|
HC HLA DISEASE ASSOCIATION
|
Facility
|
IP
|
$856.00
|
|
|
Service Code
|
CPT 81830
|
| Hospital Charge Code |
900913209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.94 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Adventist Health Commercial |
$171.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$551.26
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$579.51
|
| Rate for Payer: Heritage Provider Network Senior |
$579.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.00
|
| Rate for Payer: Multiplan Commercial |
$642.00
|
|
|
HC HLA DISEASE ASSOCIATION
|
Facility
|
IP
|
$1,292.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
903913209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$233.85 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Adventist Health Commercial |
$258.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$832.05
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.68
|
| Rate for Payer: Heritage Provider Network Senior |
$874.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.00
|
| Rate for Payer: Multiplan Commercial |
$969.00
|
|
|
HC HLA DISEASE ASSOCIATION
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
903913209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$1,147.14 |
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Adventist Health Commercial |
$258.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$798.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,147.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,147.14
|
| Rate for Payer: Blue Shield of California Commercial |
$788.12
|
| Rate for Payer: Blue Shield of California Commercial |
$270.84
|
| Rate for Payer: Blue Shield of California EPN |
$216.67
|
| Rate for Payer: Blue Shield of California EPN |
$630.50
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$839.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$288.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$839.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$127.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$127.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$799.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$274.84
|
| Rate for Payer: Heritage Provider Network Senior |
$799.75
|
| Rate for Payer: Heritage Provider Network Senior |
$274.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$127.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$127.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$616.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$211.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$170.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$170.76
|
| Rate for Payer: Multiplan Commercial |
$969.00
|
| Rate for Payer: Multiplan Commercial |
$333.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$127.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$127.43
|
| Rate for Payer: TriValley Medical Group Senior |
$127.43
|
| Rate for Payer: TriValley Medical Group Senior |
$127.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Vantage Medical Group Senior |
$127.43
|
| Rate for Payer: Vantage Medical Group Senior |
$127.43
|
|
|
HC HLA DISEASE ASSOCIATION
|
Facility
|
OP
|
$856.00
|
|
|
Service Code
|
CPT 81830
|
| Hospital Charge Code |
900913209
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.94 |
| Max. Negotiated Rate |
$727.60 |
| Rate for Payer: Adventist Health Commercial |
$171.20
|
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$529.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$727.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$470.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$642.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$428.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.54
|
| Rate for Payer: Blue Shield of California Commercial |
$522.16
|
| Rate for Payer: Blue Shield of California Commercial |
$115.29
|
| Rate for Payer: Blue Shield of California EPN |
$92.23
|
| Rate for Payer: Blue Shield of California EPN |
$417.73
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$556.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$727.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$727.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$727.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$556.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$529.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.99
|
| Rate for Payer: Heritage Provider Network Senior |
$116.99
|
| Rate for Payer: Heritage Provider Network Senior |
$529.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$408.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$90.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$599.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$132.30
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$428.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$94.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$94.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$428.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$727.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$727.60
|
| Rate for Payer: Vantage Medical Group Senior |
$160.65
|
| Rate for Payer: Vantage Medical Group Senior |
$727.60
|
|
|
HC HLA DISEASE ASSOCIATION 81376 CLASS II
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903913210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$718.04 |
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$824.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| 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 Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$718.04
|
| Rate for Payer: Blue Shield of California Commercial |
$813.74
|
| Rate for Payer: Blue Shield of California Commercial |
$270.84
|
| Rate for Payer: Blue Shield of California EPN |
$216.67
|
| Rate for Payer: Blue Shield of California EPN |
$650.99
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$867.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$288.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$122.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$122.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$825.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$274.84
|
| Rate for Payer: Heritage Provider Network Senior |
$825.75
|
| Rate for Payer: Heritage Provider Network Senior |
$274.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$636.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$211.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$163.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$1,000.50
|
| Rate for Payer: Multiplan Commercial |
$333.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$122.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$122.22
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$132.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC HLA DISEASE ASSOCIATION 81376 CLASS II
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903913210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$241.45 |
| Max. Negotiated Rate |
$1,000.50 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$859.10
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$903.12
|
| Rate for Payer: Heritage Provider Network Senior |
$903.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.50
|
| Rate for Payer: Multiplan Commercial |
$1,000.50
|
|
|
HC HLA DRUG SENSITIVITY
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
900913210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$241.45 |
| Max. Negotiated Rate |
$1,000.50 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$859.10
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$903.12
|
| Rate for Payer: Heritage Provider Network Senior |
$903.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.50
|
| Rate for Payer: Multiplan Commercial |
$1,000.50
|
|
|
HC HLA DRUG SENSITIVITY
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
900913210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$1,018.53 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$824.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,018.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,018.53
|
| Rate for Payer: Blue Shield of California Commercial |
$813.74
|
| Rate for Payer: Blue Shield of California Commercial |
$115.29
|
| Rate for Payer: Blue Shield of California EPN |
$92.23
|
| Rate for Payer: Blue Shield of California EPN |
$650.99
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$867.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$177.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$177.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$825.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.99
|
| Rate for Payer: Heritage Provider Network Senior |
$825.75
|
| Rate for Payer: Heritage Provider Network Senior |
$116.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$636.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$90.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$203.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$203.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$237.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$237.51
|
| Rate for Payer: Multiplan Commercial |
$1,000.50
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$177.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$177.25
|
| Rate for Payer: TriValley Medical Group Senior |
$177.25
|
| Rate for Payer: TriValley Medical Group Senior |
$177.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$191.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$191.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$191.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$191.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
|
|
HC HLA DRUG SENSITIVITY
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
903913211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$1,147.14 |
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$824.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,147.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,147.14
|
| Rate for Payer: Blue Shield of California Commercial |
$813.74
|
| Rate for Payer: Blue Shield of California Commercial |
$270.84
|
| Rate for Payer: Blue Shield of California EPN |
$216.67
|
| Rate for Payer: Blue Shield of California EPN |
$650.99
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$867.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$288.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$127.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$127.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$825.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$274.84
|
| Rate for Payer: Heritage Provider Network Senior |
$825.75
|
| Rate for Payer: Heritage Provider Network Senior |
$274.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$127.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$127.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$636.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$211.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$170.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$170.76
|
| Rate for Payer: Multiplan Commercial |
$1,000.50
|
| Rate for Payer: Multiplan Commercial |
$333.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$127.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$127.43
|
| Rate for Payer: TriValley Medical Group Senior |
$127.43
|
| Rate for Payer: TriValley Medical Group Senior |
$127.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Vantage Medical Group Senior |
$127.43
|
| Rate for Payer: Vantage Medical Group Senior |
$127.43
|
|
|
HC HLA DRUG SENSITIVITY
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
903913211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$241.45 |
| Max. Negotiated Rate |
$1,000.50 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$859.10
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$903.12
|
| Rate for Payer: Heritage Provider Network Senior |
$903.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.50
|
| Rate for Payer: Multiplan Commercial |
$1,000.50
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
900913204
|
|
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 DSA (PRA CLASS I&II)
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
900913203
|
|
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 DSA (PRA CLASS I&II)
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903913204
|
|
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 DSA (PRA CLASS I&II)
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
900913203
|
|
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 DSA (PRA CLASS I&II)
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903913203
|
|
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 DSA (PRA CLASS I&II)
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903913203
|
|
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 DSA (PRA CLASS I&II)
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903913204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.43 |
| Max. Negotiated Rate |
$734.98 |
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
| 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
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
900913204
|
|
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 X MATCH FLOW
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901914
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$109.49 |
| Max. Negotiated Rate |
$673.55 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$690.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$389.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$109.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$109.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$673.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$673.55
|
| Rate for Payer: Blue Shield of California Commercial |
$662.63
|
| Rate for Payer: Blue Shield of California Commercial |
$662.63
|
| Rate for Payer: Blue Shield of California EPN |
$531.48
|
| Rate for Payer: Blue Shield of California EPN |
$531.48
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$726.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$409.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$371.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$109.49
|
| Rate for Payer: EPIC Health Plan Medicare |
$109.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$692.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$389.97
|
| Rate for Payer: Heritage Provider Network Senior |
$692.04
|
| Rate for Payer: Heritage Provider Network Senior |
$389.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$109.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$109.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$533.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$300.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$146.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$146.72
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Multiplan Commercial |
$472.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$109.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$109.49
|
| Rate for Payer: TriValley Medical Group Senior |
$109.49
|
| Rate for Payer: TriValley Medical Group Senior |
$109.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$118.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$118.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$118.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$118.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Vantage Medical Group Senior |
$109.49
|
| Rate for Payer: Vantage Medical Group Senior |
$109.49
|
|
|
HC HLA X MATCH FLOW
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901914
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$202.36 |
| Max. Negotiated Rate |
$838.50 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$719.99
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$756.89
|
| Rate for Payer: Heritage Provider Network Senior |
$756.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.50
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$664.20 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$664.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,138.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,335.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,335.04
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,527.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,793.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,537.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,537.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,660.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,660.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,660.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$830.25
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,199.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,099.58
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$830.25 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$1,361.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,052.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,826.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,490.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,335.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,335.04
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,527.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,822.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,822.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,125.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,537.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,537.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,660.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,660.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,660.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$830.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,324.70
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,199.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,099.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,822.85
|
|
|
HC HOMOVANILLIC ACID (HVA)
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900910532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$155.91 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.91
|
| Rate for Payer: Blue Shield of California Commercial |
$155.75
|
| Rate for Payer: Blue Shield of California Commercial |
$155.75
|
| Rate for Payer: Blue Shield of California EPN |
$124.92
|
| Rate for Payer: Blue Shield of California EPN |
$124.92
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.62
|
| Rate for Payer: Heritage Provider Network Senior |
$139.89
|
| Rate for Payer: Heritage Provider Network Senior |
$52.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$107.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$40.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.03
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.41
|
| Rate for Payer: TriValley Medical Group Senior |
$22.41
|
| Rate for Payer: TriValley Medical Group Senior |
$22.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$22.41
|
| Rate for Payer: Vantage Medical Group Senior |
$22.41
|
|
|
HC HOMOVANILLIC ACID (HVA)
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900910532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.91 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.54
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$153.00
|
| Rate for Payer: Heritage Provider Network Senior |
$153.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.50
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
|
|
HC HOMOVANILLIC ACID URINE 24 HOURS
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900912207
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.91 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$145.54
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$153.00
|
| Rate for Payer: Heritage Provider Network Senior |
$153.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.50
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
|
