|
HC HEMECH-EPINEPHRINE
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900910197
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$84.71 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Adventist Health Commercial |
$93.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$321.52
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$316.84
|
| Rate for Payer: Heritage Provider Network Senior |
$316.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$351.00
|
|
|
HC HEMECH SCRN-ARACHEDONIC ACID A
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$70.41 |
| Max. Negotiated Rate |
$291.75 |
| Rate for Payer: Adventist Health Commercial |
$77.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$267.24
|
| Rate for Payer: Cash Price |
$175.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$263.35
|
| Rate for Payer: Heritage Provider Network Senior |
$263.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.25
|
| Rate for Payer: Multiplan Commercial |
$291.75
|
|
|
HC HEMECH SCRN-ARACHEDONIC ACID A
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$167.76 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.77
|
| Rate for Payer: Blue Shield of California Commercial |
$167.76
|
| Rate for Payer: Blue Shield of California EPN |
$131.14
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Senior |
$24.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.76
|
| Rate for Payer: Heritage Provider Network Senior |
$50.76
|
| Rate for Payer: Humana Medicare |
$24.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.39
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.91
|
| Rate for Payer: TriValley Medical Group Senior |
$24.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC HEMODIALYSIS, ONE EVALUATION
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
900501419
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$366.34 |
| Max. Negotiated Rate |
$1,518.00 |
| Rate for Payer: Adventist Health Commercial |
$404.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,390.49
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,370.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1,370.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$506.00
|
| Rate for Payer: Multiplan Commercial |
$1,518.00
|
|
|
HC HEMODIALYSIS, ONE EVALUATION
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
900501419
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.09 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$404.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$170.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,390.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$873.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,315.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.41
|
| Rate for Payer: Dignity Health Senior |
$873.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,315.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$873.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,370.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1,370.25
|
| Rate for Payer: Humana Medicare |
$873.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$873.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$975.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,030.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$506.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,100.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,100.11
|
| Rate for Payer: Multiplan Commercial |
$1,518.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$734.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$676.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: Vantage Medical Group Senior |
$873.10
|
|
|
HC HEMOGLOBIN A1C
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
900912128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$81.26 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.26
|
| Rate for Payer: Blue Shield of California Commercial |
$75.80
|
| Rate for Payer: Blue Shield of California EPN |
$59.26
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.68
|
| Rate for Payer: Dignity Health Senior |
$9.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Humana Medicare |
$9.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.23
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.71
|
| Rate for Payer: TriValley Medical Group Senior |
$9.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Vantage Medical Group Senior |
$9.71
|
|
|
HC HEMOGLOBIN A1C
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
900912128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.64
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.52
|
| Rate for Payer: Heritage Provider Network Senior |
$143.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
|
|
HC HEMOGLOBIN A1C (POC)
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
900912157
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.64
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.52
|
| Rate for Payer: Heritage Provider Network Senior |
$143.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
|
|
HC HEMOGLOBIN A1C (POC)
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
900912157
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.26
|
| Rate for Payer: Blue Shield of California Commercial |
$75.80
|
| Rate for Payer: Blue Shield of California EPN |
$59.26
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$137.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.68
|
| Rate for Payer: Dignity Health Senior |
$9.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.23
|
| Rate for Payer: Heritage Provider Network Senior |
$131.23
|
| Rate for Payer: Humana Medicare |
$9.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.23
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.71
|
| Rate for Payer: TriValley Medical Group Senior |
$9.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Vantage Medical Group Senior |
$9.71
|
|
|
HC HEMOGLOBIN CITRATE
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900910898
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.93 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$284.42
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$280.28
|
| Rate for Payer: Heritage Provider Network Senior |
$280.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
|
|
HC HEMOGLOBIN CITRATE
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900910898
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$100.56 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.51
|
| Rate for Payer: Blue Shield of California Commercial |
$100.56
|
| Rate for Payer: Blue Shield of California EPN |
$78.62
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Humana Medicare |
$12.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.87
|
| Rate for Payer: TriValley Medical Group Senior |
$12.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900910897
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.93 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$284.42
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$280.28
|
| Rate for Payer: Heritage Provider Network Senior |
$280.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900910897
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$100.56 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.51
|
| Rate for Payer: Blue Shield of California Commercial |
$100.56
|
| Rate for Payer: Blue Shield of California EPN |
$78.62
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Humana Medicare |
$12.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.87
|
| Rate for Payer: TriValley Medical Group Senior |
$12.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC HEMOGLOBIN FETAL, STAIN
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 85460
|
| Hospital Charge Code |
900910133
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$64.75 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.75
|
| Rate for Payer: Blue Shield of California Commercial |
$60.43
|
| Rate for Payer: Blue Shield of California EPN |
$47.24
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Senior |
$7.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.95
|
| Rate for Payer: Heritage Provider Network Senior |
$17.95
|
| Rate for Payer: Humana Medicare |
$7.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.74
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.73
|
| Rate for Payer: TriValley Medical Group Senior |
$7.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Senior |
$7.73
|
|
|
HC HEMOGLOBIN FETAL, STAIN
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
CPT 85460
|
| Hospital Charge Code |
900910133
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$379.50 |
| Rate for Payer: Adventist Health Commercial |
$101.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$347.62
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$342.56
|
| Rate for Payer: Heritage Provider Network Senior |
$342.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.50
|
| Rate for Payer: Multiplan Commercial |
$379.50
|
|
|
HC HEMOGLOBIN PLASMA
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
900912162
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$61.14 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.14
|
| Rate for Payer: Blue Shield of California Commercial |
$57.07
|
| Rate for Payer: Blue Shield of California EPN |
$44.62
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.04
|
| Rate for Payer: Dignity Health Senior |
$7.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Senior |
$16.09
|
| Rate for Payer: Humana Medicare |
$7.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.21
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.31
|
| Rate for Payer: TriValley Medical Group Senior |
$7.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.04
|
| Rate for Payer: Vantage Medical Group Senior |
$7.31
|
|
|
HC HEMOGLOBIN PLASMA
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
900912162
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.63
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.19
|
| Rate for Payer: Heritage Provider Network Senior |
$165.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
|
|
HC HEMOGLOBIN (POC)
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
900912023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Senior |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
|
|
HC HEMOGLOBIN (POC)
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
900912023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.78
|
| Rate for Payer: Blue Shield of California Commercial |
$18.50
|
| Rate for Payer: Blue Shield of California EPN |
$14.46
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.61
|
| Rate for Payer: Dignity Health Senior |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.90
|
| Rate for Payer: Heritage Provider Network Senior |
$61.90
|
| Rate for Payer: Humana Medicare |
$2.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.99
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.37
|
| Rate for Payer: TriValley Medical Group Senior |
$2.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Vantage Medical Group Senior |
$2.37
|
|
|
HC HEMOSTASIS TEST FOR QUANTRA
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 85396
|
| Hospital Charge Code |
900912041
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$188.25 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$172.44
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$169.93
|
| Rate for Payer: Heritage Provider Network Senior |
$169.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.75
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
|
|
HC HEMOSTASIS TEST FOR QUANTRA
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 85396
|
| Hospital Charge Code |
900912041
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.23
|
| Rate for Payer: Blue Shield of California Commercial |
$111.16
|
| Rate for Payer: Blue Shield of California EPN |
$105.07
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$116.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.15
|
| Rate for Payer: Dignity Health Senior |
$152.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.80
|
| Rate for Payer: Heritage Provider Network Senior |
$110.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$86.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.75
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.15
|
| Rate for Payer: Vantage Medical Group Senior |
$152.15
|
|
|
HC HEMOSTATIC VALVE
|
Facility
|
OP
|
$60.50
|
|
| Hospital Charge Code |
909081232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$51.42 |
| Rate for Payer: Adventist Health Commercial |
$12.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$32.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.38
|
| Rate for Payer: Blue Shield of California Commercial |
$37.57
|
| Rate for Payer: Blue Shield of California EPN |
$35.51
|
| Rate for Payer: Cash Price |
$27.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.42
|
| Rate for Payer: Dignity Health Senior |
$51.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.45
|
| Rate for Payer: Heritage Provider Network Senior |
$37.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$45.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.42
|
| Rate for Payer: Vantage Medical Group Senior |
$51.42
|
|
|
HC HEMOSTATIC VALVE
|
Facility
|
IP
|
$60.50
|
|
| Hospital Charge Code |
909081232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$45.38 |
| Rate for Payer: Adventist Health Commercial |
$12.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.56
|
| Rate for Payer: Cash Price |
$27.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.96
|
| Rate for Payer: Heritage Provider Network Senior |
$40.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$45.38
|
|
|
HC HEPARIN NEUTRALIZED PT/PTT
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
900910094
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.15
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.11
|
| Rate for Payer: Heritage Provider Network Senior |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
|
|
HC HEPARIN NEUTRALIZED PT/PTT
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
900910094
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$72.56 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.90
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.02
|
| Rate for Payer: Dignity Health Senior |
$11.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.92
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.84
|
| Rate for Payer: TriValley Medical Group Senior |
$11.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.02
|
| Rate for Payer: Vantage Medical Group Senior |
$11.84
|
|
