|
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 |
$127.60
|
| 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
|
|
|
HC CULTURE TISSUE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911516
|
|
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 TISSUE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911516
|
|
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 TRACHEAL ASPIRATE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911517
|
|
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 TRACHEAL ASPIRATE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911517
|
|
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 URINE
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
900911530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.08 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Adventist Health Commercial |
$91.80
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$310.74
|
| Rate for Payer: Heritage Provider Network Senior |
$310.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.75
|
| Rate for Payer: Multiplan Commercial |
$344.25
|
|
|
HC CULTURE URINE
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
900911530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Adventist Health Commercial |
$91.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$245.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$315.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.70
|
| Rate for Payer: Blue Shield of California Commercial |
$65.15
|
| Rate for Payer: Blue Shield of California EPN |
$52.25
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$298.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.90
|
| Rate for Payer: Dignity Health Senior |
$8.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$284.12
|
| Rate for Payer: Heritage Provider Network Senior |
$284.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$218.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.19
|
| Rate for Payer: Multiplan Commercial |
$344.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.09
|
| Rate for Payer: TriValley Medical Group Senior |
$8.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.90
|
| Rate for Payer: Vantage Medical Group Senior |
$8.09
|
|
|
HC CULTURE URINE ID
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
900911556
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.09 |
| 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 |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.70
|
| Rate for Payer: Blue Shield of California Commercial |
$65.15
|
| Rate for Payer: Blue Shield of California EPN |
$52.25
|
| 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 |
$12.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.90
|
| Rate for Payer: Dignity Health Senior |
$8.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.09
|
| 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 |
$9.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.09
|
| 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 |
$9.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.19
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.09
|
| Rate for Payer: TriValley Medical Group Senior |
$8.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.90
|
| Rate for Payer: Vantage Medical Group Senior |
$8.09
|
|
|
HC CULTURE URINE ID
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
900911556
|
|
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 UROGENITAL
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911519
|
|
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 UROGENITAL
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911519
|
|
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 WOUND
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911520
|
|
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 WOUND
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911520
|
|
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 YEAST ID
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
900911555
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$176.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$227.40
|
| 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 |
$182.05
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.15
|
| 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 |
$215.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.89
|
| Rate for Payer: Heritage Provider Network Senior |
$204.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$157.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| 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 |
$248.25
|
| 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 YEAST ID
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
900911555
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.09
|
| Rate for Payer: Heritage Provider Network Senior |
$224.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
|
|
HC CULTURE YEAST RAPID ID
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912425
|
|
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 |
$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 |
$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 |
$10.77
|
| 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 YEAST RAPID ID
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912425
|
|
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 YERSINIA
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
900911529
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$192.36
|
| 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 |
$21.51
|
| 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 |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.00
|
| 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 |
$182.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.32
|
| Rate for Payer: Heritage Provider Network Senior |
$173.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$133.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| 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 |
$210.00
|
| 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 YERSINIA
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
900911529
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.56
|
| Rate for Payer: Heritage Provider Network Senior |
$189.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
|
|
HC CUTTING BALLOON
|
Facility
|
OP
|
$1,920.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$347.52 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Adventist Health Commercial |
$384.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,026.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,319.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,632.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,056.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,440.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,171.20
|
| Rate for Payer: Blue Shield of California EPN |
$936.96
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,248.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,632.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,632.00
|
| Rate for Payer: Dignity Health Senior |
$1,632.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,248.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$915.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,344.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,344.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$960.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$960.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,632.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,632.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,632.00
|
|
|
HC CUTTING BALLOON
|
Facility
|
IP
|
$1,920.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909080044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$347.52 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Adventist Health Commercial |
$384.00
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,299.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,299.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
|
|
HC CVP-R & L TESSO CATH
|
Facility
|
IP
|
$1,019.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.44 |
| Max. Negotiated Rate |
$764.25 |
| Rate for Payer: Adventist Health Commercial |
$203.80
|
| Rate for Payer: Cash Price |
$560.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$689.86
|
| Rate for Payer: Heritage Provider Network Senior |
$689.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$254.75
|
| Rate for Payer: Multiplan Commercial |
$764.25
|
|
|
HC CVP-R & L TESSO CATH
|
Facility
|
OP
|
$1,019.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.44 |
| Max. Negotiated Rate |
$866.15 |
| Rate for Payer: Adventist Health Commercial |
$203.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$544.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$700.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$866.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$560.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$764.25
|
| Rate for Payer: Blue Shield of California Commercial |
$621.59
|
| Rate for Payer: Blue Shield of California EPN |
$497.27
|
| Rate for Payer: Cash Price |
$560.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$662.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$866.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$866.15
|
| Rate for Payer: Dignity Health Senior |
$866.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$630.76
|
| Rate for Payer: Heritage Provider Network Senior |
$630.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$486.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$254.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$713.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$713.30
|
| Rate for Payer: Multiplan Commercial |
$764.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$509.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$509.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$866.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$866.15
|
| Rate for Payer: Vantage Medical Group Senior |
$866.15
|
|
|
HC CYCLIC CITRUL PEPT AB
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
900913652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$115.61 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.61
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Senior |
$12.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.66
|
| Rate for Payer: Heritage Provider Network Senior |
$47.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.32
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.95
|
| Rate for Payer: TriValley Medical Group Senior |
$12.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
|
|
HC CYCLIC CITRUL PEPT AB
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
900913652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$42.35
|
| 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
|
|
