|
HC CULTURE PBP2 LATEX AGGLUTINATION
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912417
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.24 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.61
|
| Rate for Payer: Heritage Provider Network Senior |
$105.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
|
|
HC CULTURE PBP2 LATEX AGGLUTINATION
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912417
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$42.72 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.54
|
| 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 |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.95
|
| 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 |
$27.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.62
|
| Rate for Payer: Heritage Provider Network Senior |
$26.62
|
| 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 |
$20.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.75
|
| 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 |
$32.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC CULTURE PHARMACY COMPOUNDING
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900912401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$78.55 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$44.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.71
|
| 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 |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.60
|
| 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 |
$54.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.00
|
| Rate for Payer: Heritage Provider Network Senior |
$52.00
|
| 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 |
$40.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| 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 |
$63.00
|
| 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 PHARMACY COMPOUNDING
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900912401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.43 |
| Max. Negotiated Rate |
$275.25 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$248.46
|
| Rate for Payer: Heritage Provider Network Senior |
$248.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.75
|
| Rate for Payer: Multiplan Commercial |
$275.25
|
|
|
HC CULTURE QUANT AEROBIC
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 87071
|
| Hospital Charge Code |
900912433
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$75.92 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.02
|
| Rate for Payer: Blue Shield of California Commercial |
$75.92
|
| Rate for Payer: Blue Shield of California EPN |
$60.89
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.88
|
| Rate for Payer: Dignity Health Senior |
$9.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.19
|
| Rate for Payer: Heritage Provider Network Senior |
$45.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.89
|
| Rate for Payer: TriValley Medical Group Senior |
$9.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.88
|
| Rate for Payer: Vantage Medical Group Senior |
$9.89
|
|
|
HC CULTURE QUANT AEROBIC
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87071
|
| Hospital Charge Code |
900912433
|
|
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 |
$175.50
|
| 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 QUANT ANAEROBIC
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 87073
|
| Hospital Charge Code |
900912434
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$68.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.02
|
| Rate for Payer: Blue Shield of California Commercial |
$75.92
|
| Rate for Payer: Blue Shield of California EPN |
$60.89
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$83.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.63
|
| Rate for Payer: Dignity Health Senior |
$9.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.23
|
| Rate for Payer: Heritage Provider Network Senior |
$79.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$61.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.17
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.66
|
| Rate for Payer: TriValley Medical Group Senior |
$9.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.63
|
| Rate for Payer: Vantage Medical Group Senior |
$9.66
|
|
|
HC CULTURE QUANT ANAEROBIC
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
CPT 87073
|
| Hospital Charge Code |
900912434
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$77.65 |
| Max. Negotiated Rate |
$321.75 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$290.43
|
| Rate for Payer: Heritage Provider Network Senior |
$290.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.25
|
| Rate for Payer: Multiplan Commercial |
$321.75
|
|
|
HC CULTURE QUANTITATIVE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87071
|
| Hospital Charge Code |
900912409
|
|
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 |
$175.50
|
| 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 QUANTITATIVE
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 87071
|
| Hospital Charge Code |
900912409
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$75.92 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.02
|
| Rate for Payer: Blue Shield of California Commercial |
$75.92
|
| Rate for Payer: Blue Shield of California EPN |
$60.89
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.88
|
| Rate for Payer: Dignity Health Senior |
$9.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.19
|
| Rate for Payer: Heritage Provider Network Senior |
$45.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.89
|
| Rate for Payer: TriValley Medical Group Senior |
$9.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.88
|
| Rate for Payer: Vantage Medical Group Senior |
$9.89
|
|
|
HC CULTURE RAPID NEG ID3
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912415
|
|
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 |
$90.00
|
| 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 RAPID NEG ID3
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912415
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$73.69 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.46
|
| 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 |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.80
|
| 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 |
$46.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.57
|
| Rate for Payer: Heritage Provider Network Senior |
$44.57
|
| 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 |
$34.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| 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 |
$54.00
|
| 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 RESPIRATORY
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900912435
|
|
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 |
$175.50
|
| 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 RESPIRATORY
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900912435
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$78.55 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.20
|
| 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 |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.80
|
| 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 |
$59.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.95
|
| Rate for Payer: Heritage Provider Network Senior |
$56.95
|
| 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 |
$43.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| 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 |
$69.00
|
| 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 SPUTUM
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911513
|
|
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 |
$175.50
|
| 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 SPUTUM
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911513
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$78.55 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$44.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.71
|
| 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 |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.60
|
| 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 |
$54.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.00
|
| Rate for Payer: Heritage Provider Network Senior |
$52.00
|
| 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 |
$40.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| 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 |
$63.00
|
| 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 STAPHAUREX
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912421
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$42.72 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.60
|
| 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 |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.90
|
| 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 |
$29.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.47
|
| Rate for Payer: Heritage Provider Network Senior |
$28.47
|
| 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 |
$21.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| 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 |
$34.50
|
| 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 STAPHAUREX
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912421
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.13
|
| Rate for Payer: Heritage Provider Network Senior |
$52.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
|
|
HC CULTURE STOOL
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
900911514
|
|
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 |
$175.50
|
| 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 STOOL
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
900911514
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.11
|
| Rate for Payer: Blue Shield of California Commercial |
$75.92
|
| Rate for Payer: Blue Shield of California EPN |
$60.89
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.38
|
| Rate for Payer: Dignity Health Senior |
$9.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.04
|
| Rate for Payer: Heritage Provider Network Senior |
$47.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.89
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.44
|
| Rate for Payer: TriValley Medical Group Senior |
$9.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
|
|
HC CULTURE STREPTOCARD
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912420
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$42.72 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.60
|
| 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 |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.90
|
| 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 |
$29.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.47
|
| Rate for Payer: Heritage Provider Network Senior |
$28.47
|
| 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 |
$21.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| 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 |
$34.50
|
| 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 STREPTOCARD
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912420
|
|
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 |
$46.35
|
| 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 CULTURE SURGICAL WOUND
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900912436
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$78.55 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.20
|
| 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 |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.80
|
| 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 |
$59.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.95
|
| Rate for Payer: Heritage Provider Network Senior |
$56.95
|
| 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 |
$43.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| 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 |
$69.00
|
| 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 SURGICAL WOUND
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900912436
|
|
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 |
$175.50
|
| 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 THROAT
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911515
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.99 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.06
|
| Rate for Payer: Heritage Provider Network Senior |
$157.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
|
