|
HC NUCLEIC ACID ID S.EPIDERMIDIS
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.44
|
| Rate for Payer: Heritage Provider Network Senior |
$116.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
|
|
HC NUCLEIC ACID ID S.LUGDUNENSIS
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912459
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$182.91 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.91
|
| Rate for Payer: Blue Shield of California Commercial |
$161.40
|
| Rate for Payer: Blue Shield of California EPN |
$129.45
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.47
|
| Rate for Payer: Heritage Provider Network Senior |
$106.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.26
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.05
|
| Rate for Payer: TriValley Medical Group Senior |
$20.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC NUCLEIC ACID ID S.LUGDUNENSIS
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912459
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.44
|
| Rate for Payer: Heritage Provider Network Senior |
$116.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
|
|
HC NUCLEIC ACID ID S.PNEUMONIAE
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912455
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$182.91 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.91
|
| Rate for Payer: Blue Shield of California Commercial |
$161.40
|
| Rate for Payer: Blue Shield of California EPN |
$129.45
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.47
|
| Rate for Payer: Heritage Provider Network Senior |
$106.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.26
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.05
|
| Rate for Payer: TriValley Medical Group Senior |
$20.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC NUCLEIC ACID ID S.PNEUMONIAE
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912455
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.44
|
| Rate for Payer: Heritage Provider Network Senior |
$116.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
|
|
HC NUCLEIC ACID ID S.PYOGENES
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$182.91 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.91
|
| Rate for Payer: Blue Shield of California Commercial |
$161.40
|
| Rate for Payer: Blue Shield of California EPN |
$129.45
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.47
|
| Rate for Payer: Heritage Provider Network Senior |
$106.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.26
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.05
|
| Rate for Payer: TriValley Medical Group Senior |
$20.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC NUCLEIC ACID ID S.PYOGENES
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.44
|
| Rate for Payer: Heritage Provider Network Senior |
$116.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
|
|
HC NUCLEIC ACID ID STAPHYLOCOCCUS
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$182.91 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.91
|
| Rate for Payer: Blue Shield of California Commercial |
$161.40
|
| Rate for Payer: Blue Shield of California EPN |
$129.45
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.47
|
| Rate for Payer: Heritage Provider Network Senior |
$106.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.26
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.05
|
| Rate for Payer: TriValley Medical Group Senior |
$20.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC NUCLEIC ACID ID STAPHYLOCOCCUS
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.44
|
| Rate for Payer: Heritage Provider Network Senior |
$116.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
|
|
HC NUCLEIC ACID ID STREPTOCOCCUS
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912460
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$182.91 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.91
|
| Rate for Payer: Blue Shield of California Commercial |
$161.40
|
| Rate for Payer: Blue Shield of California EPN |
$129.45
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.47
|
| Rate for Payer: Heritage Provider Network Senior |
$106.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.26
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.05
|
| Rate for Payer: TriValley Medical Group Senior |
$20.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC NUCLEIC ACID ID STREPTOCOCCUS
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912460
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.44
|
| Rate for Payer: Heritage Provider Network Senior |
$116.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
|
|
HC NUCLEIC ACID ID VANA
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$182.91 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.91
|
| Rate for Payer: Blue Shield of California Commercial |
$161.40
|
| Rate for Payer: Blue Shield of California EPN |
$129.45
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.47
|
| Rate for Payer: Heritage Provider Network Senior |
$106.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.26
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.05
|
| Rate for Payer: TriValley Medical Group Senior |
$20.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC NUCLEIC ACID ID VANA
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.44
|
| Rate for Payer: Heritage Provider Network Senior |
$116.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
|
|
HC NUCLEIC ACID ID VANB
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912466
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$182.91 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.91
|
| Rate for Payer: Blue Shield of California Commercial |
$161.40
|
| Rate for Payer: Blue Shield of California EPN |
$129.45
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.47
|
| Rate for Payer: Heritage Provider Network Senior |
$106.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.26
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.05
|
| Rate for Payer: TriValley Medical Group Senior |
$20.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC NUCLEIC ACID ID VANB
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912466
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.44
|
| Rate for Payer: Heritage Provider Network Senior |
$116.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
|
|
HC NUCLEIC ACID ID VIM
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$182.91 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.91
|
| Rate for Payer: Blue Shield of California Commercial |
$161.40
|
| Rate for Payer: Blue Shield of California EPN |
$129.45
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.47
|
| Rate for Payer: Heritage Provider Network Senior |
$106.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.26
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.05
|
| Rate for Payer: TriValley Medical Group Senior |
$20.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC NUCLEIC ACID ID VIM
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.44
|
| Rate for Payer: Heritage Provider Network Senior |
$116.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
|
|
HC NUTRITION THER GRP 30 MIN
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
902000205
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.53 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Adventist Health Commercial |
$71.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$119.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.50
|
| Rate for Payer: Blue Shield of California Commercial |
$106.14
|
| Rate for Payer: Blue Shield of California EPN |
$84.91
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.90
|
| Rate for Payer: Dignity Health Senior |
$147.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.71
|
| Rate for Payer: Heritage Provider Network Senior |
$107.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.80
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$158.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.90
|
| Rate for Payer: Vantage Medical Group Senior |
$147.90
|
|
|
HC NUTRITION THER GRP 30 MIN
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
902000205
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.80
|
| Rate for Payer: Heritage Provider Network Senior |
$117.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
|
|
HC NUTR THER INIT EVAL 15 MIN
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
902000200
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$175.95 |
| Rate for Payer: Adventist Health Commercial |
$84.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$110.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$142.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$175.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.25
|
| Rate for Payer: Blue Shield of California Commercial |
$126.27
|
| Rate for Payer: Blue Shield of California EPN |
$101.02
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$134.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$175.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.95
|
| Rate for Payer: Dignity Health Senior |
$175.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.13
|
| Rate for Payer: Heritage Provider Network Senior |
$128.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$49.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$98.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$144.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$144.90
|
| Rate for Payer: Multiplan Commercial |
$155.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$158.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$175.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.95
|
| Rate for Payer: Vantage Medical Group Senior |
$175.95
|
|
|
HC NUTR THER INIT EVAL 15 MIN
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
902000200
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$155.25 |
| Rate for Payer: Adventist Health Commercial |
$41.40
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.14
|
| Rate for Payer: Heritage Provider Network Senior |
$140.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$155.25
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Adventist Health Commercial |
$27.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.00
|
| Rate for Payer: Blue Shield of California Commercial |
$41.48
|
| Rate for Payer: Blue Shield of California EPN |
$33.18
|
| Rate for Payer: Cash Price |
$37.40
|
| Rate for Payer: Cash Price |
$37.40
|
| Rate for Payer: Cash Price |
$37.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.80
|
| Rate for Payer: Dignity Health Senior |
$57.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.09
|
| Rate for Payer: Heritage Provider Network Senior |
$42.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.60
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$158.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.80
|
| Rate for Payer: Vantage Medical Group Senior |
$57.80
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Cash Price |
$37.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.04
|
| Rate for Payer: Heritage Provider Network Senior |
$46.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
|
|
HC NVLGN JGLR VENA CAVA FLTER SET
|
Facility
|
IP
|
$3,885.00
|
|
|
Service Code
|
CPT C1880
|
| Hospital Charge Code |
909000880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$777.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$777.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,864.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,561.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,561.77
|
| Rate for Payer: Cash Price |
$2,136.75
|
| Rate for Payer: Cash Price |
$2,136.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,787.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,097.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,798.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,798.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,942.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,942.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,942.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$971.25
|
| Rate for Payer: Multiplan Commercial |
$2,913.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,403.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,286.32
|
|
|
HC NVLGN JGLR VENA CAVA FLTER SET
|
Facility
|
OP
|
$3,885.00
|
|
|
Service Code
|
CPT C1880
|
| Hospital Charge Code |
909000880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$777.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$777.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,864.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,668.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,302.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,136.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,913.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,561.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,561.77
|
| Rate for Payer: Cash Price |
$2,136.75
|
| Rate for Payer: Cash Price |
$2,136.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,787.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,302.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,302.25
|
| Rate for Payer: Dignity Health Senior |
$3,302.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,486.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,798.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,798.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,942.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,942.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,942.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$971.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,719.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,719.50
|
| Rate for Payer: Multiplan Commercial |
$2,913.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,403.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,286.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,302.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,302.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,302.25
|
|
