|
HC HIP ARTHROGRAPHY INJECTION
|
Facility
|
IP
|
$651.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
909000116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$117.83 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Adventist Health Commercial |
$130.20
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$440.73
|
| Rate for Payer: Heritage Provider Network Senior |
$440.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.75
|
| Rate for Payer: Multiplan Commercial |
$488.25
|
|
|
HC HISTONE AUTO AB
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913528
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.92
|
| Rate for Payer: Heritage Provider Network Senior |
$125.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
|
|
HC HISTONE AUTO AB
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913528
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.08
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC HIV 1 2 AB CONFIRMATION
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900913681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.63
|
| Rate for Payer: Heritage Provider Network Senior |
$172.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
|
|
HC HIV 1 2 AB CONFIRMATION
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900913681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$80.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.01
|
| Rate for Payer: Blue Shield of California Commercial |
$110.42
|
| Rate for Payer: Blue Shield of California EPN |
$88.57
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$98.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: Dignity Health Senior |
$13.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.47
|
| Rate for Payer: Heritage Provider Network Senior |
$93.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$72.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$113.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.71
|
| Rate for Payer: TriValley Medical Group Senior |
$13.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
|
|
HC HIV 1/2 AG AB
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT G0475 QW
|
| Hospital Charge Code |
900912044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.63
|
| Rate for Payer: Heritage Provider Network Senior |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
|
|
HC HIV 1/2 AG AB
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT G0475 QW
|
| Hospital Charge Code |
900912044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$135.59 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.59
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Senior |
$24.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.95
|
| Rate for Payer: Heritage Provider Network Senior |
$17.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.34
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.08
|
| Rate for Payer: TriValley Medical Group Senior |
$24.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
|
HC HIV-1,2 AG AB SCREEN
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913626
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$196.53 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.47
|
| Rate for Payer: Blue Shield of California Commercial |
$196.53
|
| Rate for Payer: Blue Shield of California EPN |
$157.63
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Senior |
$24.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.43
|
| Rate for Payer: Heritage Provider Network Senior |
$33.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.34
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.08
|
| Rate for Payer: TriValley Medical Group Senior |
$24.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
|
HC HIV-1,2 AG AB SCREEN
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913626
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$84.75 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.50
|
| Rate for Payer: Heritage Provider Network Senior |
$76.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.25
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
|
|
HC HIV 1 ANTIBODY
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900913682
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$81.75 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.79
|
| Rate for Payer: Heritage Provider Network Senior |
$73.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.25
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
|
|
HC HIV 1 ANTIBODY
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900913682
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$81.07 |
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.07
|
| Rate for Payer: Blue Shield of California Commercial |
$71.48
|
| Rate for Payer: Blue Shield of California EPN |
$57.33
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.78
|
| Rate for Payer: Dignity Health Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Senior |
$58.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.89
|
| Rate for Payer: TriValley Medical Group Senior |
$8.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
HC HIV 1 P24 ANTIGEN
|
Facility
|
IP
|
$174.33
|
|
|
Service Code
|
CPT 87390
|
| Hospital Charge Code |
900913684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.55 |
| Max. Negotiated Rate |
$130.75 |
| Rate for Payer: Adventist Health Commercial |
$34.87
|
| Rate for Payer: Cash Price |
$78.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.02
|
| Rate for Payer: Heritage Provider Network Senior |
$118.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.58
|
| Rate for Payer: Multiplan Commercial |
$130.75
|
|
|
HC HIV 1 P24 ANTIGEN
|
Facility
|
OP
|
$156.90
|
|
|
Service Code
|
CPT 87390
|
| Hospital Charge Code |
900913684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.06 |
| Max. Negotiated Rate |
$155.87 |
| Rate for Payer: Adventist Health Commercial |
$31.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$83.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$107.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.87
|
| Rate for Payer: Blue Shield of California Commercial |
$141.98
|
| Rate for Payer: Blue Shield of California EPN |
$113.88
|
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$101.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.47
|
| Rate for Payer: Dignity Health Senior |
$24.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.12
|
| Rate for Payer: Heritage Provider Network Senior |
$97.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$74.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.32
|
| Rate for Payer: Multiplan Commercial |
$117.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.06
|
| Rate for Payer: TriValley Medical Group Senior |
$24.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Vantage Medical Group Senior |
$24.06
|
|
|
HC HIV 2 ANTIBODY
|
Facility
|
OP
|
$140.24
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900913683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$125.38 |
| Rate for Payer: Adventist Health Commercial |
$28.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.38
|
| Rate for Payer: Blue Shield of California Commercial |
$108.75
|
| Rate for Payer: Blue Shield of California EPN |
$87.23
|
| Rate for Payer: Cash Price |
$63.11
|
| Rate for Payer: Cash Price |
$63.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Senior |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.81
|
| Rate for Payer: Heritage Provider Network Senior |
$86.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$105.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.52
|
| Rate for Payer: TriValley Medical Group Senior |
$13.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC HIV 2 ANTIBODY
|
Facility
|
IP
|
$154.26
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900913683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$115.69 |
| Rate for Payer: Adventist Health Commercial |
$30.85
|
| Rate for Payer: Cash Price |
$69.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.43
|
| Rate for Payer: Heritage Provider Network Senior |
$104.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.56
|
| Rate for Payer: Multiplan Commercial |
$115.69
|
|
|
HC HIV ANTIGEN, ANTIBODY
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913662
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$196.53 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.47
|
| Rate for Payer: Blue Shield of California Commercial |
$196.53
|
| Rate for Payer: Blue Shield of California EPN |
$157.63
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Senior |
$24.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.34
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.08
|
| Rate for Payer: TriValley Medical Group Senior |
$24.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
|
HC HIV ANTIGEN, ANTIBODY
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913662
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.59
|
| Rate for Payer: Heritage Provider Network Senior |
$38.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
|
|
HC HIV RAPID TESTING
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900912325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.01
|
| Rate for Payer: Blue Shield of California Commercial |
$110.42
|
| Rate for Payer: Blue Shield of California EPN |
$88.57
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: Dignity Health Senior |
$13.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.99
|
| Rate for Payer: Heritage Provider Network Senior |
$77.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.71
|
| Rate for Payer: TriValley Medical Group Senior |
$13.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
|
|
HC HIV RAPID TESTING
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900912325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$830.25 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,361.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,594.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,281.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,826.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,490.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,335.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,335.04
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,527.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,822.85
|
| Rate for Payer: Dignity Health Senior |
$2,822.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,125.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,537.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,537.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,061.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,660.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,660.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,660.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$830.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,324.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,324.70
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,199.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,099.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,822.85
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$664.20 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$664.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,594.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,335.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,335.04
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,527.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,793.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,537.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,537.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,660.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,660.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,660.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$830.25
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,199.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,099.58
|
|
|
HC HOMOVANILLIC ACID (HVA)
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900910532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$155.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.91
|
| Rate for Payer: Blue Shield of California Commercial |
$155.75
|
| Rate for Payer: Blue Shield of California EPN |
$124.92
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Senior |
$22.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.62
|
| Rate for Payer: Heritage Provider Network Senior |
$52.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.24
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.41
|
| Rate for Payer: TriValley Medical Group Senior |
$22.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$22.41
|
|
|
HC HOMOVANILLIC ACID (HVA)
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900910532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.91 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$153.00
|
| Rate for Payer: Heritage Provider Network Senior |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.50
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
|
|
HC HOMOVANILLIC ACID URINE 24 HOURS
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900912207
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$155.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.91
|
| Rate for Payer: Blue Shield of California Commercial |
$155.75
|
| Rate for Payer: Blue Shield of California EPN |
$124.92
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Senior |
$22.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.62
|
| Rate for Payer: Heritage Provider Network Senior |
$52.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.24
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.41
|
| Rate for Payer: TriValley Medical Group Senior |
$22.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$22.41
|
|
|
HC HOMOVANILLIC ACID URINE 24 HOURS
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900912207
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.91 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$153.00
|
| Rate for Payer: Heritage Provider Network Senior |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.50
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
|
