|
HC SOUOC NSD1 DEL/DUP
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 81407
|
| Hospital Charge Code |
900914719
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$95.03 |
| Max. Negotiated Rate |
$393.75 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$355.43
|
| Rate for Payer: Heritage Provider Network Senior |
$355.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.25
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
|
|
HC SOUOC NSD1 SEQ
|
Facility
|
OP
|
$2,425.00
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914718
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$282.88 |
| Max. Negotiated Rate |
$2,194.72 |
| Rate for Payer: Adventist Health Commercial |
$485.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,296.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,665.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,194.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,479.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,183.40
|
| Rate for Payer: Cash Price |
$1,091.25
|
| Rate for Payer: Cash Price |
$1,091.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,576.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.17
|
| Rate for Payer: Dignity Health Senior |
$282.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,576.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$282.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,501.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,501.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$458.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$282.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,156.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$606.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$356.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$356.43
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$282.88
|
| Rate for Payer: TriValley Medical Group Senior |
$282.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$305.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$305.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Vantage Medical Group Senior |
$282.88
|
|
|
HC SOUOC NSD1 SEQ
|
Facility
|
IP
|
$2,425.00
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914718
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$438.93 |
| Max. Negotiated Rate |
$1,818.75 |
| Rate for Payer: Adventist Health Commercial |
$485.00
|
| Rate for Payer: Cash Price |
$1,091.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,641.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,641.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$606.25
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 1
|
Facility
|
IP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915332
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$14.38 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.98
|
| Rate for Payer: Heritage Provider Network Senior |
$12.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$14.38
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 1
|
Facility
|
OP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915332
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.60
|
| Rate for Payer: Dignity Health Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.87
|
| Rate for Payer: Heritage Provider Network Senior |
$11.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.85
|
| Rate for Payer: Multiplan Commercial |
$14.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 2
|
Facility
|
IP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$14.38 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.98
|
| Rate for Payer: Heritage Provider Network Senior |
$12.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$14.38
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 2
|
Facility
|
OP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.60
|
| Rate for Payer: Dignity Health Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.87
|
| Rate for Payer: Heritage Provider Network Senior |
$11.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.85
|
| Rate for Payer: Multiplan Commercial |
$14.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 3
|
Facility
|
IP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$14.38 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.98
|
| Rate for Payer: Heritage Provider Network Senior |
$12.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$14.38
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 3
|
Facility
|
OP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.60
|
| Rate for Payer: Dignity Health Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.87
|
| Rate for Payer: Heritage Provider Network Senior |
$11.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.85
|
| Rate for Payer: Multiplan Commercial |
$14.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 4
|
Facility
|
IP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$14.38 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.98
|
| Rate for Payer: Heritage Provider Network Senior |
$12.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$14.38
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 4
|
Facility
|
OP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.60
|
| Rate for Payer: Dignity Health Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.87
|
| Rate for Payer: Heritage Provider Network Senior |
$11.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.85
|
| Rate for Payer: Multiplan Commercial |
$14.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 5
|
Facility
|
OP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.60
|
| Rate for Payer: Dignity Health Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.87
|
| Rate for Payer: Heritage Provider Network Senior |
$11.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.85
|
| Rate for Payer: Multiplan Commercial |
$14.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 5
|
Facility
|
IP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$14.38 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.98
|
| Rate for Payer: Heritage Provider Network Senior |
$12.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$14.38
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 6
|
Facility
|
OP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.60
|
| Rate for Payer: Dignity Health Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.87
|
| Rate for Payer: Heritage Provider Network Senior |
$11.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.85
|
| Rate for Payer: Multiplan Commercial |
$14.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 6
|
Facility
|
IP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$14.38 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.98
|
| Rate for Payer: Heritage Provider Network Senior |
$12.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$14.38
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 7
|
Facility
|
IP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$14.38 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.98
|
| Rate for Payer: Heritage Provider Network Senior |
$12.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$14.38
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 7
|
Facility
|
OP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.60
|
| Rate for Payer: Dignity Health Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.87
|
| Rate for Payer: Heritage Provider Network Senior |
$11.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.85
|
| Rate for Payer: Multiplan Commercial |
$14.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 8
|
Facility
|
IP
|
$19.21
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$14.41 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.01
|
| Rate for Payer: Heritage Provider Network Senior |
$13.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$14.41
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 8
|
Facility
|
OP
|
$19.21
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.60
|
| Rate for Payer: Dignity Health Senior |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.49
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.89
|
| Rate for Payer: Heritage Provider Network Senior |
$11.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.85
|
| Rate for Payer: Multiplan Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
HC SPCL TRT PROC LG SGL RAD DOSE
|
Facility
|
OP
|
$4,409.00
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
909100313
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$188.31 |
| Max. Negotiated Rate |
$3,306.75 |
| Rate for Payer: Adventist Health Commercial |
$881.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,356.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,028.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,535.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2,345.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,886.23
|
| Rate for Payer: Cash Price |
$1,984.05
|
| Rate for Payer: Cash Price |
$1,984.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,865.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.50
|
| Rate for Payer: Dignity Health Senior |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,865.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$735.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,729.17
|
| Rate for Payer: Heritage Provider Network Senior |
$2,729.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$188.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,103.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$798.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$845.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$926.10
|
| Rate for Payer: Multiplan Commercial |
$3,306.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$624.75
|
| Rate for Payer: TriValley Medical Group Senior |
$624.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,204.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,204.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Vantage Medical Group Senior |
$735.00
|
|
|
HC SPCL TRT PROC LG SGL RAD DOSE
|
Facility
|
IP
|
$4,409.00
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
909100313
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$798.03 |
| Max. Negotiated Rate |
$3,306.75 |
| Rate for Payer: Adventist Health Commercial |
$881.80
|
| Rate for Payer: Cash Price |
$1,984.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,984.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,984.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$798.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.25
|
| Rate for Payer: Multiplan Commercial |
$3,306.75
|
|
|
HC SPEC GRAVITY HEMATOLOGY
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910178
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.16
|
| Rate for Payer: Heritage Provider Network Senior |
$54.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
|
|
HC SPEC GRAVITY HEMATOLOGY
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910178
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$21.70 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.70
|
| Rate for Payer: Blue Shield of California Commercial |
$20.56
|
| Rate for Payer: Blue Shield of California EPN |
$16.49
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Senior |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.48
|
| Rate for Payer: TriValley Medical Group Senior |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC SPECIAL STAINS, GROUP 1
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$96.29 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Adventist Health Commercial |
$106.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$360.16
|
| Rate for Payer: Heritage Provider Network Senior |
$360.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$399.00
|
|
|
HC SPECIAL STAINS, GROUP 1
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$225.65 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$79.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.17
|
| Rate for Payer: Blue Shield of California Commercial |
$225.65
|
| Rate for Payer: Blue Shield of California EPN |
$181.46
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Senior |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.61
|
| Rate for Payer: Heritage Provider Network Senior |
$91.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.54
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.89
|
| Rate for Payer: TriValley Medical Group Senior |
$67.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
