|
HC HIV RAPID TESTING
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900912325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.88
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC HLA A B C DR DQ DP HI RES MOLECULAR
|
Facility
|
OP
|
$295.17
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903913201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.43 |
| Max. Negotiated Rate |
$799.66 |
| Rate for Payer: EPIC Health Plan Medicare |
$123.68
|
| Rate for Payer: Adventist Health Commercial |
$59.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$182.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$799.66
|
| Rate for Payer: Blue Shield of California Commercial |
$180.05
|
| Rate for Payer: Blue Shield of California EPN |
$144.04
|
| Rate for Payer: Cash Price |
$132.83
|
| Rate for Payer: Cash Price |
$132.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$191.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.71
|
| Rate for Payer: Heritage Provider Network Senior |
$182.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$140.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$221.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$123.68
|
| Rate for Payer: TriValley Medical Group Senior |
$123.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$133.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC HLA A B C DR DQ DP HI RES MOLECULAR
|
Facility
|
IP
|
$295.17
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903913201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.43 |
| Max. Negotiated Rate |
$221.38 |
| Rate for Payer: Adventist Health Commercial |
$59.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.09
|
| Rate for Payer: Cash Price |
$132.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$199.83
|
| Rate for Payer: Heritage Provider Network Senior |
$199.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.79
|
| Rate for Payer: Multiplan Commercial |
$221.38
|
|
|
HC HLA A B C DR DQ DP HI RES MOLECULAR
|
Facility
|
OP
|
$4,007.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$335.38 |
| Max. Negotiated Rate |
$3,556.36 |
| Rate for Payer: TriValley Medical Group Senior |
$335.38
|
| Rate for Payer: Adventist Health Commercial |
$801.40
|
| Rate for Payer: Adventist Health Commercial |
$668.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,064.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,476.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,556.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,556.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,037.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,444.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,955.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,629.92
|
| Rate for Payer: Cash Price |
$1,503.00
|
| Rate for Payer: Cash Price |
$1,803.15
|
| Rate for Payer: Cash Price |
$1,503.00
|
| Rate for Payer: Cash Price |
$1,803.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,171.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,604.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$335.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$335.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,604.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,171.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$335.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$335.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,067.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,480.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2,067.46
|
| Rate for Payer: Heritage Provider Network Senior |
$2,480.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,593.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,911.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$604.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$725.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$385.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$385.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,001.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$449.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$449.41
|
| Rate for Payer: Multiplan Commercial |
$2,505.00
|
| Rate for Payer: Multiplan Commercial |
$3,005.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$335.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$335.38
|
| Rate for Payer: TriValley Medical Group Senior |
$335.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$362.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$362.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$362.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$362.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Vantage Medical Group Senior |
$335.38
|
| Rate for Payer: Vantage Medical Group Senior |
$335.38
|
|
|
HC HLA A B C DR DQ DP HI RES MOLECULAR
|
Facility
|
IP
|
$4,007.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$725.27 |
| Max. Negotiated Rate |
$3,005.25 |
| Rate for Payer: Adventist Health Commercial |
$801.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,580.51
|
| Rate for Payer: Cash Price |
$1,803.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,712.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,712.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$725.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,001.75
|
| Rate for Payer: Multiplan Commercial |
$3,005.25
|
|
|
HC HLA A, B, C, DR, DQ, DP HI-RES MOLECULAR
|
Facility
|
OP
|
$1,771.00
|
|
|
Service Code
|
CPT 81979
|
| Hospital Charge Code |
900913201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$320.55 |
| Max. Negotiated Rate |
$1,505.35 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$877.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,094.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$781.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$974.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,328.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,065.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$885.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$710.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,080.31
|
| Rate for Payer: Blue Shield of California Commercial |
$866.20
|
| Rate for Payer: Blue Shield of California EPN |
$692.96
|
| Rate for Payer: Blue Shield of California EPN |
$864.25
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$923.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,151.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,505.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,207.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,207.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,505.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,151.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,096.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$878.98
|
| Rate for Payer: Heritage Provider Network Senior |
$878.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,096.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$844.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$677.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,239.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$994.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$885.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$710.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$710.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$885.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,207.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,505.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,207.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,505.35
|
|
|
HC HLA A, B, C, DR, DQ, DP HI-RES MOLECULAR
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$320.55 |
| Max. Negotiated Rate |
$1,328.25 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,140.52
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,198.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,198.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.75
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
|
|
HC HLA A, B, C, DR, DQ, DP HI-RES MOLECULAR
|
Facility
|
OP
|
$1,771.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900913202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.68 |
| Max. Negotiated Rate |
$1,328.25 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$877.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,094.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$799.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$799.66
|
| Rate for Payer: Blue Shield of California Commercial |
$866.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,080.31
|
| Rate for Payer: Blue Shield of California EPN |
$864.25
|
| Rate for Payer: Blue Shield of California EPN |
$692.96
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$923.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,151.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,151.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$123.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$123.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$878.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,096.25
|
| Rate for Payer: Heritage Provider Network Senior |
$878.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,096.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$677.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$844.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$165.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$123.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$123.68
|
| Rate for Payer: TriValley Medical Group Senior |
$123.68
|
| Rate for Payer: TriValley Medical Group Senior |
$123.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$133.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$133.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC HLA A, B, C, DR, DQ, DP HI-RES MOLECULAR
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 81979
|
| Hospital Charge Code |
900913201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$320.55 |
| Max. Negotiated Rate |
$1,328.25 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,140.52
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,198.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,198.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.75
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
|
|
HC HLA A B C DR DQ DP MOLECULA
|
Facility
|
IP
|
$2,341.00
|
|
|
Service Code
|
CPT 81370
|
| Hospital Charge Code |
903902023
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$423.72 |
| Max. Negotiated Rate |
$1,755.75 |
| Rate for Payer: Adventist Health Commercial |
$468.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,507.60
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,584.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1,584.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$423.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.25
|
| Rate for Payer: Multiplan Commercial |
$1,755.75
|
|
|
HC HLA A B C DR DQ DP MOLECULA
|
Facility
|
OP
|
$2,341.00
|
|
|
Service Code
|
CPT 81370
|
| Hospital Charge Code |
903902023
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$402.12 |
| Max. Negotiated Rate |
$1,755.75 |
| Rate for Payer: Adventist Health Commercial |
$468.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,446.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$402.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,569.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,428.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,142.41
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cash Price |
$1,053.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,521.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$402.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,381.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$402.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,449.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,449.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$402.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,116.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$423.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$462.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$538.84
|
| Rate for Payer: Multiplan Commercial |
$1,755.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$402.12
|
| Rate for Payer: TriValley Medical Group Senior |
$402.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$434.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$434.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.33
|
| Rate for Payer: Vantage Medical Group Senior |
$402.12
|
|
|
HC HLA A B C DR DQ DP MOLECULAR
|
Facility
|
IP
|
$678.67
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903913200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.84 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Adventist Health Commercial |
$135.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$437.06
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$459.46
|
| Rate for Payer: Heritage Provider Network Senior |
$459.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.67
|
| Rate for Payer: Multiplan Commercial |
$509.00
|
|
|
HC HLA A B C DR DQ DP MOLECULAR
|
Facility
|
OP
|
$678.67
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903913200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.22 |
| Max. Negotiated Rate |
$718.04 |
| Rate for Payer: Adventist Health Commercial |
$135.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$419.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$718.04
|
| Rate for Payer: Blue Shield of California Commercial |
$413.99
|
| Rate for Payer: Blue Shield of California EPN |
$331.19
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$441.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$122.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$420.10
|
| Rate for Payer: Heritage Provider Network Senior |
$420.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$323.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$509.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$122.22
|
| Rate for Payer: TriValley Medical Group Senior |
$122.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$132.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$132.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC HLA A B C DR DQ DP MOLECULAR
|
Facility
|
IP
|
$2,036.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
900913200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$368.52 |
| Max. Negotiated Rate |
$1,527.00 |
| Rate for Payer: Adventist Health Commercial |
$407.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,311.18
|
| Rate for Payer: Cash Price |
$916.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,378.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,378.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$368.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.00
|
| Rate for Payer: Multiplan Commercial |
$1,527.00
|
|
|
HC HLA A B C DR DQ DP MOLECULAR
|
Facility
|
OP
|
$2,036.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
900913200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$122.22 |
| Max. Negotiated Rate |
$1,527.00 |
| Rate for Payer: Adventist Health Commercial |
$407.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,258.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$718.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,241.96
|
| Rate for Payer: Blue Shield of California EPN |
$993.57
|
| Rate for Payer: Cash Price |
$916.20
|
| Rate for Payer: Cash Price |
$916.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,323.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$122.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,260.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,260.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$971.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$368.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$1,527.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$122.22
|
| Rate for Payer: TriValley Medical Group Senior |
$122.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$132.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$132.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC HLA-A B C HI-RES MOLECULAR
|
Facility
|
IP
|
$4,007.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903902022
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$725.27 |
| Max. Negotiated Rate |
$3,005.25 |
| Rate for Payer: Adventist Health Commercial |
$801.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,580.51
|
| Rate for Payer: Cash Price |
$1,803.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,712.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,712.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$725.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,001.75
|
| Rate for Payer: Multiplan Commercial |
$3,005.25
|
|
|
HC HLA-A B C HI-RES MOLECULAR
|
Facility
|
OP
|
$4,007.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903902022
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$335.38 |
| Max. Negotiated Rate |
$3,556.36 |
| Rate for Payer: Adventist Health Commercial |
$801.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,476.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,556.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,444.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,955.42
|
| Rate for Payer: Cash Price |
$1,803.15
|
| Rate for Payer: Cash Price |
$1,803.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,604.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$335.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,364.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$335.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,480.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2,480.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,911.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$725.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$385.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,001.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$449.41
|
| Rate for Payer: Multiplan Commercial |
$3,005.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$335.38
|
| Rate for Payer: TriValley Medical Group Senior |
$335.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$362.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$362.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Vantage Medical Group Senior |
$335.38
|
|
|
HC HLA C1Q I
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
900913205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.43 |
| Max. Negotiated Rate |
$693.75 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$595.70
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$626.23
|
| Rate for Payer: Heritage Provider Network Senior |
$626.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.25
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
|
|
HC HLA C1Q I
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
900913205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.43 |
| Max. Negotiated Rate |
$808.47 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$500.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$571.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$767.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$767.45
|
| Rate for Payer: Blue Shield of California Commercial |
$808.47
|
| Rate for Payer: Blue Shield of California Commercial |
$808.47
|
| Rate for Payer: Blue Shield of California EPN |
$648.46
|
| Rate for Payer: Blue Shield of California EPN |
$648.46
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$526.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$601.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$601.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$526.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$323.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$323.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$501.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$572.58
|
| Rate for Payer: Heritage Provider Network Senior |
$501.39
|
| Rate for Payer: Heritage Provider Network Senior |
$572.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$386.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$441.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$372.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$372.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$433.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$433.82
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$323.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$323.75
|
| Rate for Payer: TriValley Medical Group Senior |
$323.75
|
| Rate for Payer: TriValley Medical Group Senior |
$323.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$349.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$349.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$349.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$349.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
|
|
HC HLA C1Q I
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903913205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.43 |
| Max. Negotiated Rate |
$808.47 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$500.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$571.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$767.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$767.45
|
| Rate for Payer: Blue Shield of California Commercial |
$808.47
|
| Rate for Payer: Blue Shield of California Commercial |
$808.47
|
| Rate for Payer: Blue Shield of California EPN |
$648.46
|
| Rate for Payer: Blue Shield of California EPN |
$648.46
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$526.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$601.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$601.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$526.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$323.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$323.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$501.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$572.58
|
| Rate for Payer: Heritage Provider Network Senior |
$501.39
|
| Rate for Payer: Heritage Provider Network Senior |
$572.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$386.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$441.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$372.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$372.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$433.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$433.82
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$323.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$323.75
|
| Rate for Payer: TriValley Medical Group Senior |
$323.75
|
| Rate for Payer: TriValley Medical Group Senior |
$323.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$349.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$349.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$349.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$349.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
|
|
HC HLA C1Q I
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903913205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.43 |
| Max. Negotiated Rate |
$693.75 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$595.70
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$626.23
|
| Rate for Payer: Heritage Provider Network Senior |
$626.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.25
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
|
|
HC HLA C1Q II
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903913206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.43 |
| Max. Negotiated Rate |
$734.98 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Adventist Health Commercial |
$157.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$485.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$571.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$697.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$697.64
|
| Rate for Payer: Blue Shield of California Commercial |
$734.98
|
| Rate for Payer: Blue Shield of California Commercial |
$734.98
|
| Rate for Payer: Blue Shield of California EPN |
$589.51
|
| Rate for Payer: Blue Shield of California EPN |
$589.51
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$510.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$601.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$601.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$325.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$325.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$486.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$572.58
|
| Rate for Payer: Heritage Provider Network Senior |
$486.53
|
| Rate for Payer: Heritage Provider Network Senior |
$572.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$374.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$441.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$436.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$436.57
|
| Rate for Payer: Multiplan Commercial |
$589.50
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.80
|
| Rate for Payer: TriValley Medical Group Senior |
$325.80
|
| Rate for Payer: TriValley Medical Group Senior |
$325.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$351.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$351.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$351.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$351.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
|
|
HC HLA C1Q II
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903913206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.43 |
| Max. Negotiated Rate |
$693.75 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$595.70
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$626.23
|
| Rate for Payer: Heritage Provider Network Senior |
$626.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.25
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
|
|
HC HLA C1Q II
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
900913206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.43 |
| Max. Negotiated Rate |
$693.75 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$595.70
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$626.23
|
| Rate for Payer: Heritage Provider Network Senior |
$626.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.25
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
|
|
HC HLA C1Q II
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
900913206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.43 |
| Max. Negotiated Rate |
$734.98 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Adventist Health Commercial |
$157.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$485.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$571.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$697.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$697.64
|
| Rate for Payer: Blue Shield of California Commercial |
$734.98
|
| Rate for Payer: Blue Shield of California Commercial |
$734.98
|
| Rate for Payer: Blue Shield of California EPN |
$589.51
|
| Rate for Payer: Blue Shield of California EPN |
$589.51
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$510.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$601.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$601.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$325.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$325.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$486.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$572.58
|
| Rate for Payer: Heritage Provider Network Senior |
$486.53
|
| Rate for Payer: Heritage Provider Network Senior |
$572.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$374.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$441.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$436.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$436.57
|
| Rate for Payer: Multiplan Commercial |
$589.50
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.80
|
| Rate for Payer: TriValley Medical Group Senior |
$325.80
|
| Rate for Payer: TriValley Medical Group Senior |
$325.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$351.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$351.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$351.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$351.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
|
