|
HC CT TSPINE WO CONTRAST
|
Facility
IP
|
$3,050.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
909201917
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$552.05 |
| Max. Negotiated Rate |
$2,287.50 |
| Rate for Payer: Adventist Health Commercial |
$610.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,095.35
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,064.85
|
| Rate for Payer: Heritage Provider Network Senior |
$2,064.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$762.50
|
| Rate for Payer: Multiplan Commercial |
$2,287.50
|
|
|
HC CT TSPINE W W/O CONTRAST
|
Facility
OP
|
$3,534.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
909201966
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,650.50 |
| Rate for Payer: Adventist Health Commercial |
$706.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,427.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,805.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,026.98
|
| Rate for Payer: Cash Price |
$1,590.30
|
| Rate for Payer: Cash Price |
$1,590.30
|
| Rate for Payer: Cash Price |
$1,590.30
|
| Rate for Payer: Cash Price |
$1,590.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: IEHP Medi-Cal |
$301.30
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$883.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$2,650.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$534.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$534.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CT TSPINE W W/O CONTRAST
|
Facility
IP
|
$3,431.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
909201966
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$621.01 |
| Max. Negotiated Rate |
$2,573.25 |
| Rate for Payer: Adventist Health Commercial |
$686.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,357.10
|
| Rate for Payer: Cash Price |
$1,543.95
|
| Rate for Payer: Cash Price |
$1,543.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,322.79
|
| Rate for Payer: Heritage Provider Network Senior |
$2,322.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$621.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.75
|
| Rate for Payer: Multiplan Commercial |
$2,573.25
|
|
|
HC CUIRASS SHELL
|
Facility
IP
|
$2,300.00
|
|
| Hospital Charge Code |
900800900
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$416.30 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,580.10
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,557.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,557.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$575.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
|
|
HC CUIRASS SHELL
|
Facility
OP
|
$2,300.00
|
|
| Hospital Charge Code |
900800900
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$416.30 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,229.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,580.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,428.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,350.10
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,495.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Senior |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,495.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,423.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,423.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,108.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$575.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC CULTURE AEROBIC ID
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900911554
|
|
Hospital Revenue Code
|
306
|
| 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 CULTURE AEROBIC ID
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900911554
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$67.56 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.56
|
| Rate for Payer: Blue Shield of California Commercial |
$63.11
|
| Rate for Payer: Blue Shield of California EPN |
$49.34
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.71
|
| Rate for Payer: Heritage Provider Network Senior |
$16.71
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: IEHP Medi-Cal |
$10.37
|
| Rate for Payer: IEHP Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC CULTURE AEROBIC ID CYSTIC FIBROSIS
|
Facility
OP
|
$31.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$67.56 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.56
|
| Rate for Payer: Blue Shield of California Commercial |
$63.11
|
| Rate for Payer: Blue Shield of California EPN |
$49.34
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: IEHP Medi-Cal |
$10.37
|
| Rate for Payer: IEHP Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC CULTURE AEROBIC ID CYSTIC FIBROSIS
|
Facility
IP
|
$399.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$72.22 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Adventist Health Commercial |
$79.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.11
|
| Rate for Payer: Cash Price |
$179.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$270.12
|
| Rate for Payer: Heritage Provider Network Senior |
$270.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$299.25
|
|
|
HC CULTURE ANAEROBIC
|
Facility
IP
|
$355.00
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
900911501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$266.25 |
| Rate for Payer: Adventist Health Commercial |
$71.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$243.88
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$240.34
|
| Rate for Payer: Heritage Provider Network Senior |
$240.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.75
|
| Rate for Payer: Multiplan Commercial |
$266.25
|
|
|
HC CULTURE ANAEROBIC
|
Facility
OP
|
$31.00
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
900911501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$79.17 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.17
|
| Rate for Payer: Blue Shield of California Commercial |
$73.90
|
| Rate for Payer: Blue Shield of California EPN |
$57.77
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.42
|
| Rate for Payer: Dignity Health Senior |
$9.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Humana Medicare |
$9.47
|
| Rate for Payer: IEHP Medi-Cal |
$13.14
|
| Rate for Payer: IEHP Medicare Advantage |
$9.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.47
|
| Rate for Payer: TriValley Medical Group Senior |
$9.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.42
|
| Rate for Payer: Vantage Medical Group Senior |
$9.47
|
|
|
HC CULTURE ANAEROBIC IDS RAPID
|
Facility
OP
|
$31.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900911553
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$105.43 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.43
|
| Rate for Payer: Blue Shield of California Commercial |
$63.11
|
| Rate for Payer: Blue Shield of California EPN |
$49.34
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: IEHP Medi-Cal |
$11.20
|
| Rate for Payer: IEHP Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC CULTURE ANAEROBIC IDS RAPID
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900911553
|
|
Hospital Revenue Code
|
306
|
| 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 CULTURE BACTERIAL AG H INFLU
|
Facility
IP
|
$115.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911711
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.86
|
| Rate for Payer: Heritage Provider Network Senior |
$77.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
|
|
HC CULTURE BACTERIAL AG H INFLU
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911711
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$40.42 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.16
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.05
|
| Rate for Payer: Heritage Provider Network Senior |
$8.05
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: IEHP Medi-Cal |
$5.66
|
| Rate for Payer: IEHP Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC CULTURE BACTERIAL AG N MENING
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911713
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$40.42 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.16
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.05
|
| Rate for Payer: Heritage Provider Network Senior |
$8.05
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: IEHP Medi-Cal |
$5.66
|
| Rate for Payer: IEHP Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC CULTURE BACTERIAL AG N MENING
|
Facility
IP
|
$115.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911713
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.86
|
| Rate for Payer: Heritage Provider Network Senior |
$77.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
|
|
HC CULTURE BACTERIAL AG S PNEUM
|
Facility
IP
|
$115.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911712
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.86
|
| Rate for Payer: Heritage Provider Network Senior |
$77.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
|
|
HC CULTURE BACTERIAL AG S PNEUM
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911712
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$40.42 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.16
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.05
|
| Rate for Payer: Heritage Provider Network Senior |
$8.05
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: IEHP Medi-Cal |
$5.66
|
| Rate for Payer: IEHP Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC CULTURE BACTERIAL AG STREP B
|
Facility
IP
|
$115.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911710
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.86
|
| Rate for Payer: Heritage Provider Network Senior |
$77.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
|
|
HC CULTURE BACTERIAL AG STREP B
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900911710
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$40.42 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.16
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.05
|
| Rate for Payer: Heritage Provider Network Senior |
$8.05
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: IEHP Medi-Cal |
$5.66
|
| Rate for Payer: IEHP Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC CULTURE BLOOD
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
900911502
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$86.39 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$30.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.39
|
| Rate for Payer: Blue Shield of California Commercial |
$80.61
|
| Rate for Payer: Blue Shield of California EPN |
$63.02
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.35
|
| Rate for Payer: Dignity Health Senior |
$10.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.00
|
| Rate for Payer: Heritage Provider Network Senior |
$39.00
|
| Rate for Payer: Humana Medicare |
$10.32
|
| Rate for Payer: IEHP Medi-Cal |
$14.01
|
| Rate for Payer: IEHP Medicare Advantage |
$10.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.32
|
| Rate for Payer: TriValley Medical Group Senior |
$10.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10.32
|
|
|
HC CULTURE BLOOD
|
Facility
IP
|
$399.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
900911502
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$72.22 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Adventist Health Commercial |
$79.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.11
|
| Rate for Payer: Cash Price |
$179.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$270.12
|
| Rate for Payer: Heritage Provider Network Senior |
$270.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$299.25
|
|
|
HC CULTURE BODY FLUID
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911503
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$72.02 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.02
|
| Rate for Payer: Blue Shield of California Commercial |
$67.25
|
| Rate for Payer: Blue Shield of California EPN |
$52.57
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.48
|
| Rate for Payer: Dignity Health Senior |
$8.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.81
|
| Rate for Payer: Heritage Provider Network Senior |
$19.81
|
| Rate for Payer: Humana Medicare |
$8.62
|
| Rate for Payer: IEHP Medi-Cal |
$11.72
|
| Rate for Payer: IEHP Medicare Advantage |
$8.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.86
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.62
|
| Rate for Payer: TriValley Medical Group Senior |
$8.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.48
|
| Rate for Payer: Vantage Medical Group Senior |
$8.62
|
|
|
HC CULTURE BODY FLUID
|
Facility
IP
|
$399.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
900911503
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$72.22 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Adventist Health Commercial |
$79.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.11
|
| Rate for Payer: Cash Price |
$179.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$270.12
|
| Rate for Payer: Heritage Provider Network Senior |
$270.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$299.25
|
|
