|
HC SBBB STAT LABORATORY PROCEDURE
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Blue Shield of California Commercial |
$64.66
|
| Rate for Payer: Blue Shield of California EPN |
$51.73
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Senior |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$31.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.61
|
| Rate for Payer: Heritage Provider Network Senior |
$65.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.21
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$31.12
|
| Rate for Payer: TriValley Medical Group Senior |
$31.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC SBBB STAT SPECIMEN PICK UP/DEL
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900904617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$89.55 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.55
|
| Rate for Payer: Blue Shield of California Commercial |
$46.36
|
| Rate for Payer: Blue Shield of California EPN |
$37.09
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Senior |
$64.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.04
|
| Rate for Payer: Heritage Provider Network Senior |
$47.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC SBBB STAT SPECIMEN PICK UP/DEL
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900904617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.45
|
| Rate for Payer: Heritage Provider Network Senior |
$51.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
|
|
HC SBBB SUPER COOMBS
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$113.20 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.05
|
| Rate for Payer: Blue Shield of California Commercial |
$43.20
|
| Rate for Payer: Blue Shield of California EPN |
$34.65
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.47
|
| Rate for Payer: TriValley Medical Group Senior |
$75.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC SBBB SUPER COOMBS
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC SBBB THERMAL AMPLITUDE STUDIES
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
900904157
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.07 |
| Max. Negotiated Rate |
$265.50 |
| Rate for Payer: Adventist Health Commercial |
$70.80
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$239.66
|
| Rate for Payer: Heritage Provider Network Senior |
$239.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.50
|
| Rate for Payer: Multiplan Commercial |
$265.50
|
|
|
HC SBBB THERMAL AMPLITUDE STUDIES
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
900904157
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$265.50 |
| Rate for Payer: Adventist Health Commercial |
$70.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$189.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$243.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.63
|
| Rate for Payer: Blue Shield of California Commercial |
$64.92
|
| Rate for Payer: Blue Shield of California EPN |
$52.07
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$230.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.87
|
| Rate for Payer: Dignity Health Senior |
$8.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$219.13
|
| Rate for Payer: Heritage Provider Network Senior |
$219.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$168.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.16
|
| Rate for Payer: Multiplan Commercial |
$265.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.06
|
| Rate for Payer: TriValley Medical Group Senior |
$8.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.87
|
| Rate for Payer: Vantage Medical Group Senior |
$8.06
|
|
|
HC SBBB TITRATION
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
900904740
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$89.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.76
|
| Rate for Payer: Blue Shield of California Commercial |
$101.87
|
| Rate for Payer: Blue Shield of California EPN |
$81.50
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$108.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Senior |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$217.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.37
|
| Rate for Payer: Heritage Provider Network Senior |
$103.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$79.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$274.34
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$239.50
|
| Rate for Payer: TriValley Medical Group Senior |
$217.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC SBBB TITRATION
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
900904740
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$125.25 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.06
|
| Rate for Payer: Heritage Provider Network Senior |
$113.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.75
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
|
|
HC SBBB UNIT SEARCH CHARGE
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$65.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Blue Shield of California Commercial |
$74.42
|
| Rate for Payer: Blue Shield of California EPN |
$59.54
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$79.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Senior |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$31.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.52
|
| Rate for Payer: Heritage Provider Network Senior |
$75.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$58.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.21
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$31.12
|
| Rate for Payer: TriValley Medical Group Senior |
$31.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC SBBB UNIT SEARCH CHARGE
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.59
|
| Rate for Payer: Heritage Provider Network Senior |
$82.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.50
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
|
|
HC SBBB VOLUME REDUCTION
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 86960
|
| Hospital Charge Code |
900904615
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.76
|
| Rate for Payer: Heritage Provider Network Senior |
$71.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
|
|
HC SBBB VOLUME REDUCTION
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 86960
|
| Hospital Charge Code |
900904615
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.14
|
| Rate for Payer: Blue Shield of California Commercial |
$64.66
|
| Rate for Payer: Blue Shield of California EPN |
$51.73
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Senior |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$217.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.61
|
| Rate for Payer: Heritage Provider Network Senior |
$65.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$274.34
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$239.50
|
| Rate for Payer: TriValley Medical Group Senior |
$217.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC SBBB WASHING OF COMPONENTS
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$117.75 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.29
|
| Rate for Payer: Heritage Provider Network Senior |
$106.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
|
|
HC SBBB WASHING OF COMPONENTS
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.25 |
| Max. Negotiated Rate |
$117.75 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$83.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$107.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Blue Shield of California Commercial |
$95.77
|
| Rate for Payer: Blue Shield of California EPN |
$76.62
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Senior |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$31.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.18
|
| Rate for Payer: Heritage Provider Network Senior |
$97.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$74.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.21
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$31.12
|
| Rate for Payer: TriValley Medical Group Senior |
$31.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC SCAN & EVAL TESTICLE
|
Facility
|
IP
|
$1,601.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
906601409
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$289.78 |
| Max. Negotiated Rate |
$1,200.75 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Cash Price |
$880.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,083.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,083.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
|
|
HC SCAN & EVAL TESTICLE
|
Facility
|
OP
|
$1,601.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
906601409
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$1,200.75 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$855.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$321.50
|
| Rate for Payer: Blue Shield of California EPN |
$258.54
|
| Rate for Payer: Cash Price |
$880.55
|
| Rate for Payer: Cash Price |
$880.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,040.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,040.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$991.02
|
| Rate for Payer: Heritage Provider Network Senior |
$991.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$763.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,200.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SCAPULA
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
909001479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Cash Price |
$332.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.91
|
| Rate for Payer: Heritage Provider Network Senior |
$408.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
|
|
HC SCAPULA
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
909001479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$322.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$414.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.32
|
| Rate for Payer: Blue Shield of California Commercial |
$107.90
|
| Rate for Payer: Blue Shield of California EPN |
$86.77
|
| Rate for Payer: Cash Price |
$332.20
|
| Rate for Payer: Cash Price |
$332.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$392.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$373.88
|
| Rate for Payer: Heritage Provider Network Senior |
$373.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$288.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SCHILLINGS W/ INTRINSIC FACTOR
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
CPT 78271
|
| Hospital Charge Code |
909301358
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$118.37 |
| Max. Negotiated Rate |
$555.90 |
| Rate for Payer: Adventist Health Commercial |
$130.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$349.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$449.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$490.50
|
| Rate for Payer: Blue Shield of California Commercial |
$398.94
|
| Rate for Payer: Blue Shield of California EPN |
$319.15
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$425.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.90
|
| Rate for Payer: Dignity Health Senior |
$555.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.83
|
| Rate for Payer: Heritage Provider Network Senior |
$404.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$311.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$457.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$457.80
|
| Rate for Payer: Multiplan Commercial |
$490.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$327.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$327.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.90
|
| Rate for Payer: Vantage Medical Group Senior |
$555.90
|
|
|
HC SCHILLINGS W/ INTRINSIC FACTOR
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
CPT 78271
|
| Hospital Charge Code |
909301358
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$118.37 |
| Max. Negotiated Rate |
$490.50 |
| Rate for Payer: Adventist Health Commercial |
$130.80
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$442.76
|
| Rate for Payer: Heritage Provider Network Senior |
$442.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.50
|
| Rate for Payer: Multiplan Commercial |
$490.50
|
|
|
HC SCHILLINGS W/O INTRINSIC FACTOR
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 78270
|
| Hospital Charge Code |
909301357
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$120.91 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$452.24
|
| Rate for Payer: Heritage Provider Network Senior |
$452.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
|
|
HC SCHILLINGS W/O INTRINSIC FACTOR
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 78270
|
| Hospital Charge Code |
909301357
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$120.91 |
| Max. Negotiated Rate |
$567.80 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$357.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$458.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$501.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.48
|
| Rate for Payer: Blue Shield of California EPN |
$325.98
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$434.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.80
|
| Rate for Payer: Dignity Health Senior |
$567.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$413.49
|
| Rate for Payer: Heritage Provider Network Senior |
$413.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$318.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.60
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$334.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$334.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$567.80
|
|
|
HC SCHILLINGS W & WO INTRINSIC FACTOR
|
Facility
|
OP
|
$1,142.00
|
|
|
Service Code
|
CPT 78272
|
| Hospital Charge Code |
909301359
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$206.70 |
| Max. Negotiated Rate |
$970.70 |
| Rate for Payer: Adventist Health Commercial |
$228.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$610.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$784.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$628.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$856.50
|
| Rate for Payer: Blue Shield of California Commercial |
$696.62
|
| Rate for Payer: Blue Shield of California EPN |
$557.30
|
| Rate for Payer: Cash Price |
$628.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$742.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$970.70
|
| Rate for Payer: Dignity Health Senior |
$970.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$742.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$706.90
|
| Rate for Payer: Heritage Provider Network Senior |
$706.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$544.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$799.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$799.40
|
| Rate for Payer: Multiplan Commercial |
$856.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$571.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$571.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$970.70
|
| Rate for Payer: Vantage Medical Group Senior |
$970.70
|
|
|
HC SCHILLINGS W & WO INTRINSIC FACTOR
|
Facility
|
IP
|
$1,142.00
|
|
|
Service Code
|
CPT 78272
|
| Hospital Charge Code |
909301359
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$206.70 |
| Max. Negotiated Rate |
$856.50 |
| Rate for Payer: Adventist Health Commercial |
$228.40
|
| Rate for Payer: Cash Price |
$628.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$773.13
|
| Rate for Payer: Heritage Provider Network Senior |
$773.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.50
|
| Rate for Payer: Multiplan Commercial |
$856.50
|
|
