|
HC DRSNG KERECIS OMEGA 3 WOUND 3 X 3.5CM
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$152.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$153.72
|
| Rate for Payer: Heritage Provider Network Senior |
$153.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$119.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$109.93
|
|
|
HC DRSNG KERECIS OMEGA 3 WOUND 3 X 7CM
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$181.05 |
| Rate for Payer: Adventist Health Commercial |
$42.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$113.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$146.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.75
|
| Rate for Payer: Blue Shield of California Commercial |
$129.93
|
| Rate for Payer: Blue Shield of California EPN |
$103.94
|
| Rate for Payer: Cash Price |
$117.15
|
| Rate for Payer: Cash Price |
$117.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.05
|
| Rate for Payer: Dignity Health Senior |
$181.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.62
|
| Rate for Payer: Heritage Provider Network Senior |
$98.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$101.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.10
|
| Rate for Payer: Multiplan Commercial |
$159.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$76.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$70.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$181.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.05
|
| Rate for Payer: Vantage Medical Group Senior |
$181.05
|
|
|
HC DRSNG KERECIS OMEGA 3 WOUND 3 X 7CM
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$159.75 |
| Rate for Payer: Adventist Health Commercial |
$42.60
|
| Rate for Payer: Cash Price |
$117.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.62
|
| Rate for Payer: Heritage Provider Network Senior |
$98.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.25
|
| Rate for Payer: Multiplan Commercial |
$159.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$76.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$70.52
|
|
|
HC DRSNG KERECIS OMEGA 3X3.5CM FENESTRATED
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900103302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.65 |
| Max. Negotiated Rate |
$321.75 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Cash Price |
$235.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$197.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$231.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$198.63
|
| Rate for Payer: Heritage Provider Network Senior |
$198.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.25
|
| Rate for Payer: Multiplan Commercial |
$321.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$155.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$142.04
|
|
|
HC DRSNG KERECIS OMEGA 3X3.5CM FENESTRATED
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900103302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.62 |
| Max. Negotiated Rate |
$364.65 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$229.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$294.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$235.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.75
|
| Rate for Payer: Blue Shield of California Commercial |
$261.69
|
| Rate for Payer: Blue Shield of California EPN |
$209.35
|
| Rate for Payer: Cash Price |
$235.95
|
| Rate for Payer: Cash Price |
$235.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$197.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$364.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$364.65
|
| Rate for Payer: Dignity Health Senior |
$364.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$198.63
|
| Rate for Payer: Heritage Provider Network Senior |
$198.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$204.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$300.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$300.30
|
| Rate for Payer: Multiplan Commercial |
$321.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$171.60
|
| Rate for Payer: TriValley Medical Group Senior |
$171.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$155.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$142.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$364.65
|
| Rate for Payer: Vantage Medical Group Senior |
$364.65
|
|
|
HC DRSNG OPTIFOAM AG 4X4" NO BRDR
|
Facility
|
OP
|
$50.08
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$42.57 |
| Rate for Payer: Adventist Health Commercial |
$10.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.56
|
| Rate for Payer: Blue Shield of California Commercial |
$30.55
|
| Rate for Payer: Blue Shield of California EPN |
$24.44
|
| Rate for Payer: Cash Price |
$27.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.57
|
| Rate for Payer: Dignity Health Senior |
$42.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.00
|
| Rate for Payer: Heritage Provider Network Senior |
$31.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.06
|
| Rate for Payer: Multiplan Commercial |
$37.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.57
|
| Rate for Payer: Vantage Medical Group Senior |
$42.57
|
|
|
HC DRSNG OPTIFOAM AG 4X4" NO BRDR
|
Facility
|
IP
|
$50.08
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$37.56 |
| Rate for Payer: Adventist Health Commercial |
$10.02
|
| Rate for Payer: Cash Price |
$27.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.90
|
| Rate for Payer: Heritage Provider Network Senior |
$33.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.52
|
| Rate for Payer: Multiplan Commercial |
$37.56
|
|
|
HC DRSNG OPTIFOAM SA 6X6" BRDR
|
Facility
|
OP
|
$36.43
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$30.97 |
| Rate for Payer: Adventist Health Commercial |
$7.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.32
|
| Rate for Payer: Blue Shield of California Commercial |
$22.22
|
| Rate for Payer: Blue Shield of California EPN |
$17.78
|
| Rate for Payer: Cash Price |
$20.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.97
|
| Rate for Payer: Dignity Health Senior |
$30.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.55
|
| Rate for Payer: Heritage Provider Network Senior |
$22.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$27.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.97
|
| Rate for Payer: Vantage Medical Group Senior |
$30.97
|
|
|
HC DRSNG OPTIFOAM SA 6X6" BRDR
|
Facility
|
IP
|
$36.43
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$27.32 |
| Rate for Payer: Adventist Health Commercial |
$7.29
|
| Rate for Payer: Cash Price |
$20.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.66
|
| Rate for Payer: Heritage Provider Network Senior |
$24.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.11
|
| Rate for Payer: Multiplan Commercial |
$27.32
|
|
|
HC DRSNG TEGADERM 4-3/4X4IN FRAME STYLE 1626W
|
Facility
|
OP
|
$5.08
|
|
| Hospital Charge Code |
900101861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.81
|
| Rate for Payer: Blue Shield of California Commercial |
$3.10
|
| Rate for Payer: Blue Shield of California EPN |
$2.48
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: Dignity Health Senior |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.14
|
| Rate for Payer: Heritage Provider Network Senior |
$3.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.56
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4.32
|
|
|
HC DRSNG TEGADERM 4-3/4X4IN FRAME STYLE 1626W
|
Facility
|
IP
|
$5.08
|
|
| Hospital Charge Code |
900101861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.44
|
| Rate for Payer: Heritage Provider Network Senior |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.27
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
|
|
HC DRUGS ABUSE SCREEN,URINE(7)COC
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$844.50 |
| Rate for Payer: Adventist Health Commercial |
$225.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$601.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$773.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.57
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Cash Price |
$619.30
|
| Rate for Payer: Cash Price |
$619.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$731.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$731.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$696.99
|
| Rate for Payer: Heritage Provider Network Senior |
$696.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$537.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.30
|
| Rate for Payer: Multiplan Commercial |
$844.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUGS ABUSE SCREEN,URINE(7)COC
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$203.81 |
| Max. Negotiated Rate |
$844.50 |
| Rate for Payer: Adventist Health Commercial |
$225.20
|
| Rate for Payer: Cash Price |
$619.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$762.30
|
| Rate for Payer: Heritage Provider Network Senior |
$762.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.50
|
| Rate for Payer: Multiplan Commercial |
$844.50
|
|
|
HC DRUG SCREEN AMPHETAMINES
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911077
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$562.57 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$148.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.57
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$180.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.08
|
| Rate for Payer: Heritage Provider Network Senior |
$172.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$132.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.30
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN AMPHETAMINES
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911077
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$208.50 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.21
|
| Rate for Payer: Heritage Provider Network Senior |
$188.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.50
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
|
|
HC DRUG SCREEN BARBITUATES
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910325
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$562.57 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$148.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.57
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$180.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.08
|
| Rate for Payer: Heritage Provider Network Senior |
$172.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$132.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.30
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN BARBITUATES
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910325
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$208.50 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.21
|
| Rate for Payer: Heritage Provider Network Senior |
$188.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.50
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
|
|
HC DRUG SCREEN BENZODIAZPINES
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$562.57 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$148.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.57
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$180.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.08
|
| Rate for Payer: Heritage Provider Network Senior |
$172.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$132.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.30
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN BENZODIAZPINES
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$208.50 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.21
|
| Rate for Payer: Heritage Provider Network Senior |
$188.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.50
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
|
|
HC DRUG SCREEN CANNABINOIDS
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$562.57 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$148.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.57
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$180.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.08
|
| Rate for Payer: Heritage Provider Network Senior |
$172.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$132.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.30
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN CANNABINOIDS
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$208.50 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.21
|
| Rate for Payer: Heritage Provider Network Senior |
$188.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.50
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
|
|
HC DRUG SCREEN COCAINE
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910390
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$208.50 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.21
|
| Rate for Payer: Heritage Provider Network Senior |
$188.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.50
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
|
|
HC DRUG SCREEN COCAINE
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910390
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$562.57 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$148.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.57
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$180.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.08
|
| Rate for Payer: Heritage Provider Network Senior |
$172.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$132.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.30
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN OPIATES
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911145
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$208.50 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.21
|
| Rate for Payer: Heritage Provider Network Senior |
$188.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.50
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
|
|
HC DRUG SCREEN OPIATES
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911145
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$562.57 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$148.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.57
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Cash Price |
$152.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$180.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.08
|
| Rate for Payer: Heritage Provider Network Senior |
$172.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$132.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.30
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
