|
HC DVLP TEST PHYS/QHP PT 1ST HR
|
Facility
IP
|
$1,138.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
900400020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$205.98 |
| Max. Negotiated Rate |
$853.50 |
| Rate for Payer: Adventist Health Commercial |
$227.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$781.81
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$770.43
|
| Rate for Payer: Heritage Provider Network Senior |
$770.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.50
|
| Rate for Payer: Multiplan Commercial |
$853.50
|
|
|
HC DVLP TEST PHYS/QHP ST 1ST HR
|
Facility
OP
|
$1,138.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
905601811
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$853.50 |
| Rate for Payer: Adventist Health Commercial |
$227.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$298.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$781.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$739.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$739.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$704.42
|
| Rate for Payer: Heritage Provider Network Senior |
$704.42
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: IEHP Medi-Cal |
$181.85
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$853.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC DVLP TEST PHYS/QHP ST 1ST HR
|
Facility
IP
|
$1,138.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
905601811
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$205.98 |
| Max. Negotiated Rate |
$853.50 |
| Rate for Payer: Adventist Health Commercial |
$227.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$781.81
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$770.43
|
| Rate for Payer: Heritage Provider Network Senior |
$770.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.50
|
| Rate for Payer: Multiplan Commercial |
$853.50
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
OP
|
$1,283.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$232.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$256.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$881.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,090.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$705.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$962.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$796.74
|
| Rate for Payer: Blue Shield of California EPN |
$753.12
|
| Rate for Payer: Cash Price |
$577.35
|
| Rate for Payer: Cash Price |
$577.35
|
| Rate for Payer: Cash Price |
$577.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$833.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,090.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,090.55
|
| Rate for Payer: Dignity Health Senior |
$1,090.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$794.18
|
| Rate for Payer: Heritage Provider Network Senior |
$794.18
|
| Rate for Payer: IEHP Medi-Cal |
$236.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$618.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.75
|
| Rate for Payer: Multiplan Commercial |
$962.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,090.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,090.55
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
IP
|
$1,283.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$232.22 |
| Max. Negotiated Rate |
$962.25 |
| Rate for Payer: Adventist Health Commercial |
$256.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$881.42
|
| Rate for Payer: Cash Price |
$577.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$868.59
|
| Rate for Payer: Heritage Provider Network Senior |
$868.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.75
|
| Rate for Payer: Multiplan Commercial |
$962.25
|
|
|
HC EA ADDL LESION STEREO
|
Facility
IP
|
$2,121.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$383.90 |
| Max. Negotiated Rate |
$1,590.75 |
| Rate for Payer: Adventist Health Commercial |
$424.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,457.13
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,435.92
|
| Rate for Payer: Heritage Provider Network Senior |
$1,435.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$530.25
|
| Rate for Payer: Multiplan Commercial |
$1,590.75
|
|
|
HC EA ADDL LESION STEREO
|
Facility
OP
|
$2,121.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$290.39 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$424.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,457.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,802.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,166.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,590.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Cash Price |
$954.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,378.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,802.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,802.85
|
| Rate for Payer: Dignity Health Senior |
$1,802.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,312.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,312.90
|
| Rate for Payer: IEHP Medi-Cal |
$290.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,022.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$530.25
|
| Rate for Payer: Multiplan Commercial |
$1,590.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,802.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,802.85
|
|
|
HC EA ADDL MAGNETIC RESONANCE
|
Facility
IP
|
$225.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
908819288
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$929.00 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.32
|
| Rate for Payer: Heritage Provider Network Senior |
$152.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
|
|
HC EA ADDL MAGNETIC RESONANCE
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
908819288
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$168.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$139.72
|
| Rate for Payer: Blue Shield of California EPN |
$132.08
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: Dignity Health Senior |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: IEHP Medi-Cal |
$85.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$108.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC EA ADDL ULTRASOUND
|
Facility
IP
|
$239.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
906619286
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.26 |
| Max. Negotiated Rate |
$179.25 |
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.19
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$161.80
|
| Rate for Payer: Heritage Provider Network Senior |
$161.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.75
|
| Rate for Payer: Multiplan Commercial |
$179.25
|
|
|
HC EA ADDL ULTRASOUND
|
Facility
OP
|
$239.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
906619286
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$203.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$131.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$179.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$148.42
|
| Rate for Payer: Blue Shield of California EPN |
$140.29
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$155.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$203.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.15
|
| Rate for Payer: Dignity Health Senior |
$203.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.94
|
| Rate for Payer: Heritage Provider Network Senior |
$147.94
|
| Rate for Payer: IEHP Medi-Cal |
$652.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$115.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.75
|
| Rate for Payer: Multiplan Commercial |
$179.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.15
|
| Rate for Payer: Vantage Medical Group Senior |
$203.15
|
|
|
HC EBNA IGG
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913537
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.15
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.11
|
| Rate for Payer: Heritage Provider Network Senior |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
|
|
HC EBNA IGG
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900913537
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$129.95 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$44.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.95
|
| Rate for Payer: Blue Shield of California Commercial |
$119.51
|
| Rate for Payer: Blue Shield of California EPN |
$93.43
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.82
|
| Rate for Payer: Dignity Health Senior |
$15.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$15.29
|
| Rate for Payer: IEHP Medi-Cal |
$21.22
|
| Rate for Payer: IEHP Medicare Advantage |
$15.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.27
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.29
|
| Rate for Payer: TriValley Medical Group Senior |
$15.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Vantage Medical Group Senior |
$15.29
|
|
|
HC EBOL SPINAL ART FOR AVM
|
Facility
OP
|
$4,170.00
|
|
|
Service Code
|
CPT 62294
|
| Hospital Charge Code |
909080025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$754.77 |
| Max. Negotiated Rate |
$5,505.00 |
| Rate for Payer: Adventist Health Commercial |
$834.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,864.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,710.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,502.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,581.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.76
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: IEHP Medi-Cal |
$962.36
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,163.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,042.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$3,127.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,252.71
|
| Rate for Payer: TriValley Medical Group Senior |
$1,252.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC EBOL SPINAL ART FOR AVM
|
Facility
IP
|
$4,170.00
|
|
|
Service Code
|
CPT 62294
|
| Hospital Charge Code |
909080025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$754.77 |
| Max. Negotiated Rate |
$3,127.50 |
| Rate for Payer: Adventist Health Commercial |
$834.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,864.79
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,823.09
|
| Rate for Payer: Heritage Provider Network Senior |
$2,823.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,042.50
|
| Rate for Payer: Multiplan Commercial |
$3,127.50
|
|
|
HC EBV DNA PCR TEST
|
Facility
IP
|
$63.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.28
|
| Rate for Payer: Cash Price |
$28.35
|
| 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 EBV DNA PCR TEST
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$334.56 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.56
|
| Rate for Payer: Blue Shield of California Commercial |
$334.56
|
| Rate for Payer: Blue Shield of California EPN |
$261.54
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Humana Medicare |
$42.84
|
| Rate for Payer: IEHP Medi-Cal |
$59.40
|
| Rate for Payer: IEHP Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.98
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC EBV IGG EARLY AB
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$102.46
|
| Rate for Payer: Blue Shield of California EPN |
$80.10
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.43
|
| Rate for Payer: Dignity Health Senior |
$13.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$13.12
|
| Rate for Payer: IEHP Medi-Cal |
$18.19
|
| Rate for Payer: IEHP Medicare Advantage |
$13.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.53
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.12
|
| Rate for Payer: TriValley Medical Group Senior |
$13.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.43
|
| Rate for Payer: Vantage Medical Group Senior |
$13.12
|
|
|
HC EBV IGG EARLY AB
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
900913538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.15
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.11
|
| Rate for Payer: Heritage Provider Network Senior |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
|
|
HC EBV PCR
|
Facility
IP
|
$516.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.40 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Adventist Health Commercial |
$103.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$354.49
|
| Rate for Payer: Cash Price |
$232.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$349.33
|
| Rate for Payer: Heritage Provider Network Senior |
$349.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.00
|
| Rate for Payer: Multiplan Commercial |
$387.00
|
|
|
HC EBV PCR
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$334.56 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.56
|
| Rate for Payer: Blue Shield of California Commercial |
$334.56
|
| Rate for Payer: Blue Shield of California EPN |
$261.54
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Humana Medicare |
$42.84
|
| Rate for Payer: IEHP Medi-Cal |
$59.40
|
| Rate for Payer: IEHP Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.98
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC EBV-VCA IGG/IGM
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913535
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$136.12 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.96
|
| Rate for Payer: Blue Shield of California Commercial |
$136.12
|
| Rate for Payer: Blue Shield of California EPN |
$106.41
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Senior |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Humana Medicare |
$18.14
|
| Rate for Payer: IEHP Medi-Cal |
$24.68
|
| Rate for Payer: IEHP Medicare Advantage |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.86
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.14
|
| Rate for Payer: TriValley Medical Group Senior |
$18.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18.14
|
|
|
HC EBV-VCA IGG/IGM
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900913535
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.15
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.11
|
| Rate for Payer: Heritage Provider Network Senior |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
|
|
HC ECG 48 HR MONITOR-RECORDING
|
Facility
OP
|
$1,319.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
900200113
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$46.52 |
| Max. Negotiated Rate |
$1,108.00 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$906.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Blue Shield of California Commercial |
$254.39
|
| Rate for Payer: Blue Shield of California EPN |
$144.66
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$857.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$857.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$816.46
|
| Rate for Payer: Heritage Provider Network Senior |
$816.46
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medi-Cal |
$46.52
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$989.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.56
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,108.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$932.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC ECG 48 HR MONITOR-RECORDING
|
Facility
IP
|
$1,319.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
900200113
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$238.74 |
| Max. Negotiated Rate |
$989.25 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$906.15
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$892.96
|
| Rate for Payer: Heritage Provider Network Senior |
$892.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.75
|
| Rate for Payer: Multiplan Commercial |
$989.25
|
|
