|
HC NUCLEIC ACID ID VANB
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912466
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.91
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.15
|
| Rate for Payer: Heritage Provider Network Senior |
$119.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
|
|
HC NUCLEIC ACID ID VANB
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912466
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$167.70 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$58.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.70
|
| Rate for Payer: Blue Shield of California Commercial |
$156.63
|
| Rate for Payer: Blue Shield of California EPN |
$122.45
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.06
|
| Rate for Payer: Dignity Health Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$20.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.26
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.05
|
| Rate for Payer: TriValley Medical Group Senior |
$20.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC NUCLEIC ACID ID VIM
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.91
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.15
|
| Rate for Payer: Heritage Provider Network Senior |
$119.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
|
|
HC NUCLEIC ACID ID VIM
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$167.70 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$58.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.70
|
| Rate for Payer: Blue Shield of California Commercial |
$156.63
|
| Rate for Payer: Blue Shield of California EPN |
$122.45
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.06
|
| Rate for Payer: Dignity Health Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$20.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.26
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.05
|
| Rate for Payer: TriValley Medical Group Senior |
$20.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC NUTRITION THER GRP 30 MIN
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
902000205
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$31.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$87.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$119.25
|
| Rate for Payer: Blue Shield of California Commercial |
$98.74
|
| Rate for Payer: Blue Shield of California EPN |
$93.33
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$103.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$135.15
|
| Rate for Payer: Dignity Health Senior |
$135.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.42
|
| Rate for Payer: Heritage Provider Network Senior |
$98.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$76.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.75
|
| Rate for Payer: Multiplan Commercial |
$119.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$135.15
|
| Rate for Payer: Vantage Medical Group Senior |
$135.15
|
|
|
HC NUTRITION THER GRP 30 MIN
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
902000205
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$28.78 |
| Max. Negotiated Rate |
$119.25 |
| Rate for Payer: Adventist Health Commercial |
$31.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.23
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.64
|
| Rate for Payer: Heritage Provider Network Senior |
$107.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.75
|
| Rate for Payer: Multiplan Commercial |
$119.25
|
|
|
HC NUTR THER INIT EVAL 15 MIN
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
902000200
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.84
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.95
|
| Rate for Payer: Heritage Provider Network Senior |
$127.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
|
|
HC NUTR THER INIT EVAL 15 MIN
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
902000200
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.75
|
| Rate for Payer: Blue Shield of California Commercial |
$117.37
|
| Rate for Payer: Blue Shield of California EPN |
$110.94
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.65
|
| Rate for Payer: Dignity Health Senior |
$160.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.99
|
| Rate for Payer: Heritage Provider Network Senior |
$116.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$91.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.65
|
| Rate for Payer: Vantage Medical Group Senior |
$160.65
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$78.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.50
|
| Rate for Payer: Blue Shield of California Commercial |
$38.50
|
| Rate for Payer: Blue Shield of California EPN |
$36.39
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.70
|
| Rate for Payer: Dignity Health Senior |
$52.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.38
|
| Rate for Payer: Heritage Provider Network Senior |
$38.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.70
|
| Rate for Payer: Vantage Medical Group Senior |
$52.70
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.59
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.97
|
| Rate for Payer: Heritage Provider Network Senior |
$41.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
|
|
HC O2/CO2 EXHALED AIR ANALYSIS RSPC
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 94681
|
| Hospital Charge Code |
900894681
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$174.48 |
| Max. Negotiated Rate |
$723.00 |
| Rate for Payer: Adventist Health Commercial |
$192.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$662.27
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$652.63
|
| Rate for Payer: Heritage Provider Network Senior |
$652.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.00
|
| Rate for Payer: Multiplan Commercial |
$723.00
|
|
|
HC O2/CO2 EXHALED AIR ANALYSIS RSPC
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 94681
|
| Hospital Charge Code |
900894681
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$114.34 |
| Max. Negotiated Rate |
$745.12 |
| Rate for Payer: Adventist Health Commercial |
$192.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$114.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$662.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Blue Shield of California Commercial |
$516.89
|
| Rate for Payer: Blue Shield of California EPN |
$293.94
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$626.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.72
|
| Rate for Payer: Heritage Provider Network Senior |
$596.72
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$745.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$723.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$431.39
|
| Rate for Payer: TriValley Medical Group Senior |
$392.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC O2 UPTAKE REST EXERCISE
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT 94680
|
| Hospital Charge Code |
900801032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$98.10 |
| Max. Negotiated Rate |
$406.50 |
| Rate for Payer: Adventist Health Commercial |
$108.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$372.35
|
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$366.93
|
| Rate for Payer: Heritage Provider Network Senior |
$366.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.50
|
| Rate for Payer: Multiplan Commercial |
$406.50
|
|
|
HC O2 UPTAKE REST EXERCISE
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 94680
|
| Hospital Charge Code |
900801032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$63.96 |
| Max. Negotiated Rate |
$406.50 |
| Rate for Payer: Adventist Health Commercial |
$108.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$111.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$372.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Blue Shield of California Commercial |
$363.34
|
| Rate for Payer: Blue Shield of California EPN |
$206.62
|
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$352.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$335.50
|
| Rate for Payer: Heritage Provider Network Senior |
$335.50
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$406.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC OBSTETRIC PANEL
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 80055
|
| Hospital Charge Code |
900913621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.17 |
| Max. Negotiated Rate |
$137.83 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$131.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.83
|
| Rate for Payer: Blue Shield of California Commercial |
$79.49
|
| Rate for Payer: Blue Shield of California EPN |
$75.14
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$83.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.59
|
| Rate for Payer: Dignity Health Senior |
$47.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$47.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.23
|
| Rate for Payer: Heritage Provider Network Senior |
$79.23
|
| Rate for Payer: Humana Medicare |
$47.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$55.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$90.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.24
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$47.81
|
| Rate for Payer: TriValley Medical Group Senior |
$47.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$51.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.59
|
| Rate for Payer: Vantage Medical Group Senior |
$47.81
|
|
|
HC OBSTETRIC PANEL
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 80055
|
| Hospital Charge Code |
900913621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.02 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Adventist Health Commercial |
$60.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$208.85
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.81
|
| Rate for Payer: Heritage Provider Network Senior |
$205.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.00
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP ADDL FETUS
|
Facility
|
OP
|
$1,832.00
|
|
|
Service Code
|
CPT 76816 59
|
| Hospital Charge Code |
906601320
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$80.87 |
| Max. Negotiated Rate |
$1,374.00 |
| Rate for Payer: Adventist Health Commercial |
$366.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$138.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,258.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$228.06
|
| Rate for Payer: Blue Shield of California EPN |
$129.69
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,190.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,134.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,134.01
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,374.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP ADDL FETUS
|
Facility
|
IP
|
$1,832.00
|
|
|
Service Code
|
CPT 76816 59
|
| Hospital Charge Code |
906601320
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$331.59 |
| Max. Negotiated Rate |
$1,374.00 |
| Rate for Payer: Adventist Health Commercial |
$366.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,258.58
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,240.26
|
| Rate for Payer: Heritage Provider Network Senior |
$1,240.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.00
|
| Rate for Payer: Multiplan Commercial |
$1,374.00
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP SINGLE FETUS
|
Facility
|
IP
|
$1,945.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
906601311
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$352.04 |
| Max. Negotiated Rate |
$1,458.75 |
| Rate for Payer: Adventist Health Commercial |
$389.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,336.22
|
| Rate for Payer: Cash Price |
$875.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,316.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,316.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.25
|
| Rate for Payer: Multiplan Commercial |
$1,458.75
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP SINGLE FETUS
|
Facility
|
OP
|
$1,945.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
906601311
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$1,458.75 |
| Rate for Payer: Adventist Health Commercial |
$389.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$138.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,336.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$228.06
|
| Rate for Payer: Blue Shield of California EPN |
$129.69
|
| Rate for Payer: Cash Price |
$875.25
|
| Rate for Payer: Cash Price |
$875.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,264.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,264.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,203.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,203.96
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$161.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,458.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC OB US AFI LMTD 1 OR MORE FETUS
|
Facility
|
OP
|
$883.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
910400110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.20 |
| Max. Negotiated Rate |
$662.25 |
| Rate for Payer: Adventist Health Commercial |
$176.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$133.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$606.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$291.67
|
| Rate for Payer: Blue Shield of California EPN |
$165.86
|
| Rate for Payer: Cash Price |
$397.35
|
| Rate for Payer: Cash Price |
$397.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$573.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$546.58
|
| Rate for Payer: Heritage Provider Network Senior |
$546.58
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$98.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$662.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC OB US AFI LMTD 1 OR MORE FETUS
|
Facility
|
IP
|
$883.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
910400110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$159.82 |
| Max. Negotiated Rate |
$662.25 |
| Rate for Payer: Adventist Health Commercial |
$176.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$606.62
|
| Rate for Payer: Cash Price |
$397.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$597.79
|
| Rate for Payer: Heritage Provider Network Senior |
$597.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.75
|
| Rate for Payer: Multiplan Commercial |
$662.25
|
|
|
HC OCA1 81479 SOUMN
|
Facility
|
IP
|
$1,181.68
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914802
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$213.88 |
| Max. Negotiated Rate |
$886.26 |
| Rate for Payer: Adventist Health Commercial |
$236.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$811.81
|
| Rate for Payer: Cash Price |
$531.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$800.00
|
| Rate for Payer: Heritage Provider Network Senior |
$800.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.42
|
| Rate for Payer: Multiplan Commercial |
$886.26
|
|
|
HC OCA1 81479 SOUMN
|
Facility
|
OP
|
$1,181.68
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914802
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$109.45 |
| Max. Negotiated Rate |
$1,004.43 |
| Rate for Payer: Adventist Health Commercial |
$236.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$811.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$649.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$886.26
|
| Rate for Payer: Blue Shield of California Commercial |
$733.82
|
| Rate for Payer: Blue Shield of California EPN |
$693.65
|
| Rate for Payer: Cash Price |
$531.76
|
| Rate for Payer: Cash Price |
$531.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$768.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,004.43
|
| Rate for Payer: Dignity Health Senior |
$1,004.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$768.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$731.46
|
| Rate for Payer: Heritage Provider Network Senior |
$731.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$569.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.42
|
| Rate for Payer: Multiplan Commercial |
$886.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,004.43
|
| Rate for Payer: Vantage Medical Group Senior |
$1,004.43
|
|
|
HC OCCLUSION CATHETER
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
909081214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.70 |
| Max. Negotiated Rate |
$915.35 |
| Rate for Payer: Adventist Health Commercial |
$119.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$915.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$505.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$327.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$446.25
|
| Rate for Payer: Blue Shield of California Commercial |
$369.50
|
| Rate for Payer: Blue Shield of California EPN |
$349.26
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$386.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$505.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$505.75
|
| Rate for Payer: Dignity Health Senior |
$505.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$386.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$368.30
|
| Rate for Payer: Heritage Provider Network Senior |
$368.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$286.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.75
|
| Rate for Payer: Multiplan Commercial |
$446.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$505.75
|
| Rate for Payer: Vantage Medical Group Senior |
$505.75
|
|
