|
HC MEMORY GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9169
|
| Hospital Charge Code |
900018234
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9169
|
| Hospital Charge Code |
900018434
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MEMORY GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9169
|
| Hospital Charge Code |
900018434
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9169
|
| Hospital Charge Code |
900018134
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MENINGITIS PANEL NUCLEIC ACID
|
Facility
|
OP
|
$1,762.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
900913643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$318.92 |
| Max. Negotiated Rate |
$3,313.14 |
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Adventist Health Commercial |
$296.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$915.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,088.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,313.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,313.14
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.11
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.11
|
| Rate for Payer: Blue Shield of California EPN |
$2,641.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,641.35
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$666.90
|
| Rate for Payer: Cash Price |
$666.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$963.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,145.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,145.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$963.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$416.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$416.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$917.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,090.68
|
| Rate for Payer: Heritage Provider Network Senior |
$917.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,090.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$706.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$840.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$268.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$318.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$479.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$479.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$558.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$558.49
|
| Rate for Payer: Multiplan Commercial |
$1,111.50
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$416.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$416.78
|
| Rate for Payer: TriValley Medical Group Senior |
$416.78
|
| Rate for Payer: TriValley Medical Group Senior |
$416.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$450.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$450.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$450.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$450.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC MENINGITIS PANEL NUCLEIC ACID
|
Facility
|
IP
|
$1,762.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
900913643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$318.92 |
| Max. Negotiated Rate |
$1,321.50 |
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,134.73
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,192.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,192.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$318.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.50
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
|
|
HC MERCI BALLOON CATHETER
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.20 |
| Max. Negotiated Rate |
$2,156.45 |
| Rate for Payer: Adventist Health Commercial |
$507.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,567.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,156.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,395.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,902.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,269.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,547.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,238.06
|
| Rate for Payer: Cash Price |
$1,141.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,649.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,156.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,156.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,156.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,496.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,570.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,570.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,210.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$459.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,775.90
|
| Rate for Payer: Multiplan Commercial |
$1,902.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,268.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,268.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,156.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,156.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,156.45
|
|
|
HC MERCI BALLOON CATHETER
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.20 |
| Max. Negotiated Rate |
$1,902.75 |
| Rate for Payer: Adventist Health Commercial |
$507.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,633.83
|
| Rate for Payer: Cash Price |
$1,141.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,717.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,717.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$459.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.25
|
| Rate for Payer: Multiplan Commercial |
$1,902.75
|
|
|
HC MERCI MICROCATHETER
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$374.67 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,279.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,138.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,552.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,035.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1,262.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,010.16
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,345.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,759.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,759.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,281.33
|
| Rate for Payer: Heritage Provider Network Senior |
$1,281.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$987.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$374.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,449.00
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,035.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,035.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,759.50
|
|
|
HC MERCI MICROCATHETER
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$374.67 |
| Max. Negotiated Rate |
$1,552.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,333.08
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,401.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,401.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$374.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.50
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
|
|
HC MERCI RETRIEVER
|
Facility
|
IP
|
$7,125.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909020000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,289.62 |
| Max. Negotiated Rate |
$5,343.75 |
| Rate for Payer: Adventist Health Commercial |
$1,425.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,588.50
|
| Rate for Payer: Cash Price |
$3,206.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,823.62
|
| Rate for Payer: Heritage Provider Network Senior |
$4,823.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,289.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,781.25
|
| Rate for Payer: Multiplan Commercial |
$5,343.75
|
|
|
HC MERCI RETRIEVER
|
Facility
|
OP
|
$7,125.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909020000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,289.62 |
| Max. Negotiated Rate |
$6,056.25 |
| Rate for Payer: Adventist Health Commercial |
$1,425.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,403.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,056.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,918.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,343.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,563.93
|
| Rate for Payer: Blue Shield of California Commercial |
$4,346.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,477.00
|
| Rate for Payer: Cash Price |
$3,206.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,631.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,056.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,056.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,056.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,203.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,410.38
|
| Rate for Payer: Heritage Provider Network Senior |
$4,410.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,398.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,289.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,781.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,987.50
|
| Rate for Payer: Multiplan Commercial |
$5,343.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,562.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,562.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,056.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,056.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,056.25
|
|
|
HC MERO ETEST
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900913009
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$23.16 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.41
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC MERO ETEST
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900913009
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.66
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.15
|
| Rate for Payer: Heritage Provider Network Senior |
$10.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
|
|
HC METANEPHRINES FRACTIONATED UR
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900910288
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.08
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.39
|
| Rate for Payer: Heritage Provider Network Senior |
$47.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
|
|
HC METANEPHRINES FRACTIONATED UR
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900910288
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$160.89 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.89
|
| Rate for Payer: Blue Shield of California Commercial |
$136.34
|
| Rate for Payer: Blue Shield of California Commercial |
$136.34
|
| Rate for Payer: Blue Shield of California EPN |
$109.36
|
| Rate for Payer: Blue Shield of California EPN |
$109.36
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$42.09
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$32.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$33.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.70
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.94
|
| Rate for Payer: TriValley Medical Group Senior |
$16.94
|
| Rate for Payer: TriValley Medical Group Senior |
$16.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC METANEPHRINE URINE 24 HOURS
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912209
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.08
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.39
|
| Rate for Payer: Heritage Provider Network Senior |
$47.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
|
|
HC METANEPHRINE URINE 24 HOURS
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912209
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$160.89 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.89
|
| Rate for Payer: Blue Shield of California Commercial |
$136.34
|
| Rate for Payer: Blue Shield of California Commercial |
$136.34
|
| Rate for Payer: Blue Shield of California EPN |
$109.36
|
| Rate for Payer: Blue Shield of California EPN |
$109.36
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$40.23
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$33.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.70
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.94
|
| Rate for Payer: TriValley Medical Group Senior |
$16.94
|
| Rate for Payer: TriValley Medical Group Senior |
$16.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC METANEPHRINE URINE RANDOM
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.08
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.39
|
| Rate for Payer: Heritage Provider Network Senior |
$47.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
|
|
HC METANEPHRINE URINE RANDOM
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$160.89 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.89
|
| Rate for Payer: Blue Shield of California Commercial |
$136.34
|
| Rate for Payer: Blue Shield of California Commercial |
$136.34
|
| Rate for Payer: Blue Shield of California EPN |
$109.36
|
| Rate for Payer: Blue Shield of California EPN |
$109.36
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$40.23
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$33.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.70
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.94
|
| Rate for Payer: TriValley Medical Group Senior |
$16.94
|
| Rate for Payer: TriValley Medical Group Senior |
$16.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC METHEMOGLOBIN CH
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
900912183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC METHEMOGLOBIN CH
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
900912183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$69.55 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.55
|
| Rate for Payer: Blue Shield of California Commercial |
$58.92
|
| Rate for Payer: Blue Shield of California EPN |
$47.26
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.99
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.20
|
| Rate for Payer: TriValley Medical Group Senior |
$8.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.02
|
| Rate for Payer: Vantage Medical Group Senior |
$8.20
|
|
|
HC METHOTREXATE
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
900910937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$222.16 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.76
|
| Rate for Payer: Blue Shield of California Commercial |
$222.16
|
| Rate for Payer: Blue Shield of California Commercial |
$222.16
|
| Rate for Payer: Blue Shield of California EPN |
$178.19
|
| Rate for Payer: Blue Shield of California EPN |
$178.19
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$144.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$38.57
|
| Rate for Payer: EPIC Health Plan Medicare |
$38.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.04
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$138.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$106.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.57
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.57
|
| Rate for Payer: TriValley Medical Group Senior |
$38.57
|
| Rate for Payer: TriValley Medical Group Senior |
$38.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC METHOTREXATE
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
900910937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$167.25 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$143.61
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$150.97
|
| Rate for Payer: Heritage Provider Network Senior |
$150.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.75
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
|
|
HC MFM INIT NUTR ADD. 15 MIN MCAL
|
Facility
|
IP
|
$138.00
|
|
| Hospital Charge Code |
901046202
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.87
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
