|
HC FACTOR XII HAGEMANN
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
900910062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$92.67 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Adventist Health Commercial |
$102.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.73
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$346.62
|
| Rate for Payer: Heritage Provider Network Senior |
$346.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.00
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
|
|
HC FACTOR XIII ANTIGEN
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900912036
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.96
|
| Rate for Payer: Blue Shield of California Commercial |
$41.59
|
| Rate for Payer: Blue Shield of California Commercial |
$41.59
|
| Rate for Payer: Blue Shield of California EPN |
$33.36
|
| Rate for Payer: Blue Shield of California EPN |
$33.36
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| 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: Cigna of CA HMO/PPO |
$31.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.33
|
| Rate for Payer: Heritage Provider Network Senior |
$16.71
|
| Rate for Payer: Heritage Provider Network Senior |
$30.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.48
|
| Rate for Payer: TriValley Medical Group Senior |
$15.48
|
| Rate for Payer: TriValley Medical Group Senior |
$15.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC FACTOR XIII ANTIGEN
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900912036
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.56
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.17
|
| Rate for Payer: Heritage Provider Network Senior |
$33.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
|
|
HC FACTOR XIII SCREEN
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 85291
|
| Hospital Charge Code |
900910023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$93.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.38
|
| Rate for Payer: Blue Shield of California Commercial |
$71.54
|
| Rate for Payer: Blue Shield of California Commercial |
$71.54
|
| Rate for Payer: Blue Shield of California EPN |
$57.38
|
| Rate for Payer: Blue Shield of California EPN |
$57.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| 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: Cigna of CA HMO/PPO |
$28.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.11
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$93.47
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$72.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.21
|
| Rate for Payer: Multiplan Commercial |
$113.25
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.11
|
| Rate for Payer: TriValley Medical Group Senior |
$9.11
|
| Rate for Payer: TriValley Medical Group Senior |
$9.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.02
|
| Rate for Payer: Vantage Medical Group Senior |
$9.11
|
| Rate for Payer: Vantage Medical Group Senior |
$9.11
|
|
|
HC FACTOR XIII SCREEN
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 85291
|
| Hospital Charge Code |
900910023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$27.33 |
| Max. Negotiated Rate |
$113.25 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.24
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.23
|
| Rate for Payer: Heritage Provider Network Senior |
$102.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.75
|
| Rate for Payer: Multiplan Commercial |
$113.25
|
|
|
HC FACTOR XI PTA
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
900910061
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$345.75 |
| Rate for Payer: Adventist Health Commercial |
$92.20
|
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$284.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.03
|
| Rate for Payer: Blue Shield of California Commercial |
$144.12
|
| Rate for Payer: Blue Shield of California Commercial |
$144.12
|
| Rate for Payer: Blue Shield of California EPN |
$115.59
|
| Rate for Payer: Blue Shield of California EPN |
$115.59
|
| Rate for Payer: Cash Price |
$207.45
|
| Rate for Payer: Cash Price |
$207.45
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$101.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$299.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$285.36
|
| Rate for Payer: Heritage Provider Network Senior |
$96.56
|
| Rate for Payer: Heritage Provider Network Senior |
$285.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$74.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$219.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$345.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.90
|
| Rate for Payer: TriValley Medical Group Senior |
$17.90
|
| Rate for Payer: TriValley Medical Group Senior |
$17.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC FACTOR XI PTA
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
900910061
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$83.44 |
| Max. Negotiated Rate |
$345.75 |
| Rate for Payer: Adventist Health Commercial |
$92.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$296.88
|
| Rate for Payer: Cash Price |
$207.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.10
|
| Rate for Payer: Heritage Provider Network Senior |
$312.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.25
|
| Rate for Payer: Multiplan Commercial |
$345.75
|
|
|
HC FACTOR X STUART-PROWER
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
900910076
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$170.03 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$319.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.03
|
| Rate for Payer: Blue Shield of California Commercial |
$144.12
|
| Rate for Payer: Blue Shield of California Commercial |
$144.12
|
| Rate for Payer: Blue Shield of California EPN |
$115.59
|
| Rate for Payer: Blue Shield of California EPN |
$115.59
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$336.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.28
|
| Rate for Payer: Heritage Provider Network Senior |
$320.02
|
| Rate for Payer: Heritage Provider Network Senior |
$48.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$246.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$387.75
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.90
|
| Rate for Payer: TriValley Medical Group Senior |
$17.90
|
| Rate for Payer: TriValley Medical Group Senior |
$17.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC FACTOR X STUART-PROWER
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
900910076
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$93.58 |
| Max. Negotiated Rate |
$387.75 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$332.95
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$350.01
|
| Rate for Payer: Heritage Provider Network Senior |
$350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.25
|
| Rate for Payer: Multiplan Commercial |
$387.75
|
|
|
HC FALLOPIAN TUBE CATHETERIZATION
|
Facility
|
IP
|
$1,202.00
|
|
|
Service Code
|
CPT 74742
|
| Hospital Charge Code |
909001872
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.56 |
| Max. Negotiated Rate |
$901.50 |
| Rate for Payer: Adventist Health Commercial |
$240.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$774.09
|
| Rate for Payer: Cash Price |
$540.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$813.75
|
| Rate for Payer: Heritage Provider Network Senior |
$813.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.50
|
| Rate for Payer: Multiplan Commercial |
$901.50
|
|
|
HC FALLOPIAN TUBE CATHETERIZATION
|
Facility
|
OP
|
$1,202.00
|
|
|
Service Code
|
CPT 74742
|
| Hospital Charge Code |
909001872
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.56 |
| Max. Negotiated Rate |
$1,021.70 |
| Rate for Payer: Adventist Health Commercial |
$240.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$742.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,021.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$661.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$901.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$850.99
|
| Rate for Payer: Blue Shield of California Commercial |
$664.90
|
| Rate for Payer: Blue Shield of California EPN |
$534.69
|
| Rate for Payer: Cash Price |
$540.90
|
| Rate for Payer: Cash Price |
$540.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$781.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,021.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,021.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,021.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$709.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.04
|
| Rate for Payer: Heritage Provider Network Senior |
$744.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$573.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$841.40
|
| Rate for Payer: Multiplan Commercial |
$901.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$601.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$601.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,021.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,021.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,021.70
|
|
|
HC FALLOPIAN TUBE RECANALIZATION
|
Facility
|
IP
|
$9,197.00
|
|
|
Service Code
|
CPT 58345
|
| Hospital Charge Code |
909000177
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,664.66 |
| Max. Negotiated Rate |
$6,897.75 |
| Rate for Payer: Adventist Health Commercial |
$1,839.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,922.87
|
| Rate for Payer: Cash Price |
$4,138.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,226.37
|
| Rate for Payer: Heritage Provider Network Senior |
$6,226.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,664.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,299.25
|
| Rate for Payer: Multiplan Commercial |
$6,897.75
|
|
|
HC FALLOPIAN TUBE RECANALIZATION
|
Facility
|
OP
|
$9,197.00
|
|
|
Service Code
|
CPT 58345
|
| Hospital Charge Code |
909000177
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,664.66 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,839.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,683.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,138.65
|
| Rate for Payer: Cash Price |
$4,138.65
|
| Rate for Payer: Cash Price |
$4,138.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,978.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,163.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,692.94
|
| Rate for Payer: Heritage Provider Network Senior |
$5,121.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,910.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,664.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,788.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,299.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$6,897.75
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,579.83
|
| Rate for Payer: TriValley Medical Group Senior |
$4,579.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC FA STAIN ADENOVIRUS
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87260
|
| Hospital Charge Code |
900911780
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.81
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC FA STAIN ADENOVIRUS
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 87260
|
| Hospital Charge Code |
900911780
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$85.34 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$158.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.34
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.43
|
| Rate for Payer: TriValley Medical Group Senior |
$14.43
|
| Rate for Payer: TriValley Medical Group Senior |
$14.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.87
|
| Rate for Payer: Vantage Medical Group Senior |
$14.43
|
| Rate for Payer: Vantage Medical Group Senior |
$14.43
|
|
|
HC FA STAIN BORDETELLA
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 87265
|
| Hospital Charge Code |
900911732
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$85.34 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$158.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC FA STAIN BORDETELLA
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87265
|
| Hospital Charge Code |
900911732
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.81
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC FA STAIN CHLAMYDIA
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 87270
|
| Hospital Charge Code |
900911730
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$85.34 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$158.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC FA STAIN CHLAMYDIA
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87270
|
| Hospital Charge Code |
900911730
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.81
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC FA STAIN CMV
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87271
|
| Hospital Charge Code |
900911784
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.81
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC FA STAIN CMV
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 87271
|
| Hospital Charge Code |
900911784
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$86.29 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.29
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$158.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.98
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.42
|
| Rate for Payer: TriValley Medical Group Senior |
$13.42
|
| Rate for Payer: TriValley Medical Group Senior |
$13.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Vantage Medical Group Senior |
$13.42
|
| Rate for Payer: Vantage Medical Group Senior |
$13.42
|
|
|
HC FA STAIN HERPES SIMPLEX VIRUS TYPE 1
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 87274
|
| Hospital Charge Code |
900911734
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$85.34 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$158.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC FA STAIN HERPES SIMPLEX VIRUS TYPE 1
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87274
|
| Hospital Charge Code |
900911734
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.81
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC FA STAIN HERPES SIMPLEX VIRUS TYPE 2
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 87273
|
| Hospital Charge Code |
900911731
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$88.15 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.15
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$158.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC FA STAIN HERPES SIMPLEX VIRUS TYPE 2
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87273
|
| Hospital Charge Code |
900911731
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.81
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
