|
HC LYMPHANGIOGRAPHY INJECTION
|
Facility
|
IP
|
$644.00
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
909000131
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.56 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$414.74
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$435.99
|
| Rate for Payer: Heritage Provider Network Senior |
$435.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
|
|
HC LYMPHANGIOGRAPHY INJECTION
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
909000131
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.56 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$397.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$354.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$483.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$418.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$547.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$547.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$398.64
|
| Rate for Payer: Heritage Provider Network Senior |
$398.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$307.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$450.80
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.40
|
| Rate for Payer: Vantage Medical Group Senior |
$547.40
|
|
|
HC LYMPHAT/ANTIMONY SCA
|
Facility
|
IP
|
$2,405.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
909301341
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$435.31 |
| Max. Negotiated Rate |
$1,803.75 |
| Rate for Payer: Adventist Health Commercial |
$481.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,548.82
|
| Rate for Payer: Cash Price |
$1,082.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,628.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,628.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$435.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.25
|
| Rate for Payer: Multiplan Commercial |
$1,803.75
|
|
|
HC LYMPHAT/ANTIMONY SCA
|
Facility
|
OP
|
$2,405.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
909301341
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$435.31 |
| Max. Negotiated Rate |
$1,803.75 |
| Rate for Payer: Adventist Health Commercial |
$481.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,486.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,202.98
|
| Rate for Payer: Blue Shield of California Commercial |
$857.95
|
| Rate for Payer: Blue Shield of California EPN |
$689.94
|
| Rate for Payer: Cash Price |
$1,082.25
|
| Rate for Payer: Cash Price |
$1,082.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,563.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$698.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,488.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,488.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,147.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$435.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$803.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$1,803.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$768.18
|
| Rate for Payer: TriValley Medical Group Senior |
$698.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,202.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,202.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC LYMPH NODE NDLE BPSY, DP AX
|
Facility
|
OP
|
$11,191.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
909000129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,025.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,238.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,916.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$5,035.95
|
| Rate for Payer: Cash Price |
$5,035.95
|
| Rate for Payer: Cash Price |
$5,035.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,274.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$5,035.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,927.23
|
| Rate for Payer: Heritage Provider Network Senior |
$6,194.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,568.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,025.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,791.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,797.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan Commercial |
$8,393.25
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,539.49
|
| Rate for Payer: TriValley Medical Group Senior |
$5,539.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
HC LYMPH NODE NDLE BPSY, DP AX
|
Facility
|
IP
|
$11,191.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
909000129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,025.57 |
| Max. Negotiated Rate |
$8,393.25 |
| Rate for Payer: Adventist Health Commercial |
$2,238.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,207.00
|
| Rate for Payer: Cash Price |
$5,035.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,576.31
|
| Rate for Payer: Heritage Provider Network Senior |
$7,576.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,025.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,797.75
|
| Rate for Payer: Multiplan Commercial |
$8,393.25
|
|
|
HC LYMPH NODE NDLE BPSY, DP CE
|
Facility
|
OP
|
$8,709.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
909000128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,576.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,741.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,382.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,919.05
|
| Rate for Payer: Cash Price |
$3,919.05
|
| Rate for Payer: Cash Price |
$3,919.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,660.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$5,035.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,390.87
|
| Rate for Payer: Heritage Provider Network Senior |
$6,194.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,568.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,576.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,791.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,177.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan Commercial |
$6,531.75
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,539.49
|
| Rate for Payer: TriValley Medical Group Senior |
$5,539.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
HC LYMPH NODE NDLE BPSY, DP CE
|
Facility
|
IP
|
$8,709.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
909000128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,576.33 |
| Max. Negotiated Rate |
$6,531.75 |
| Rate for Payer: Adventist Health Commercial |
$1,741.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,608.60
|
| Rate for Payer: Cash Price |
$3,919.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,895.99
|
| Rate for Payer: Heritage Provider Network Senior |
$5,895.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,576.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,177.25
|
| Rate for Payer: Multiplan Commercial |
$6,531.75
|
|
|
HC LYMPH NODE NDLE BPSY, INT M
|
Facility
|
IP
|
$8,709.00
|
|
|
Service Code
|
CPT 38530
|
| Hospital Charge Code |
909000130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,576.33 |
| Max. Negotiated Rate |
$6,531.75 |
| Rate for Payer: Adventist Health Commercial |
$1,741.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,608.60
|
| Rate for Payer: Cash Price |
$3,919.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,895.99
|
| Rate for Payer: Heritage Provider Network Senior |
$5,895.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,576.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,177.25
|
| Rate for Payer: Multiplan Commercial |
$6,531.75
|
|
|
HC LYMPH NODE NDLE BPSY, INT M
|
Facility
|
OP
|
$8,709.00
|
|
|
Service Code
|
CPT 38530
|
| Hospital Charge Code |
909000130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,576.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,741.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,382.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,919.05
|
| Rate for Payer: Cash Price |
$3,919.05
|
| Rate for Payer: Cash Price |
$3,919.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,660.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$5,035.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,390.87
|
| Rate for Payer: Heritage Provider Network Senior |
$6,194.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,568.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,576.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,791.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,177.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan Commercial |
$6,531.75
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,539.49
|
| Rate for Payer: TriValley Medical Group Senior |
$5,539.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
HC LYMPH NODE NDLE BPSY,SUPFCL
|
Facility
|
IP
|
$2,124.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
909000127
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.44 |
| Max. Negotiated Rate |
$1,593.00 |
| Rate for Payer: Adventist Health Commercial |
$424.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,367.86
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,437.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1,437.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$384.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.00
|
| Rate for Payer: Multiplan Commercial |
$1,593.00
|
|
|
HC LYMPH NODE NDLE BPSY,SUPFCL
|
Facility
|
OP
|
$2,124.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
909000127
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.44 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$424.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,312.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cash Price |
$955.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,380.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,314.76
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,036.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$384.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$1,593.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,336.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2,336.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC LYMPHOCYTE PROLIFERATION MITOG
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
900914187
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$49.03 |
| Max. Negotiated Rate |
$465.42 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$168.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.42
|
| Rate for Payer: Blue Shield of California Commercial |
$394.50
|
| Rate for Payer: Blue Shield of California EPN |
$316.42
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$177.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$49.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.99
|
| Rate for Payer: Heritage Provider Network Senior |
$168.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$130.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$65.70
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$49.03
|
| Rate for Payer: TriValley Medical Group Senior |
$49.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$52.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.93
|
| Rate for Payer: Vantage Medical Group Senior |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION MITOG
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
900914187
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.81
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$184.82
|
| Rate for Payer: Heritage Provider Network Senior |
$184.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.25
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
IP
|
$4,641.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$840.02 |
| Max. Negotiated Rate |
$3,480.75 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,988.80
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,141.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,141.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
OP
|
$4,641.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$840.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,868.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,204.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,754.30
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Cash Price |
$2,088.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,016.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,163.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,141.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,141.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,213.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$840.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,788.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,784.60
|
| Rate for Payer: TriValley Medical Group Senior |
$2,784.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC MAGNESIUM
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$63.22 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$93.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.22
|
| Rate for Payer: Blue Shield of California Commercial |
$53.91
|
| Rate for Payer: Blue Shield of California Commercial |
$53.91
|
| Rate for Payer: Blue Shield of California EPN |
$43.24
|
| Rate for Payer: Blue Shield of California EPN |
$43.24
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$98.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$94.09
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$72.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.98
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.70
|
| Rate for Payer: TriValley Medical Group Senior |
$6.70
|
| Rate for Payer: TriValley Medical Group Senior |
$6.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
|
|
HC MAGNESIUM
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.89
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.90
|
| Rate for Payer: Heritage Provider Network Senior |
$102.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
|
|
HC MAGNETIC RESONANCE ELSTGRPHY
|
Facility
|
IP
|
$1,671.00
|
|
|
Service Code
|
CPT 76391
|
| Hospital Charge Code |
908876391
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$302.45 |
| Max. Negotiated Rate |
$1,253.25 |
| Rate for Payer: Adventist Health Commercial |
$334.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,076.12
|
| Rate for Payer: Cash Price |
$751.95
|
| Rate for Payer: Cash Price |
$751.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,131.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1,131.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$302.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.75
|
| Rate for Payer: Multiplan Commercial |
$1,253.25
|
|
|
HC MAGNETIC RESONANCE ELSTGRPHY
|
Facility
|
OP
|
$1,671.00
|
|
|
Service Code
|
CPT 76391
|
| Hospital Charge Code |
908876391
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$302.45 |
| Max. Negotiated Rate |
$1,253.25 |
| Rate for Payer: Adventist Health Commercial |
$334.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,032.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$835.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1,025.52
|
| Rate for Payer: Blue Shield of California EPN |
$824.69
|
| Rate for Payer: Cash Price |
$751.95
|
| Rate for Payer: Cash Price |
$751.95
|
| Rate for Payer: Cash Price |
$751.95
|
| Rate for Payer: Cash Price |
$751.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$797.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$302.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,253.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$368.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$368.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC MALARIA QUANTITAT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911640
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.22
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.69
|
| Rate for Payer: Heritage Provider Network Senior |
$132.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
|
|
HC MALARIA QUANTITAT
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911640
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$56.89 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.89
|
| Rate for Payer: Blue Shield of California Commercial |
$48.21
|
| Rate for Payer: Blue Shield of California Commercial |
$48.21
|
| Rate for Payer: Blue Shield of California EPN |
$38.67
|
| Rate for Payer: Blue Shield of California EPN |
$38.67
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$127.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$121.32
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$93.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.99
|
| Rate for Payer: TriValley Medical Group Senior |
$5.99
|
| Rate for Payer: TriValley Medical Group Senior |
$5.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC MALARIA SCREEN AG TEST
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900912441
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$85.34 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$127.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$121.32
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$93.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Senior |
$16.07
|
| Rate for Payer: TriValley Medical Group Senior |
$16.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC MALARIA SCREEN AG TEST
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900912441
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.22
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.69
|
| Rate for Payer: Heritage Provider Network Senior |
$132.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
|
|
HC MALARIA SMEARS
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911686
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$56.89 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.89
|
| Rate for Payer: Blue Shield of California Commercial |
$48.21
|
| Rate for Payer: Blue Shield of California Commercial |
$48.21
|
| Rate for Payer: Blue Shield of California EPN |
$38.67
|
| Rate for Payer: Blue Shield of California EPN |
$38.67
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$127.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$121.32
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$93.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.99
|
| Rate for Payer: TriValley Medical Group Senior |
$5.99
|
| Rate for Payer: TriValley Medical Group Senior |
$5.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
