|
HC FA STAIN INFLUENZA A
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87276
|
| Hospital Charge Code |
900911781
|
|
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 INFLUENZA A
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 87276
|
| Hospital Charge Code |
900911781
|
|
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 |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| 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 |
$24.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.07
|
| 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 |
$16.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.07
|
| 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 |
$16.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| 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 |
$18.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.48
|
| 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 |
$21.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Senior |
$16.07
|
| Rate for Payer: TriValley Medical Group Senior |
$16.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC FA STAIN INFLUENZA B
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 87275
|
| Hospital Charge Code |
900911782
|
|
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 |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.25
|
| 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 |
$18.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.25
|
| 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 |
$12.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.25
|
| 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 |
$12.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.25
|
| 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 |
$14.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.09
|
| 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 |
$16.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.41
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.25
|
| Rate for Payer: TriValley Medical Group Senior |
$12.25
|
| Rate for Payer: TriValley Medical Group Senior |
$12.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
HC FA STAIN INFLUENZA B
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87275
|
| Hospital Charge Code |
900911782
|
|
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 LEGIONELLA
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 87278
|
| Hospital Charge Code |
900911733
|
|
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 |
$23.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.60
|
| 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 |
$23.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.60
|
| 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 |
$15.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.60
|
| 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 |
$15.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.60
|
| 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 |
$17.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.94
|
| 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 |
$20.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.90
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Senior |
$15.60
|
| Rate for Payer: TriValley Medical Group Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.16
|
| Rate for Payer: Vantage Medical Group Senior |
$15.60
|
| Rate for Payer: Vantage Medical Group Senior |
$15.60
|
|
|
HC FA STAIN LEGIONELLA
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87278
|
| Hospital Charge Code |
900911733
|
|
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 PARAINFLUENZA
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 87279
|
| Hospital Charge Code |
900911783
|
|
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 |
$24.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.43
|
| 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 |
$24.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.43
|
| 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 |
$16.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.43
|
| 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 |
$16.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.43
|
| 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 |
$18.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.89
|
| 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 |
$22.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.02
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.43
|
| Rate for Payer: TriValley Medical Group Senior |
$16.43
|
| Rate for Payer: TriValley Medical Group Senior |
$16.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.07
|
| Rate for Payer: Vantage Medical Group Senior |
$16.43
|
| Rate for Payer: Vantage Medical Group Senior |
$16.43
|
|
|
HC FA STAIN PARAINFLUENZA
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87279
|
| Hospital Charge Code |
900911783
|
|
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 FECAL MICROBIOTA PREP INSTIL
|
Facility
|
OP
|
$2,159.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906700799
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$390.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$431.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,334.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,079.93
|
| 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 |
$971.55
|
| Rate for Payer: Cash Price |
$971.55
|
| Rate for Payer: Cash Price |
$971.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,403.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,336.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,029.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$390.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$1,619.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC FECAL MICROBIOTA PREP INSTIL
|
Facility
|
IP
|
$2,159.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906700799
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$390.78 |
| Max. Negotiated Rate |
$1,619.25 |
| Rate for Payer: Adventist Health Commercial |
$431.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,390.40
|
| Rate for Payer: Cash Price |
$971.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,461.64
|
| Rate for Payer: Heritage Provider Network Senior |
$1,461.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$390.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.75
|
| Rate for Payer: Multiplan Commercial |
$1,619.25
|
|
|
HC FEET BOTH 1 VIEW
|
Facility
|
IP
|
$718.00
|
|
|
Service Code
|
CPT 73620 50
|
| Hospital Charge Code |
909001641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.96 |
| Max. Negotiated Rate |
$538.50 |
| Rate for Payer: Adventist Health Commercial |
$143.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$462.39
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$486.09
|
| Rate for Payer: Heritage Provider Network Senior |
$486.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$129.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.50
|
| Rate for Payer: Multiplan Commercial |
$538.50
|
|
|
HC FEET BOTH 1 VIEW
|
Facility
|
OP
|
$718.00
|
|
|
Service Code
|
CPT 73620 50
|
| Hospital Charge Code |
909001641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$610.30 |
| Rate for Payer: Adventist Health Commercial |
$143.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$443.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$610.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$394.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$538.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.98
|
| Rate for Payer: Blue Shield of California Commercial |
$101.86
|
| Rate for Payer: Blue Shield of California EPN |
$81.91
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$466.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$610.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$610.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$610.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$423.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$444.44
|
| Rate for Payer: Heritage Provider Network Senior |
$444.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$342.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$129.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$502.60
|
| Rate for Payer: Multiplan Commercial |
$538.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$610.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$610.30
|
| Rate for Payer: Vantage Medical Group Senior |
$610.30
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
OP
|
$1,615.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$260.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$323.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$998.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$807.82
|
| 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 |
$726.75
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,049.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$260.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$999.68
|
| Rate for Payer: Heritage Provider Network Senior |
$319.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$494.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$292.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$348.44
|
| Rate for Payer: Multiplan Commercial |
$1,211.25
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$286.03
|
| Rate for Payer: TriValley Medical Group Senior |
$286.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Vantage Medical Group Senior |
$260.03
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
IP
|
$1,615.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$292.31 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Adventist Health Commercial |
$323.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,040.06
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,093.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,093.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$292.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.75
|
| Rate for Payer: Multiplan Commercial |
$1,211.25
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
IP
|
$1,615.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.31 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Adventist Health Commercial |
$323.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,040.06
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,093.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,093.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$292.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.75
|
| Rate for Payer: Multiplan Commercial |
$1,211.25
|
|
|
HC FEMALE GENITAL SYTM PROC UNLST
|
Facility
|
OP
|
$1,615.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
900501441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$260.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$323.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$998.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$767.12
|
| Rate for Payer: Blue Shield of California EPN |
$610.47
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Cash Price |
$726.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,049.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$260.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,093.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,093.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$770.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$292.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$348.44
|
| Rate for Payer: Multiplan Commercial |
$1,211.25
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$969.00
|
| Rate for Payer: TriValley Medical Group Senior |
$969.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Vantage Medical Group Senior |
$260.03
|
|
|
HC FEMORAL NERVE BLOCK SINGLE
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
900501590
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$168.69 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$575.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| 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 |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$605.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$559.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$576.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,724.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$998.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC FEMORAL NERVE BLOCK SINGLE
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
900501590
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$168.69 |
| Max. Negotiated Rate |
$699.00 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$600.21
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$630.96
|
| Rate for Payer: Heritage Provider Network Senior |
$630.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
|
|
HC FERNING
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900912032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.62
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.14
|
| Rate for Payer: Heritage Provider Network Senior |
$31.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
|
|
HC FERNING
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900912032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$40.53 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.53
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.47
|
| Rate for Payer: Heritage Provider Network Senior |
$28.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC FERN TEST
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 82120
|
| Hospital Charge Code |
910400132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.92
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.92
|
| Rate for Payer: Heritage Provider Network Senior |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
|
|
HC FERN TEST
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 82120
|
| Hospital Charge Code |
910400132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.86
|
| Rate for Payer: Blue Shield of California Commercial |
$30.24
|
| Rate for Payer: Blue Shield of California EPN |
$24.25
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.90
|
| Rate for Payer: Heritage Provider Network Senior |
$74.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.99
|
| Rate for Payer: TriValley Medical Group Senior |
$5.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC FERRITIN
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
900910819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.88
|
| 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 Foundation Hospitals Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC FERRITIN
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
900910819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Blue Shield of California EPN |
$87.92
|
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.38
|
| Rate for Payer: Blue Shield of California Commercial |
$109.61
|
| Rate for Payer: Blue Shield of California Commercial |
$109.61
|
| Rate for Payer: Blue Shield of California EPN |
$87.92
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$61.90
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$128.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.26
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.63
|
| Rate for Payer: TriValley Medical Group Senior |
$13.63
|
| Rate for Payer: TriValley Medical Group Senior |
$13.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.99
|
| Rate for Payer: Vantage Medical Group Senior |
$13.63
|
| Rate for Payer: Vantage Medical Group Senior |
$13.63
|
|
|
HC FETAL BLEED SCREEN
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
900904562
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$182.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.23
|
| Rate for Payer: Blue Shield of California Commercial |
$53.34
|
| Rate for Payer: Blue Shield of California EPN |
$42.78
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$192.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.22
|
| Rate for Payer: Heritage Provider Network Senior |
$183.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$141.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.54
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.36
|
| Rate for Payer: TriValley Medical Group Senior |
$9.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9.36
|
|
