|
HC HIGH FREQUENCY VENT INTL DAILY
|
Facility
|
IP
|
$7,109.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,286.73 |
| Max. Negotiated Rate |
$5,331.75 |
| Rate for Payer: Adventist Health Commercial |
$1,421.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,883.88
|
| Rate for Payer: Cash Price |
$3,199.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,812.79
|
| Rate for Payer: Heritage Provider Network Senior |
$4,812.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,286.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,777.25
|
| Rate for Payer: Multiplan Commercial |
$5,331.75
|
|
|
HC HIGH FREQUENCY VENT INTL DAILY
|
Facility
|
OP
|
$7,109.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$69.89 |
| Max. Negotiated Rate |
$5,331.75 |
| Rate for Payer: Adventist Health Commercial |
$1,421.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$202.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,883.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$782.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$3,199.05
|
| Rate for Payer: Cash Price |
$3,199.05
|
| Rate for Payer: Cash Price |
$3,199.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,620.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$861.27
|
| Rate for Payer: Dignity Health Senior |
$782.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,620.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$782.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,400.47
|
| Rate for Payer: Heritage Provider Network Senior |
$4,400.47
|
| Rate for Payer: Humana Medicare |
$782.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$782.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,487.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,286.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$923.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,777.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$986.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$986.54
|
| Rate for Payer: Multiplan Commercial |
$5,331.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: Vantage Medical Group Senior |
$782.97
|
|
|
HC HIGH FREQUENCY VENT SUB
|
Facility
|
OP
|
$4,527.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800016
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$55.07 |
| Max. Negotiated Rate |
$3,395.25 |
| Rate for Payer: Adventist Health Commercial |
$905.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$146.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,110.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$782.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$2,037.15
|
| Rate for Payer: Cash Price |
$2,037.15
|
| Rate for Payer: Cash Price |
$2,037.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,942.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$861.27
|
| Rate for Payer: Dignity Health Senior |
$782.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,942.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$782.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,802.21
|
| Rate for Payer: Heritage Provider Network Senior |
$2,802.21
|
| Rate for Payer: Humana Medicare |
$782.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$55.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$782.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,487.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$819.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$923.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,131.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$986.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$986.54
|
| Rate for Payer: Multiplan Commercial |
$3,395.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,174.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$861.27
|
| Rate for Payer: Vantage Medical Group Senior |
$782.97
|
|
|
HC HIGH FREQUENCY VENT SUB
|
Facility
|
IP
|
$4,527.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800016
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$819.39 |
| Max. Negotiated Rate |
$3,395.25 |
| Rate for Payer: Adventist Health Commercial |
$905.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,110.05
|
| Rate for Payer: Cash Price |
$2,037.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,064.78
|
| Rate for Payer: Heritage Provider Network Senior |
$3,064.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$819.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,131.75
|
| Rate for Payer: Multiplan Commercial |
$3,395.25
|
|
|
HC HIP ARTHROGRAPHY INJECTION
|
Facility
|
OP
|
$951.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
909000116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$190.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$653.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$808.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$523.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$713.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$427.95
|
| Rate for Payer: Cash Price |
$427.95
|
| Rate for Payer: Cash Price |
$427.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$618.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$808.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.35
|
| Rate for Payer: Dignity Health Senior |
$808.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$588.67
|
| Rate for Payer: Heritage Provider Network Senior |
$588.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$314.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$458.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.75
|
| Rate for Payer: Multiplan Commercial |
$713.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.35
|
| Rate for Payer: Vantage Medical Group Senior |
$808.35
|
|
|
HC HIP ARTHROGRAPHY INJECTION
|
Facility
|
IP
|
$951.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
909000116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$713.25 |
| Rate for Payer: Adventist Health Commercial |
$190.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$653.34
|
| Rate for Payer: Cash Price |
$427.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.83
|
| Rate for Payer: Heritage Provider Network Senior |
$643.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.75
|
| Rate for Payer: Multiplan Commercial |
$713.25
|
|
|
HC HISTONE AUTO AB
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913528
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$100.92 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC HISTONE AUTO AB
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913528
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.29
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.67
|
| Rate for Payer: Heritage Provider Network Senior |
$109.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
|
|
HC HIV 1 2 AB CONFIRMATION
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900913681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.93 |
| Max. Negotiated Rate |
$144.75 |
| Rate for Payer: Adventist Health Commercial |
$38.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$132.59
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$130.66
|
| Rate for Payer: Heritage Provider Network Senior |
$130.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.25
|
| Rate for Payer: Multiplan Commercial |
$144.75
|
|
|
HC HIV 1 2 AB CONFIRMATION
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900913681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$118.28 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.28
|
| Rate for Payer: Blue Shield of California Commercial |
$107.16
|
| Rate for Payer: Blue Shield of California EPN |
$83.77
|
| 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 |
$20.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: Dignity Health Senior |
$13.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.19
|
| Rate for Payer: Heritage Provider Network Senior |
$45.19
|
| Rate for Payer: Humana Medicare |
$13.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.71
|
| Rate for Payer: TriValley Medical Group Senior |
$13.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
|
|
HC HIV-1,2 AG AB SCREEN
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913626
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$190.73 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$70.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.54
|
| Rate for Payer: Blue Shield of California Commercial |
$190.73
|
| Rate for Payer: Blue Shield of California EPN |
$149.10
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Senior |
$24.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.81
|
| Rate for Payer: Heritage Provider Network Senior |
$32.81
|
| Rate for Payer: Humana Medicare |
$24.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.34
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.08
|
| Rate for Payer: TriValley Medical Group Senior |
$24.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
|
HC HIV-1,2 AG AB SCREEN
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913626
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.69
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.53
|
| Rate for Payer: Heritage Provider Network Senior |
$78.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
|
|
HC HIV 1 ANTIBODY
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900913682
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$74.33 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.33
|
| Rate for Payer: Blue Shield of California Commercial |
$69.37
|
| Rate for Payer: Blue Shield of California EPN |
$54.23
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.78
|
| Rate for Payer: Dignity Health Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$8.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.89
|
| Rate for Payer: TriValley Medical Group Senior |
$8.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
HC HIV 1 ANTIBODY
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900913682
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.27
|
| Rate for Payer: Heritage Provider Network Senior |
$39.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
|
|
HC HIV 1 P24 ANTIGEN
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87390
|
| Hospital Charge Code |
900913684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$142.91 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.91
|
| Rate for Payer: Blue Shield of California Commercial |
$137.79
|
| Rate for Payer: Blue Shield of California EPN |
$107.72
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.47
|
| Rate for Payer: Dignity Health Senior |
$24.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$24.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.32
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.06
|
| Rate for Payer: TriValley Medical Group Senior |
$24.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Vantage Medical Group Senior |
$24.06
|
|
|
HC HIV 1 P24 ANTIGEN
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 87390
|
| Hospital Charge Code |
900913684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.27
|
| Rate for Payer: Heritage Provider Network Senior |
$39.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
|
|
HC HIV 2 ANTIBODY
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900913683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.72
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.20
|
| Rate for Payer: Heritage Provider Network Senior |
$35.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
|
|
HC HIV 2 ANTIBODY
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900913683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$114.96 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.96
|
| Rate for Payer: Blue Shield of California Commercial |
$105.54
|
| Rate for Payer: Blue Shield of California EPN |
$82.51
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Senior |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Humana Medicare |
$13.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.52
|
| Rate for Payer: TriValley Medical Group Senior |
$13.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC HIV ANTIGEN, ANTIBODY
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913662
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$190.73 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$70.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.54
|
| Rate for Payer: Blue Shield of California Commercial |
$190.73
|
| Rate for Payer: Blue Shield of California EPN |
$149.10
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Senior |
$24.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$24.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.34
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.08
|
| Rate for Payer: TriValley Medical Group Senior |
$24.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
|
HC HIV ANTIGEN, ANTIBODY
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913662
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.27
|
| Rate for Payer: Heritage Provider Network Senior |
$39.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
|
|
HC HIV RAPID TESTING
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900912325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$118.28 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.28
|
| Rate for Payer: Blue Shield of California Commercial |
$107.16
|
| Rate for Payer: Blue Shield of California EPN |
$83.77
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: Dignity Health Senior |
$13.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.81
|
| Rate for Payer: Heritage Provider Network Senior |
$32.81
|
| Rate for Payer: Humana Medicare |
$13.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.71
|
| Rate for Payer: TriValley Medical Group Senior |
$13.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
|
|
HC HIV RAPID TESTING
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900912325
|
|
Hospital Revenue Code
|
302
|
| 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 HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$664.20 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$664.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,594.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,281.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,826.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,490.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,062.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,949.43
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,527.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,822.85
|
| Rate for Payer: Dignity Health Senior |
$2,822.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,125.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,537.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,537.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,021.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,660.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,660.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,660.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$830.25
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,210.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,109.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,822.85
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$664.20 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$664.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,594.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,281.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,527.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,793.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,248.32
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,660.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,660.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,660.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$830.25
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,210.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,109.55
|
|
|
HC HOMOVANILLIC ACID (HVA)
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900910532
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
