|
HC HEPATITIS B SURFACE AG (CONF)
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
900910812
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.89 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.71
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.90
|
| Rate for Payer: Heritage Provider Network Senior |
$167.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
|
|
HC HEPATITIS B SURFACE AG INDIVIDUAL
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900912333
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.87
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
|
HC HEPATITIS B SURFACE AG INDIVIDUAL
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900912333
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.86
|
| Rate for Payer: Blue Shield of California Commercial |
$83.12
|
| Rate for Payer: Blue Shield of California Commercial |
$83.12
|
| Rate for Payer: Blue Shield of California EPN |
$66.67
|
| Rate for Payer: Blue Shield of California EPN |
$66.67
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.76
|
| Rate for Payer: Heritage Provider Network Senior |
$85.42
|
| Rate for Payer: Heritage Provider Network Senior |
$50.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$65.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$39.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.84
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.33
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.33
|
| Rate for Payer: TriValley Medical Group Senior |
$10.33
|
| Rate for Payer: TriValley Medical Group Senior |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$10.33
|
| Rate for Payer: Vantage Medical Group Senior |
$10.33
|
|
|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
900910860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$167.25 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$143.61
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$150.97
|
| Rate for Payer: Heritage Provider Network Senior |
$150.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.75
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
|
|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
900910860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$98.63 |
| Rate for Payer: Adventist Health Commercial |
$19.40
|
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.63
|
| Rate for Payer: Blue Shield of California Commercial |
$86.46
|
| Rate for Payer: Blue Shield of California Commercial |
$86.46
|
| Rate for Payer: Blue Shield of California EPN |
$69.35
|
| Rate for Payer: Blue Shield of California EPN |
$69.35
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$144.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.04
|
| Rate for Payer: Heritage Provider Network Senior |
$138.04
|
| Rate for Payer: Heritage Provider Network Senior |
$60.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$106.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Senior |
$10.74
|
| Rate for Payer: TriValley Medical Group Senior |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC HEPATITIS C AB TOTAL
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.17
|
| Rate for Payer: Blue Shield of California Commercial |
$114.85
|
| Rate for Payer: Blue Shield of California Commercial |
$114.85
|
| Rate for Payer: Blue Shield of California EPN |
$92.12
|
| Rate for Payer: Blue Shield of California EPN |
$92.12
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$207.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.46
|
| Rate for Payer: Heritage Provider Network Senior |
$83.56
|
| Rate for Payer: Heritage Provider Network Senior |
$197.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$152.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.12
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.27
|
| Rate for Payer: TriValley Medical Group Senior |
$14.27
|
| Rate for Payer: TriValley Medical Group Senior |
$14.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Vantage Medical Group Senior |
$14.27
|
| Rate for Payer: Vantage Medical Group Senior |
$14.27
|
|
|
HC HEPATITIS C AB TOTAL
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.44
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.96
|
| Rate for Payer: Heritage Provider Network Senior |
$215.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
|
|
HC HEPATITIS C AB TOTAL INDIVIDUAL
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912156
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.17
|
| Rate for Payer: Blue Shield of California Commercial |
$114.85
|
| Rate for Payer: Blue Shield of California Commercial |
$114.85
|
| Rate for Payer: Blue Shield of California EPN |
$92.12
|
| Rate for Payer: Blue Shield of California EPN |
$92.12
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$207.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.46
|
| Rate for Payer: Heritage Provider Network Senior |
$77.99
|
| Rate for Payer: Heritage Provider Network Senior |
$197.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$60.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$152.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.12
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.27
|
| Rate for Payer: TriValley Medical Group Senior |
$14.27
|
| Rate for Payer: TriValley Medical Group Senior |
$14.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Vantage Medical Group Senior |
$14.27
|
| Rate for Payer: Vantage Medical Group Senior |
$14.27
|
|
|
HC HEPATITIS C AB TOTAL INDIVIDUAL
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912156
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.44
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.96
|
| Rate for Payer: Heritage Provider Network Senior |
$215.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
|
|
HC HEPATOBIL SYST IMAGE W DRUG
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
909301227
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$172.85 |
| Max. Negotiated Rate |
$716.25 |
| Rate for Payer: Adventist Health Commercial |
$191.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$615.02
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$646.53
|
| Rate for Payer: Heritage Provider Network Senior |
$646.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$172.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.75
|
| Rate for Payer: Multiplan Commercial |
$716.25
|
|
|
HC HEPATOBIL SYST IMAGE W DRUG
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
909301227
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$172.85 |
| Max. Negotiated Rate |
$2,415.55 |
| Rate for Payer: Adventist Health Commercial |
$191.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$590.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,305.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,415.55
|
| Rate for Payer: Blue Shield of California EPN |
$1,942.51
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$620.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$698.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$591.14
|
| Rate for Payer: Heritage Provider Network Senior |
$591.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$455.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$172.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$803.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$716.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$768.18
|
| Rate for Payer: TriValley Medical Group Senior |
$698.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$477.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$477.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC HERNIA REDUCTION
|
Facility
|
IP
|
$13,231.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,394.81 |
| Max. Negotiated Rate |
$9,923.25 |
| Rate for Payer: Adventist Health Commercial |
$2,646.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,520.76
|
| Rate for Payer: Cash Price |
$5,953.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,957.39
|
| Rate for Payer: Heritage Provider Network Senior |
$8,957.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,394.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,307.75
|
| Rate for Payer: Multiplan Commercial |
$9,923.25
|
|
|
HC HERNIA REDUCTION
|
Facility
|
OP
|
$13,231.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,166.53 |
| Max. Negotiated Rate |
$9,923.25 |
| Rate for Payer: Adventist Health Commercial |
$2,646.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,176.76
|
| 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 |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,284.73
|
| Rate for Payer: Blue Shield of California EPN |
$5,001.32
|
| Rate for Payer: Cash Price |
$5,953.95
|
| Rate for Payer: Cash Price |
$5,953.95
|
| Rate for Payer: Cash Price |
$5,953.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,600.15
|
| 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 |
$8,957.39
|
| Rate for Payer: Heritage Provider Network Senior |
$8,957.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,311.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,394.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,307.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$9,923.25
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,938.60
|
| Rate for Payer: TriValley Medical Group Senior |
$7,938.60
|
| 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 HERNIA REDUCTION
|
Facility
|
IP
|
$13,231.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,394.81 |
| Max. Negotiated Rate |
$9,923.25 |
| Rate for Payer: Adventist Health Commercial |
$2,646.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,520.76
|
| Rate for Payer: Cash Price |
$5,953.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,957.39
|
| Rate for Payer: Heritage Provider Network Senior |
$8,957.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,394.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,307.75
|
| Rate for Payer: Multiplan Commercial |
$9,923.25
|
|
|
HC HERNIA REDUCTION
|
Facility
|
OP
|
$13,231.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,166.53 |
| Max. Negotiated Rate |
$9,923.25 |
| Rate for Payer: Adventist Health Commercial |
$2,646.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,176.76
|
| 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 |
$6,618.15
|
| 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 |
$5,953.95
|
| Rate for Payer: Cash Price |
$5,953.95
|
| Rate for Payer: Cash Price |
$5,953.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,600.15
|
| 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 |
$8,189.99
|
| 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 |
$2,216.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,394.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,307.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$9,923.25
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,283.18
|
| Rate for Payer: TriValley Medical Group Senior |
$1,283.18
|
| 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 HERPES SIMPLEX TYPE 1
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900913660
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$106.16
|
| Rate for Payer: Blue Shield of California Commercial |
$106.16
|
| Rate for Payer: Blue Shield of California EPN |
$85.15
|
| Rate for Payer: Blue Shield of California EPN |
$85.15
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.19
|
| Rate for Payer: TriValley Medical Group Senior |
$13.19
|
| Rate for Payer: TriValley Medical Group Senior |
$13.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC HERPES SIMPLEX TYPE 1
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900913660
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
|
HC HERPES SIMPLEX TYPE 2
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900913661
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$183.65 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.65
|
| Rate for Payer: Blue Shield of California Commercial |
$155.81
|
| Rate for Payer: Blue Shield of California Commercial |
$155.81
|
| Rate for Payer: Blue Shield of California EPN |
$124.97
|
| Rate for Payer: Blue Shield of California EPN |
$124.97
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.35
|
| Rate for Payer: TriValley Medical Group Senior |
$19.35
|
| Rate for Payer: TriValley Medical Group Senior |
$19.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC HERPES SIMPLEX TYPE 2
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900913661
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
|
HC HFO WO JOINT PF
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
903203954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$108.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$163.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$106.13
|
| Rate for Payer: Blue Shield of California EPN |
$106.13
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$121.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$224.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.23
|
| Rate for Payer: Heritage Provider Network Senior |
$122.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$132.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC HFO WO JOINT PF
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
903203954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$170.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$106.13
|
| Rate for Payer: Blue Shield of California EPN |
$106.13
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$121.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.23
|
| Rate for Payer: Heritage Provider Network Senior |
$122.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$132.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.41
|
|
|
HC HIGH FLOW 02
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800912
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$62.99 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$215.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.07
|
| Rate for Payer: Blue Shield of California Commercial |
$212.28
|
| Rate for Payer: Blue Shield of California EPN |
$169.82
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$226.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.41
|
| Rate for Payer: Heritage Provider Network Senior |
$215.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$166.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$182.04
|
| Rate for Payer: TriValley Medical Group Senior |
$165.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$174.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$174.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC HIGH FLOW 02
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800912
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$62.99 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$224.11
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$235.60
|
| Rate for Payer: Heritage Provider Network Senior |
$235.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$261.00
|
|
|
HC HIGH FREQUENCY VENT INTL DAILY
|
Facility
|
IP
|
$3,740.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$676.94 |
| Max. Negotiated Rate |
$2,805.00 |
| Rate for Payer: Adventist Health Commercial |
$748.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,408.56
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,531.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,531.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$676.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.00
|
| Rate for Payer: Multiplan Commercial |
$2,805.00
|
|
|
HC HIGH FREQUENCY VENT INTL DAILY
|
Facility
|
OP
|
$3,740.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$2,805.00 |
| Rate for Payer: Adventist Health Commercial |
$748.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,311.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$794.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,431.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$794.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,431.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$794.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,315.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2,315.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$794.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,783.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$676.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$913.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,064.74
|
| Rate for Payer: Multiplan Commercial |
$2,805.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Vantage Medical Group Senior |
$794.58
|
|
