|
HC DRUG SCREEN PHENCYCLIDINE
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911147
|
|
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 PHENCYCLIDINE
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911147
|
|
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, PRE-EMPLOYMENT
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912158
|
|
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 DRUG SCREEN, PRE-EMPLOYMENT
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912158
|
|
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 DRUGS OF ABUSE SCREEN,URINE(5)
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.11 |
| Max. Negotiated Rate |
$232.50 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$209.87
|
| Rate for Payer: Heritage Provider Network Senior |
$209.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
|
|
HC DRUGS OF ABUSE SCREEN,URINE(5)
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.11 |
| Max. Negotiated Rate |
$562.57 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$165.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$212.97
|
| 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 |
$170.50
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$201.50
|
| 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 |
$201.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$191.89
|
| Rate for Payer: Heritage Provider Network Senior |
$191.89
|
| 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 |
$147.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.50
|
| 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 |
$232.50
|
| 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 OF ABUSE SCREEN,URINE(7)
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912161
|
|
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 OF ABUSE SCREEN,URINE(7)
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912161
|
|
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 DRVVT
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
900912008
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$95.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.34
|
| Rate for Payer: Blue Shield of California Commercial |
$77.01
|
| Rate for Payer: Blue Shield of California EPN |
$61.77
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.54
|
| Rate for Payer: Dignity Health Senior |
$9.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.18
|
| Rate for Payer: Heritage Provider Network Senior |
$110.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$84.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.07
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.58
|
| Rate for Payer: TriValley Medical Group Senior |
$9.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Vantage Medical Group Senior |
$9.58
|
|
|
HC DRVVT
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
900912008
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.51
|
| Rate for Payer: Heritage Provider Network Senior |
$120.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
|
|
HC DRVVT CONFIRM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
900912009
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$95.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.34
|
| Rate for Payer: Blue Shield of California Commercial |
$77.01
|
| Rate for Payer: Blue Shield of California EPN |
$61.77
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.54
|
| Rate for Payer: Dignity Health Senior |
$9.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.18
|
| Rate for Payer: Heritage Provider Network Senior |
$110.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$84.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.07
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.58
|
| Rate for Payer: TriValley Medical Group Senior |
$9.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Vantage Medical Group Senior |
$9.58
|
|
|
HC DRVVT CONFIRM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
900912009
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.51
|
| Rate for Payer: Heritage Provider Network Senior |
$120.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
|
|
HC DSCHG RCP EDU TRAINING EA 30MN
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
900898960
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Senior |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.76
|
| Rate for Payer: Heritage Provider Network Senior |
$50.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| 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 |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC DSCHG RCP EDU TRAINING EA 30MN
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
900898960
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$61.50 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.51
|
| Rate for Payer: Heritage Provider Network Senior |
$55.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
|
|
HC DSTRCTN NEORLTC AGT TRGMNL NRV
|
Facility
|
OP
|
$2,471.00
|
|
|
Service Code
|
CPT 64600
|
| Hospital Charge Code |
909004600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$494.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,697.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,359.05
|
| Rate for Payer: Cash Price |
$1,359.05
|
| Rate for Payer: Cash Price |
$1,359.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,606.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,529.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,149.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$1,853.25
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,244.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1,244.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC DSTRCTN NEORLTC AGT TRGMNL NRV
|
Facility
|
IP
|
$2,471.00
|
|
|
Service Code
|
CPT 64600
|
| Hospital Charge Code |
909004600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$447.25 |
| Max. Negotiated Rate |
$1,853.25 |
| Rate for Payer: Adventist Health Commercial |
$494.20
|
| Rate for Payer: Cash Price |
$1,359.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,672.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,672.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.75
|
| Rate for Payer: Multiplan Commercial |
$1,853.25
|
|
|
HC D TEST
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912427
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.24 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.61
|
| Rate for Payer: Heritage Provider Network Senior |
$105.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
|
|
HC D TEST
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912427
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$83.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$107.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.88
|
| Rate for Payer: Blue Shield of California Commercial |
$55.47
|
| Rate for Payer: Blue Shield of California EPN |
$44.49
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$101.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: Dignity Health Senior |
$7.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.56
|
| Rate for Payer: Heritage Provider Network Senior |
$96.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$74.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.42
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Senior |
$7.48
|
|
|
HC DT VACCINE IM LT 7 YRS
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 90702
|
| Hospital Charge Code |
900501449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$170.53 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$33.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.53
|
| Rate for Payer: Blue Shield of California Commercial |
$38.43
|
| Rate for Payer: Blue Shield of California EPN |
$30.74
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.55
|
| Rate for Payer: Dignity Health Senior |
$53.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.00
|
| Rate for Payer: Heritage Provider Network Senior |
$39.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$111.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.10
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.55
|
| Rate for Payer: Vantage Medical Group Senior |
$53.55
|
|
|
HC DT VACCINE IM LT 7 YRS
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 90702
|
| Hospital Charge Code |
900501449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.65
|
| Rate for Payer: Heritage Provider Network Senior |
$42.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
|
|
HC DUCTOGRAM/ASPIRATION-2 OR MORE
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
909001446
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.29 |
| Max. Negotiated Rate |
$956.73 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$606.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$779.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$956.73
|
| Rate for Payer: Blue Shield of California Commercial |
$316.32
|
| Rate for Payer: Blue Shield of California EPN |
$254.37
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$737.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$737.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$701.95
|
| Rate for Payer: Heritage Provider Network Senior |
$701.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$540.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$850.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$307.13
|
| Rate for Payer: TriValley Medical Group Senior |
$307.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DUCTOGRAM/ASPIRATION-2 OR MORE
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
909001446
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$205.25 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$767.72
|
| Rate for Payer: Heritage Provider Network Senior |
$767.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$850.50
|
|
|
HC DUCTOGRAM/ASPIRATION- SINGLE
|
Facility
|
IP
|
$1,034.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
909001433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.15 |
| Max. Negotiated Rate |
$775.50 |
| Rate for Payer: Adventist Health Commercial |
$206.80
|
| Rate for Payer: Cash Price |
$568.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$700.02
|
| Rate for Payer: Heritage Provider Network Senior |
$700.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.50
|
| Rate for Payer: Multiplan Commercial |
$775.50
|
|
|
HC DUCTOGRAM/ASPIRATION- SINGLE
|
Facility
|
OP
|
$1,034.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
909001433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$775.50 |
| Rate for Payer: Adventist Health Commercial |
$206.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$552.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$710.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$687.53
|
| Rate for Payer: Blue Shield of California Commercial |
$119.23
|
| Rate for Payer: Blue Shield of California EPN |
$95.88
|
| Rate for Payer: Cash Price |
$568.70
|
| Rate for Payer: Cash Price |
$568.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$672.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$640.05
|
| Rate for Payer: Heritage Provider Network Senior |
$640.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$79.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$493.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$775.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$307.13
|
| Rate for Payer: TriValley Medical Group Senior |
$307.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DUPLEX ABD PELVIS SCROTAL CONTENTS AND OR RETROPERI ORGANS LIMITED
|
Facility
|
IP
|
$2,068.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
906601559
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$374.31 |
| Max. Negotiated Rate |
$1,551.00 |
| Rate for Payer: Adventist Health Commercial |
$413.60
|
| Rate for Payer: Cash Price |
$1,137.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,400.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.00
|
| Rate for Payer: Multiplan Commercial |
$1,551.00
|
|
