|
HC HIV 1 P24 ANTIGEN
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 87390
|
| Hospital Charge Code |
900913684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.27
|
| Rate for Payer: Heritage Provider Network Senior |
$39.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
|
|
HC HIV 2 ANTIBODY
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900913683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$114.96 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.96
|
| Rate for Payer: Blue Shield of California Commercial |
$105.54
|
| Rate for Payer: Blue Shield of California EPN |
$82.51
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Senior |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Humana Medicare |
$13.52
|
| Rate for Payer: IEHP Medi-Cal |
$18.42
|
| Rate for Payer: IEHP Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.52
|
| Rate for Payer: TriValley Medical Group Senior |
$13.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC HIV 2 ANTIBODY
|
Facility
IP
|
$52.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900913683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.72
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.20
|
| Rate for Payer: Heritage Provider Network Senior |
$35.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
|
|
HC HIV ANTIGEN, ANTIBODY
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913662
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.27
|
| Rate for Payer: Heritage Provider Network Senior |
$39.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
|
|
HC HIV ANTIGEN, ANTIBODY
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913662
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$190.73 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$70.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.54
|
| Rate for Payer: Blue Shield of California Commercial |
$190.73
|
| Rate for Payer: Blue Shield of California EPN |
$149.10
|
| 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 |
$36.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Senior |
$24.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$24.08
|
| Rate for Payer: IEHP Medi-Cal |
$31.61
|
| Rate for Payer: IEHP Medicare Advantage |
$24.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.34
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.08
|
| Rate for Payer: TriValley Medical Group Senior |
$24.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
|
HC HIV RAPID TESTING
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900912325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.15
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.11
|
| Rate for Payer: Heritage Provider Network Senior |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
|
|
HC HIV RAPID TESTING
|
Facility
OP
|
$53.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900912325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$118.28 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.28
|
| Rate for Payer: Blue Shield of California Commercial |
$107.16
|
| Rate for Payer: Blue Shield of California EPN |
$83.77
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: Dignity Health Senior |
$13.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.81
|
| Rate for Payer: Heritage Provider Network Senior |
$32.81
|
| Rate for Payer: Humana Medicare |
$13.71
|
| Rate for Payer: IEHP Medi-Cal |
$18.66
|
| Rate for Payer: IEHP Medicare Advantage |
$13.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.71
|
| Rate for Payer: TriValley Medical Group Senior |
$13.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
IP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$664.20 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$664.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,594.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,281.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,527.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,793.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,248.32
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,660.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,660.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,660.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$830.25
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,210.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,109.55
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
OP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$664.20 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$664.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,594.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,281.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,826.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,490.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,062.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,949.43
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,527.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,822.85
|
| Rate for Payer: Dignity Health Senior |
$2,822.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,125.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,537.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,537.62
|
| Rate for Payer: IEHP Medi-Cal |
$1,021.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,660.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,660.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,660.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$830.25
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,210.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,109.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,822.85
|
|
|
HC HOMOVANILLIC ACID (HVA)
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900910532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.15
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.11
|
| Rate for Payer: Heritage Provider Network Senior |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
|
|
HC HOMOVANILLIC ACID (HVA)
|
Facility
OP
|
$74.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900910532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$151.15 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.44
|
| Rate for Payer: Blue Shield of California Commercial |
$151.15
|
| Rate for Payer: Blue Shield of California EPN |
$118.16
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Senior |
$22.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.81
|
| Rate for Payer: Heritage Provider Network Senior |
$45.81
|
| Rate for Payer: Humana Medicare |
$22.41
|
| Rate for Payer: IEHP Medi-Cal |
$17.78
|
| Rate for Payer: IEHP Medicare Advantage |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.24
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.41
|
| Rate for Payer: TriValley Medical Group Senior |
$22.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$22.41
|
|
|
HC HOMOVANILLIC ACID URINE 24 HOURS
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900912207
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.15
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.11
|
| Rate for Payer: Heritage Provider Network Senior |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
|
|
HC HOMOVANILLIC ACID URINE 24 HOURS
|
Facility
OP
|
$74.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900912207
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$151.15 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.44
|
| Rate for Payer: Blue Shield of California Commercial |
$151.15
|
| Rate for Payer: Blue Shield of California EPN |
$118.16
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Senior |
$22.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.81
|
| Rate for Payer: Heritage Provider Network Senior |
$45.81
|
| Rate for Payer: Humana Medicare |
$22.41
|
| Rate for Payer: IEHP Medi-Cal |
$17.78
|
| Rate for Payer: IEHP Medicare Advantage |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.24
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.41
|
| Rate for Payer: TriValley Medical Group Senior |
$22.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$22.41
|
|
|
HC HOMOVANILLIC ACID URINE RANDOM
|
Facility
OP
|
$74.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900912206
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$151.15 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.44
|
| Rate for Payer: Blue Shield of California Commercial |
$151.15
|
| Rate for Payer: Blue Shield of California EPN |
$118.16
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Senior |
$22.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.81
|
| Rate for Payer: Heritage Provider Network Senior |
$45.81
|
| Rate for Payer: Humana Medicare |
$22.41
|
| Rate for Payer: IEHP Medi-Cal |
$17.78
|
| Rate for Payer: IEHP Medicare Advantage |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.24
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.41
|
| Rate for Payer: TriValley Medical Group Senior |
$22.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$22.41
|
|
|
HC HOMOVANILLIC ACID URINE RANDOM
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900912206
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.15
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.11
|
| Rate for Payer: Heritage Provider Network Senior |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
|
|
HC HOSPITAL BLOOD BANK STORAGE FEE
|
Facility
IP
|
$86.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905000
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.08
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.22
|
| Rate for Payer: Heritage Provider Network Senior |
$58.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
|
|
HC HOSPITAL BLOOD BANK STORAGE FEE
|
Facility
OP
|
$86.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905000
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$596.00 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.32
|
| Rate for Payer: Blue Shield of California Commercial |
$53.41
|
| Rate for Payer: Blue Shield of California EPN |
$50.48
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.23
|
| Rate for Payer: Heritage Provider Network Senior |
$53.23
|
| Rate for Payer: Humana Medicare |
$37.20
|
| Rate for Payer: IEHP Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.87
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$40.92
|
| Rate for Payer: TriValley Medical Group Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC HPV BY NUCLEIC ACID
|
Facility
IP
|
$77.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
900913641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.90
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.13
|
| Rate for Payer: Heritage Provider Network Senior |
$52.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
|
|
HC HPV BY NUCLEIC ACID
|
Facility
OP
|
$56.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
900913641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$266.98 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$98.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$220.33
|
| Rate for Payer: Blue Shield of California Commercial |
$266.98
|
| Rate for Payer: Blue Shield of California EPN |
$208.71
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.66
|
| Rate for Payer: Heritage Provider Network Senior |
$34.66
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: IEHP Medi-Cal |
$48.66
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC H. PYLORI AB, IGG
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
900913556
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.15
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.11
|
| Rate for Payer: Heritage Provider Network Senior |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
|
|
HC H. PYLORI AB, IGG
|
Facility
OP
|
$56.00
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
900913556
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$124.65 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.65
|
| Rate for Payer: Blue Shield of California Commercial |
$113.37
|
| Rate for Payer: Blue Shield of California EPN |
$88.62
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.54
|
| Rate for Payer: Dignity Health Senior |
$16.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.66
|
| Rate for Payer: Heritage Provider Network Senior |
$34.66
|
| Rate for Payer: Humana Medicare |
$16.85
|
| Rate for Payer: IEHP Medi-Cal |
$20.20
|
| Rate for Payer: IEHP Medicare Advantage |
$16.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.23
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.85
|
| Rate for Payer: TriValley Medical Group Senior |
$16.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
|
HC HRHC INT TRANAL DARTLZN 2+
|
Facility
OP
|
$6,526.00
|
|
|
Service Code
|
CPT 46948
|
| Hospital Charge Code |
906706948
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$608.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,305.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,483.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,508.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,936.70
|
| Rate for Payer: Cash Price |
$2,936.70
|
| Rate for Payer: Cash Price |
$2,936.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,241.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,858.96
|
| Rate for Payer: Dignity Health Senior |
$3,508.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,508.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,039.59
|
| Rate for Payer: Heritage Provider Network Senior |
$4,315.02
|
| Rate for Payer: Humana Medicare |
$3,508.15
|
| Rate for Payer: IEHP Medi-Cal |
$608.98
|
| Rate for Payer: IEHP Medicare Advantage |
$3,508.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,665.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,181.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,139.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,631.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,420.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,420.27
|
| Rate for Payer: Multiplan Commercial |
$4,894.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,858.96
|
| Rate for Payer: TriValley Medical Group Senior |
$3,858.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,508.15
|
|
|
HC HRHC INT TRANAL DARTLZN 2+
|
Facility
IP
|
$6,526.00
|
|
|
Service Code
|
CPT 46948
|
| Hospital Charge Code |
906706948
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,181.21 |
| Max. Negotiated Rate |
$4,894.50 |
| Rate for Payer: Adventist Health Commercial |
$1,305.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,483.36
|
| Rate for Payer: Cash Price |
$2,936.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,418.10
|
| Rate for Payer: Heritage Provider Network Senior |
$4,418.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,181.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,631.50
|
| Rate for Payer: Multiplan Commercial |
$4,894.50
|
|
|
HC H STRISCPE LRG SNGL USE BRNCHSCPE 5.8 MM OD 2.8 MM WC
|
Facility
OP
|
$738.00
|
|
| Hospital Charge Code |
900831715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.58 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$394.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$507.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$405.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$553.50
|
| Rate for Payer: Blue Shield of California Commercial |
$458.30
|
| Rate for Payer: Blue Shield of California EPN |
$433.21
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$479.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$627.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$627.30
|
| Rate for Payer: Dignity Health Senior |
$627.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$479.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.82
|
| Rate for Payer: Heritage Provider Network Senior |
$456.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$355.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.50
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
|
HC H STRISCPE LRG SNGL USE BRNCHSCPE 5.8 MM OD 2.8 MM WC
|
Facility
IP
|
$738.00
|
|
| Hospital Charge Code |
900831715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.58 |
| Max. Negotiated Rate |
$553.50 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$507.01
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.63
|
| Rate for Payer: Heritage Provider Network Senior |
$499.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.50
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
|
