|
HC SELF CARE D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8989
|
| Hospital Charge Code |
900018311
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| 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 |
$334.00
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| 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 SELF CARE D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8989
|
| Hospital Charge Code |
900018411
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC SELF CARE D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8989
|
| Hospital Charge Code |
900018311
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC SELF CARE D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8989
|
| Hospital Charge Code |
900018411
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| 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 |
$334.00
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA 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 SELF CARE GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8988
|
| Hospital Charge Code |
900018310
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| 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 |
$334.00
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| 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 SELF CARE GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8988
|
| Hospital Charge Code |
900018410
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC SELF CARE GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8988
|
| Hospital Charge Code |
900018310
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC SELF CARE GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8988
|
| Hospital Charge Code |
900018410
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| 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 |
$334.00
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA 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 SELF CARE/HOME MGT TRNG 15 MIN MCAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
901300066
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$59.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$99.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$123.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$94.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$123.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.25
|
| Rate for Payer: Dignity Health Senior |
$123.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.75
|
| Rate for Payer: Heritage Provider Network Senior |
$89.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$69.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.50
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| 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 |
$123.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.25
|
| Rate for Payer: Vantage Medical Group Senior |
$123.25
|
|
|
HC SELF CARE/HOME MGT TRNG 15 MIN MCAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
901300066
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.17
|
| Rate for Payer: Heritage Provider Network Senior |
$98.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.25
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
|
|
HC SELF CARE/HOME MGT TRNG 15 MIN OT
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
905104363
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$59.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$99.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$123.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$94.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$123.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.25
|
| Rate for Payer: Dignity Health Senior |
$123.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.75
|
| Rate for Payer: Heritage Provider Network Senior |
$89.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$69.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.50
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| 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 |
$123.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.25
|
| Rate for Payer: Vantage Medical Group Senior |
$123.25
|
|
|
HC SELF CARE/HOME MGT TRNG 15 MIN OT
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
905104363
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.17
|
| Rate for Payer: Heritage Provider Network Senior |
$98.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.25
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
|
|
HC SELF CARE/HOME MGT TRNG 15 MIN PT
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
900419056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$59.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$99.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$123.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$94.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$123.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.25
|
| Rate for Payer: Dignity Health Senior |
$123.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.75
|
| Rate for Payer: Heritage Provider Network Senior |
$89.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$69.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.50
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| 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 |
$123.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.25
|
| Rate for Payer: Vantage Medical Group Senior |
$123.25
|
|
|
HC SELF CARE/HOME MGT TRNG 15 MIN PT
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
900419056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.17
|
| Rate for Payer: Heritage Provider Network Senior |
$98.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.25
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
|
|
HC SELLA TURCICA
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
909001114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$173.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$222.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$85.73
|
| Rate for Payer: Blue Shield of California EPN |
$68.94
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$210.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$200.56
|
| Rate for Payer: Heritage Provider Network Senior |
$200.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$154.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| 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 |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC SELLA TURCICA
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
909001114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.64 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$219.35
|
| Rate for Payer: Heritage Provider Network Senior |
$219.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
|
|
HC SEMEN ANALYSIS
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
900910151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.86 |
| Max. Negotiated Rate |
$297.75 |
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.77
|
| Rate for Payer: Heritage Provider Network Senior |
$268.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.25
|
| Rate for Payer: Multiplan Commercial |
$297.75
|
|
|
HC SEMEN ANALYSIS
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
900910151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$136.76 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$59.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.76
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$72.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.54
|
| Rate for Payer: Dignity Health Senior |
$12.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.33
|
| Rate for Payer: Heritage Provider Network Senior |
$69.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$53.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.51
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.31
|
| Rate for Payer: TriValley Medical Group Senior |
$12.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.54
|
| Rate for Payer: Vantage Medical Group Senior |
$12.31
|
|
|
HC SENSITIVITY DISK DIFFUSION
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912403
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$62.88 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.88
|
| Rate for Payer: Blue Shield of California Commercial |
$55.47
|
| Rate for Payer: Blue Shield of California EPN |
$44.49
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: Dignity Health Senior |
$7.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.47
|
| Rate for Payer: Heritage Provider Network Senior |
$28.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.42
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Senior |
$7.48
|
|
|
HC SENSITIVITY DISK DIFFUSION
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912403
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.43 |
| Max. Negotiated Rate |
$275.25 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$248.46
|
| Rate for Payer: Heritage Provider Network Senior |
$248.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.75
|
| Rate for Payer: Multiplan Commercial |
$275.25
|
|
|
HC SENSITIVITY E TESTS
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912404
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC SENSITIVITY E TESTS
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912404
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$23.16 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| 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 Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.59
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| 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 |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| 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) Medi-Cal |
$1.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$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 Navigate/Select/Select+ |
$5.14
|
| 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 Senior |
$4.75
|
|
|
HC SENSITIVITY GRAM NEGATIVE MIC
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912414
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.65 |
| Max. Negotiated Rate |
$234.75 |
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.90
|
| Rate for Payer: Heritage Provider Network Senior |
$211.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.25
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
|
|
HC SENSITIVITY GRAM NEGATIVE MIC
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912414
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$78.92 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.92
|
| Rate for Payer: Blue Shield of California Commercial |
$69.58
|
| Rate for Payer: Blue Shield of California EPN |
$55.81
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Senior |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.47
|
| Rate for Payer: Heritage Provider Network Senior |
$54.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.90
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.65
|
| Rate for Payer: TriValley Medical Group Senior |
$8.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC SENSITIVITY GRAM POSITIVE MIC
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912412
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.65 |
| Max. Negotiated Rate |
$234.75 |
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.90
|
| Rate for Payer: Heritage Provider Network Senior |
$211.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.25
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
|
