|
HC SLITTING OF PREPUCE
|
Facility
|
IP
|
$4,915.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$889.62 |
| Max. Negotiated Rate |
$3,686.25 |
| Rate for Payer: Adventist Health Commercial |
$983.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,165.26
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,327.45
|
| Rate for Payer: Heritage Provider Network Senior |
$3,327.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$889.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,228.75
|
| Rate for Payer: Multiplan Commercial |
$3,686.25
|
|
|
HC SLITTING OF PREPUCE
|
Facility
|
OP
|
$4,915.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$889.62 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$983.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,037.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,334.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,857.87
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,194.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,688.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,327.45
|
| Rate for Payer: Heritage Provider Network Senior |
$3,327.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,344.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$889.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,091.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,228.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$3,686.25
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,949.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,949.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC SLOW ACTIVATION
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910078
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$57.02 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.02
|
| Rate for Payer: Blue Shield of California Commercial |
$48.27
|
| Rate for Payer: Blue Shield of California Commercial |
$48.27
|
| Rate for Payer: Blue Shield of California EPN |
$38.72
|
| Rate for Payer: Blue Shield of California EPN |
$38.72
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$100.28
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$77.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$30.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.05
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Senior |
$6.01
|
| Rate for Payer: TriValley Medical Group Senior |
$6.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC SLOW ACTIVATION
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910078
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.33
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.67
|
| Rate for Payer: Heritage Provider Network Senior |
$109.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
|
|
HC SM153 LEXIDRONAMM 50 MCI QUADR
|
Facility
|
OP
|
$30,214.00
|
|
|
Service Code
|
CPT A9604
|
| Hospital Charge Code |
909301571
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$3,159.80 |
| Max. Negotiated Rate |
$22,660.50 |
| Rate for Payer: Adventist Health Commercial |
$6,042.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,672.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,949.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,475.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,475.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,638.89
|
| Rate for Payer: Blue Shield of California Commercial |
$18,430.54
|
| Rate for Payer: Blue Shield of California EPN |
$14,744.43
|
| Rate for Payer: Cash Price |
$13,596.30
|
| Rate for Payer: Cash Price |
$13,596.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,639.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,949.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,475.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,475.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,336.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,159.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,702.47
|
| Rate for Payer: Heritage Provider Network Senior |
$18,702.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,159.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,412.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,468.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,633.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,553.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,234.13
|
| Rate for Payer: Multiplan Commercial |
$22,660.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,475.78
|
| Rate for Payer: TriValley Medical Group Senior |
$3,159.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,916.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,003.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,949.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,475.78
|
| Rate for Payer: Vantage Medical Group Senior |
$3,475.78
|
|
|
HC SM153 LEXIDRONAMM 50 MCI QUADR
|
Facility
|
IP
|
$30,214.00
|
|
|
Service Code
|
CPT A9604
|
| Hospital Charge Code |
909301571
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$5,468.73 |
| Max. Negotiated Rate |
$22,660.50 |
| Rate for Payer: Adventist Health Commercial |
$6,042.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,457.82
|
| Rate for Payer: Cash Price |
$13,596.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,315.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,454.88
|
| Rate for Payer: Heritage Provider Network Senior |
$20,454.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,468.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,553.50
|
| Rate for Payer: Multiplan Commercial |
$22,660.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,916.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,003.86
|
|
|
HC SMALL BOWEL SNGL CNTRST
|
Facility
|
IP
|
$1,301.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
909001828
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$975.75 |
| Rate for Payer: Adventist Health Commercial |
$260.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$837.84
|
| Rate for Payer: Cash Price |
$585.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$880.78
|
| Rate for Payer: Heritage Provider Network Senior |
$880.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$235.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.25
|
| Rate for Payer: Multiplan Commercial |
$975.75
|
|
|
HC SMALL BOWEL SNGL CNTRST
|
Facility
|
OP
|
$1,301.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
909001828
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.33 |
| Max. Negotiated Rate |
$975.75 |
| Rate for Payer: Adventist Health Commercial |
$260.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$804.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$274.70
|
| Rate for Payer: Blue Shield of California EPN |
$220.91
|
| Rate for Payer: Cash Price |
$585.45
|
| Rate for Payer: Cash Price |
$585.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$845.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$767.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$805.32
|
| Rate for Payer: Heritage Provider Network Senior |
$805.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$620.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$235.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$975.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.59
|
| Rate for Payer: TriValley Medical Group Senior |
$225.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC SMALLPOX AND MONKEYPOX VAC 0.5ML SUBQ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
948000200
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$275.40
|
| Rate for Payer: Blue Shield of California EPN |
$275.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Senior |
$0.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.00
|
| Rate for Payer: TriValley Medical Group Senior |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
| 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 SMALLPOX AND MONKEYPOX VAC 0.5ML SUBQ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
948000200
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Senior |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
|
|
HC SMIC/ID
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.50
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
|
|
HC SMIC/ID
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$76.64 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.64
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.85
|
| Rate for Payer: Heritage Provider Network Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SMITHAB
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913711
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.17
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.89
|
| Rate for Payer: Heritage Provider Network Senior |
$14.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
|
|
HC SMITHAB
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913711
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SMMG CNCRNT APPL IMU SENSORS OT
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 0778T
|
| Hospital Charge Code |
905103779
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$58.64 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$208.66
|
| 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 Foundation Hospitals Medi-Cal |
$58.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
|
|
HC SMMG CNCRNT APPL IMU SENSORS OT
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 0778T
|
| Hospital Charge Code |
905103779
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$58.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$132.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$200.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| 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 |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| 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) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$154.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| 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 |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC SMMG CNCRNT APPL IMU SENSORS PT
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 0778T
|
| Hospital Charge Code |
905103778
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.64 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$208.66
|
| 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 Foundation Hospitals Medi-Cal |
$58.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
|
|
HC SMMG CNCRNT APPL IMU SENSORS PT
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 0778T
|
| Hospital Charge Code |
905103778
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$132.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$200.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| 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 |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.49
|
| 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) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$154.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$190.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| 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 |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC SMOKING/TOBACCO INTENS >10 MIN
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
900201907
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Adventist Health Commercial |
$56.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.03
|
| Rate for Payer: Blue Shield of California Commercial |
$84.18
|
| Rate for Payer: Blue Shield of California EPN |
$67.34
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.42
|
| Rate for Payer: Heritage Provider Network Senior |
$85.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$65.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.57
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$53.01
|
| Rate for Payer: TriValley Medical Group Senior |
$48.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$158.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Vantage Medical Group Senior |
$48.19
|
|
|
HC SMOKING/TOBACCO INTENS >10 MIN
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
900201907
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.87
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
|
HC SMOKING/TOBACCO VISIT 3-10 MIN
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
900201906
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Adventist Health Commercial |
$37.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.02
|
| Rate for Payer: Blue Shield of California Commercial |
$56.12
|
| Rate for Payer: Blue Shield of California EPN |
$44.90
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.95
|
| Rate for Payer: Heritage Provider Network Senior |
$56.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$43.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.57
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$53.01
|
| Rate for Payer: TriValley Medical Group Senior |
$48.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$158.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Vantage Medical Group Senior |
$48.19
|
|
|
HC SMOKING/TOBACCO VISIT 3-10 MIN
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
900201906
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.25
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.28
|
| Rate for Payer: Heritage Provider Network Senior |
$62.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
|
|
HC SM (SMITH) ANTIBODY
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.12
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.77
|
| Rate for Payer: Heritage Provider Network Senior |
$115.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
|
|
HC SM (SMITH) ANTIBODY
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$105.85
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$81.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SOA 55284 CYSTICER AB IGG
|
Facility
|
IP
|
$59.10
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$44.33 |
| Rate for Payer: Adventist Health Commercial |
$11.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.06
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.01
|
| Rate for Payer: Heritage Provider Network Senior |
$40.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.78
|
| Rate for Payer: Multiplan Commercial |
$44.33
|
|
