|
HC TOBRAMYCIN
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
900910408
|
|
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 |
$153.20
|
| 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 Permanente of CA Medi-Cal |
$40.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.75
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
|
|
HC TOES
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
909001634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$77.83 |
| Max. Negotiated Rate |
$322.50 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$295.41
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$291.11
|
| Rate for Payer: Heritage Provider Network Senior |
$291.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.50
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
|
|
HC TOES
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
909001634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.32 |
| Max. Negotiated Rate |
$322.50 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$295.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.04
|
| Rate for Payer: Blue Shield of California Commercial |
$83.23
|
| Rate for Payer: Blue Shield of California EPN |
$47.33
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$279.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$266.17
|
| Rate for Payer: Heritage Provider Network Senior |
$266.17
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| 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 |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC TOMOGRAPHY SINGLE PLANE BODY SEC
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 76100
|
| Hospital Charge Code |
909001551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.35 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$544.10
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$536.18
|
| Rate for Payer: Heritage Provider Network Senior |
$536.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
|
|
HC TOMOGRAPHY SINGLE PLANE BODY SEC
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 76100
|
| Hospital Charge Code |
909001551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.09 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$544.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.14
|
| Rate for Payer: Blue Shield of California Commercial |
$254.95
|
| Rate for Payer: Blue Shield of California EPN |
$144.98
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$514.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$514.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$490.25
|
| Rate for Payer: Heritage Provider Network Senior |
$490.25
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$89.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC TOTAL BODY THYROID SCAN
|
Facility
|
IP
|
$2,761.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
909301317
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$499.74 |
| Max. Negotiated Rate |
$2,070.75 |
| Rate for Payer: Adventist Health Commercial |
$552.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,896.81
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,869.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,869.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.25
|
| Rate for Payer: Multiplan Commercial |
$2,070.75
|
|
|
HC TOTAL BODY THYROID SCAN
|
Facility
|
OP
|
$2,761.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
909301317
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$202.49 |
| Max. Negotiated Rate |
$2,070.75 |
| Rate for Payer: Adventist Health Commercial |
$552.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$616.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,896.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,109.45
|
| Rate for Payer: Blue Shield of California EPN |
$630.91
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cash Price |
$1,242.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: Dignity Health Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,794.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$675.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,709.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,709.06
|
| Rate for Payer: Humana Medicare |
$675.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$202.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,283.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$796.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$850.92
|
| Rate for Payer: Multiplan Commercial |
$2,070.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$742.86
|
| Rate for Payer: TriValley Medical Group Senior |
$675.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC TOTAL CONTACT CAST LEG
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
900101505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.09 |
| Max. Negotiated Rate |
$414.75 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$379.91
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$374.38
|
| Rate for Payer: Heritage Provider Network Senior |
$374.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.25
|
| Rate for Payer: Multiplan Commercial |
$414.75
|
|
|
HC TOTAL CONTACT CAST LEG
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
900101505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$223.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$379.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.41
|
| Rate for Payer: Blue Shield of California EPN |
$324.61
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$359.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: Dignity Health Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$335.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$342.31
|
| Rate for Payer: Heritage Provider Network Senior |
$342.31
|
| Rate for Payer: Humana Medicare |
$335.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$213.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$637.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$422.79
|
| Rate for Payer: Multiplan Commercial |
$414.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$369.10
|
| Rate for Payer: TriValley Medical Group Senior |
$369.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC TOTAL LUNG LAVAGE UNILATERAL
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
CPT 32997
|
| Hospital Charge Code |
900803550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$356.21 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Adventist Health Commercial |
$393.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,352.02
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,332.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,332.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.00
|
| Rate for Payer: Multiplan Commercial |
$1,476.00
|
|
|
HC TOTAL LUNG LAVAGE UNILATERAL
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
CPT 32997
|
| Hospital Charge Code |
900803550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$356.21 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$393.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$717.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,352.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,672.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,082.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,476.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,222.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,155.22
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,279.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,672.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,672.80
|
| Rate for Payer: Dignity Health Senior |
$1,672.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,218.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,218.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$948.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.00
|
| Rate for Payer: Multiplan Commercial |
$1,476.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$984.00
|
| Rate for Payer: TriValley Medical Group Senior |
$984.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,672.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,672.80
|
|
|
HC TOXOPLASMA AB IGG
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900910989
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$120.08 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.08
|
| Rate for Payer: Blue Shield of California Commercial |
$112.41
|
| Rate for Payer: Blue Shield of California EPN |
$87.88
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.04
|
| Rate for Payer: Heritage Provider Network Senior |
$34.04
|
| Rate for Payer: Humana Medicare |
$14.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.13
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC TOXOPLASMA AB IGG
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900910989
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| 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 TOXOPLASMA AB IGM
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900912320
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$124.65 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.65
|
| Rate for Payer: Blue Shield of California Commercial |
$112.47
|
| Rate for Payer: Blue Shield of California EPN |
$87.92
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Senior |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.04
|
| Rate for Payer: Heritage Provider Network Senior |
$34.04
|
| Rate for Payer: Humana Medicare |
$14.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Senior |
$14.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC TOXOPLASMA AB IGM
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900912320
|
|
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: Aetna of CA Non-Gatekeeper |
$144.27
|
| 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 TOXOPLASMA ANTIBODY IGG
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900913667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.27
|
| Rate for Payer: Heritage Provider Network Senior |
$39.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
|
|
HC TOXOPLASMA ANTIBODY IGG
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900913667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$120.08 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.08
|
| Rate for Payer: Blue Shield of California Commercial |
$112.41
|
| Rate for Payer: Blue Shield of California EPN |
$87.88
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$14.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.13
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC TOXOPLASMA ANTIBODY IGM
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900913668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$124.65 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.65
|
| Rate for Payer: Blue Shield of California Commercial |
$112.47
|
| Rate for Payer: Blue Shield of California EPN |
$87.92
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Senior |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$14.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Senior |
$14.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC TOXOPLASMA ANTIBODY IGM
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900913668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.27
|
| Rate for Payer: Heritage Provider Network Senior |
$39.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
|
|
HC TPN/QUINTON CATH DUAL
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$198.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$284.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$351.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$227.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$257.09
|
| Rate for Payer: Blue Shield of California EPN |
$243.02
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$190.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$351.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$351.90
|
| Rate for Payer: Dignity Health Senior |
$351.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$191.68
|
| Rate for Payer: Heritage Provider Network Senior |
$191.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$150.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$138.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$351.90
|
| Rate for Payer: Vantage Medical Group Senior |
$351.90
|
|
|
HC TPN/QUINTON CATH DUAL
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$198.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$284.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$190.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$280.28
|
| Rate for Payer: Heritage Provider Network Senior |
$280.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$150.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$138.32
|
|
|
HC TPN/QUINTON CATH SIMPLE
|
Facility
|
IP
|
$393.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$78.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$188.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$270.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$177.12
|
| Rate for Payer: Cash Price |
$177.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$181.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$266.47
|
| Rate for Payer: Heritage Provider Network Senior |
$266.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$196.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Multiplan Commercial |
$295.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$143.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.50
|
|
|
HC TPN/QUINTON CATH SIMPLE
|
Facility
|
OP
|
$393.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$78.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$188.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$270.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$334.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$244.43
|
| Rate for Payer: Blue Shield of California EPN |
$231.04
|
| Rate for Payer: Cash Price |
$177.12
|
| Rate for Payer: Cash Price |
$177.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$181.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$334.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$334.56
|
| Rate for Payer: Dignity Health Senior |
$334.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$251.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.24
|
| Rate for Payer: Heritage Provider Network Senior |
$182.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$196.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Multiplan Commercial |
$295.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$143.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$334.56
|
| Rate for Payer: Vantage Medical Group Senior |
$334.56
|
|
|
HC TRACH CHANGE
|
Facility
|
OP
|
$1,322.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801125
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$991.50 |
| Rate for Payer: Adventist Health Commercial |
$264.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$706.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$908.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Blue Shield of California Commercial |
$820.96
|
| Rate for Payer: Blue Shield of California EPN |
$776.01
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$859.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$859.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$818.32
|
| Rate for Payer: Heritage Provider Network Senior |
$818.32
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$991.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC TRACH CHANGE
|
Facility
|
IP
|
$1,322.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801125
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$239.28 |
| Max. Negotiated Rate |
$991.50 |
| Rate for Payer: Adventist Health Commercial |
$264.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$908.21
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$894.99
|
| Rate for Payer: Heritage Provider Network Senior |
$894.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.50
|
| Rate for Payer: Multiplan Commercial |
$991.50
|
|
