blue Shield of California Commercial |
$69.29
|
| Rate for Payer: Blue Shield of California EPN |
$55.58
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$253.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.48
|
| Rate for Payer: Dignity Health Senior |
$8.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.41
|
| Rate for Payer: Heritage Provider Network Senior |
$241.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$186.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.86
|
| Rate for Payer: Multiplan Commercial |
$292.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.62
|
| Rate for Payer: TriValley Medical Group Senior |
$8.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.48
|
| Rate for Payer: Vantage Medical Group Senior |
$8.62
|
|
|
HC CULTURE BODY FLUID
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911503
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$264.03
|
| Rate for Payer: Heritage Provider Network Senior |
$264.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.50
|
| Rate for Payer: Multiplan Commercial |
$292.50
|
|
|
HC CULTURE BORDATELLA PERTUSS
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911521
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$208.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$267.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.55
|
| Rate for Payer: Blue Shield of California Commercial |
$69.29
|
| Rate for Payer: Blue Shield of California EPN |
$55.58
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$253.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.48
|
| Rate for Payer: Dignity Health Senior |
$8.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.41
|
| Rate for Payer: Heritage Provider Network Senior |
$241.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$186.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.86
|
| Rate for Payer: Multiplan Commercial |
$292.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.62
|
| Rate for Payer: TriValley Medical Group Senior |
$8.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.48
|
| Rate for Payer: Vantage Medical Group Senior |
$8.62
|
|
|
HC CULTURE BORDATELLA PERTUSS
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911521
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$264.03
|
| Rate for Payer: Heritage Provider Network Senior |
$264.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.50
|
| Rate for Payer: Multiplan Commercial |
$292.50
|
|
|
HC CULTURE BRONCHIAL WASH/BRUSH
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911504
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$208.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$267.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.55
|
| Rate for Payer: Blue Shield of California Commercial |
$69.29
|
| Rate for Payer: Blue Shield of California EPN |
$55.58
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$253.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.48
|
| Rate for Payer: Dignity Health Senior |
$8.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.41
|
| Rate for Payer: Heritage Provider Network Senior |
$241.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$186.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.86
|
| Rate for Payer: Multiplan Commercial |
$292.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.62
|
| Rate for Payer: TriValley Medical Group Senior |
$8.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.48
|
| Rate for Payer: Vantage Medical Group Senior |
$8.62
|
|
|
HC CULTURE BRONCHIAL WASH/BRUSH
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911504
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$264.03
|
| Rate for Payer: Heritage Provider Network Senior |
$264.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.50
|
| Rate for Payer: Multiplan Commercial |
$292.50
|
|
|
HC CULTURE CATHETER TIP
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900912437
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$208.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$267.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.55
|
| Rate for Payer: Blue Shield of California Commercial |
$69.29
|
| Rate for Payer: Blue Shield of California EPN |
$55.58
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$253.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.48
|
| Rate for Payer: Dignity Health Senior |
$8.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.41
|
| Rate for Payer: Heritage Provider Network Senior |
$241.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$186.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.86
|
| Rate for Payer: Multiplan Commercial |
$292.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.62
|
| Rate for Payer: TriValley Medical Group Senior |
$8.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.48
|
| Rate for Payer: Vantage Medical Group Senior |
$8.62
|
|
|
HC CULTURE CATHETER TIP
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900912437
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$264.03
|
| Rate for Payer: Heritage Provider Network Senior |
$264.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.50
|
| Rate for Payer: Multiplan Commercial |
$292.50
|
|
|
HC CULTURE CLO TEST
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900910670
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$71.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$91.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.69
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$86.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.33
|
| Rate for Payer: Heritage Provider Network Senior |
$82.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$63.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC CULTURE CLO TEST
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900910670
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.04
|
| Rate for Payer: Heritage Provider Network Senior |
$90.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
|
|
HC CULTURE CRYPTOCOCCUS SCREEN
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.89 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.36
|
| Rate for Payer: Heritage Provider Network Senior |
$89.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
|
|
HC CULTURE CRYPTOCOCCUS SCREEN
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$70.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.68
|
| 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 |
$42.72
|
| 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 |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$85.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.71
|
| Rate for Payer: Heritage Provider Network Senior |
$81.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$62.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| 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
|
|
