|
HC SOSTL ABPA ALLERG SP IGG
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900914780
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$43.73 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.73
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| 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 |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$7.82
|
| Rate for Payer: IEHP Medi-Cal |
$8.86
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| 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 |
$18.75
|
| 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 SOSTL ABPA INTERP
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
CPT 95199
|
| Hospital Charge Code |
900914782
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC SOSTL ABPA INTERP
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 95199
|
| Hospital Charge Code |
900914782
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$70.68 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Blue Shield of California Commercial |
$31.05
|
| Rate for Payer: Blue Shield of California EPN |
$29.35
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Humana Medicare |
$37.20
|
| Rate for Payer: IEHP Medi-Cal |
$7.96
|
| Rate for Payer: IEHP Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.87
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Senior |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC SOSTL ABPA PRECIP AB
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
900914781
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.30
|
| Rate for Payer: Blue Shield of California Commercial |
$93.63
|
| Rate for Payer: Blue Shield of California EPN |
$73.20
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Humana Medicare |
$11.98
|
| Rate for Payer: IEHP Medi-Cal |
$9.20
|
| Rate for Payer: IEHP Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOSTL ABPA PRECIP AB
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
900914781
|
|
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 SOSTL ABPA TOTAL IGE
|
Facility
IP
|
$75.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
900914778
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.52
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.78
|
| Rate for Payer: Heritage Provider Network Senior |
$50.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
|
|
HC SOSTL ABPA TOTAL IGE
|
Facility
OP
|
$75.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
900914778
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$137.83 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.83
|
| Rate for Payer: Blue Shield of California Commercial |
$128.63
|
| Rate for Payer: Blue Shield of California EPN |
$100.55
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.11
|
| Rate for Payer: Dignity Health Senior |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.42
|
| Rate for Payer: Heritage Provider Network Senior |
$46.42
|
| Rate for Payer: Humana Medicare |
$16.46
|
| Rate for Payer: IEHP Medi-Cal |
$22.78
|
| Rate for Payer: IEHP Medicare Advantage |
$16.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.46
|
| Rate for Payer: TriValley Medical Group Senior |
$16.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.11
|
| Rate for Payer: Vantage Medical Group Senior |
$16.46
|
|
|
HC SOUCI METHOTREXATE
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 80229
|
| Hospital Charge Code |
900915251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.24
|
| Rate for Payer: Heritage Provider Network Senior |
$37.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC SOUCI METHOTREXATE
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 80229
|
| Hospital Charge Code |
900915251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$46.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.25
|
| Rate for Payer: Blue Shield of California Commercial |
$34.16
|
| Rate for Payer: Blue Shield of California EPN |
$32.28
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.75
|
| Rate for Payer: Dignity Health Senior |
$46.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.04
|
| Rate for Payer: Heritage Provider Network Senior |
$34.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: Vantage Medical Group Senior |
$46.75
|
|
|
HC SOUOC NSD1 DEL/DUP
|
Facility
IP
|
$525.00
|
|
|
Service Code
|
CPT 81407
|
| Hospital Charge Code |
900914719
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$95.02 |
| Max. Negotiated Rate |
$393.75 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$360.68
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$355.42
|
| Rate for Payer: Heritage Provider Network Senior |
$355.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.25
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
|
|
HC SOUOC NSD1 DEL/DUP
|
Facility
OP
|
$525.00
|
|
|
Service Code
|
CPT 81407
|
| Hospital Charge Code |
900914719
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$95.02 |
| Max. Negotiated Rate |
$16,220.69 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,751.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$360.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,269.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$930.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$846.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,220.69
|
| Rate for Payer: Blue Shield of California Commercial |
$326.02
|
| Rate for Payer: Blue Shield of California EPN |
$308.18
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$341.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,269.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.90
|
| Rate for Payer: Dignity Health Senior |
$846.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$846.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.98
|
| Rate for Payer: Heritage Provider Network Senior |
$324.98
|
| Rate for Payer: Humana Medicare |
$846.27
|
| Rate for Payer: IEHP Medi-Cal |
$1,320.18
|
| Rate for Payer: IEHP Medicare Advantage |
$846.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,607.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$998.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,066.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,066.30
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$846.27
|
| Rate for Payer: TriValley Medical Group Senior |
$846.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$913.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$913.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,269.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.90
|
| Rate for Payer: Vantage Medical Group Senior |
$846.27
|
|
|
HC SOUOC NSD1 SEQ
|
Facility
IP
|
$2,425.00
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914718
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$438.92 |
| Max. Negotiated Rate |
$1,818.75 |
| Rate for Payer: Adventist Health Commercial |
$485.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,665.98
|
| 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 |
$438.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$606.25
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
|
|
HC SOUOC NSD1 SEQ
|
Facility
OP
|
$2,425.00
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914718
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$145.45 |
| Max. Negotiated Rate |
$2,012.18 |
| Rate for Payer: Adventist Health Commercial |
$485.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$145.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,665.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$282.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,012.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,505.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,423.48
|
| 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: Humana Medicare |
$282.88
|
| Rate for Payer: IEHP Medi-Cal |
$441.29
|
| Rate for Payer: IEHP Medicare Advantage |
$282.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$537.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$333.80
|
| 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 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: Aetna of CA Non-Gatekeeper |
$13.17
|
| 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 |
$43.73 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.73
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| 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: Humana Medicare |
$7.82
|
| Rate for Payer: IEHP Medi-Cal |
$8.86
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.23
|
| 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
OP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$43.73 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.73
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| 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: Humana Medicare |
$7.82
|
| Rate for Payer: IEHP Medi-Cal |
$8.86
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.23
|
| 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: Aetna of CA Non-Gatekeeper |
$13.17
|
| 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 |
$43.73 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.73
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| 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: Humana Medicare |
$7.82
|
| Rate for Payer: IEHP Medi-Cal |
$8.86
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.23
|
| 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: Aetna of CA Non-Gatekeeper |
$13.17
|
| 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 |
$43.73 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.73
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| 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: Humana Medicare |
$7.82
|
| Rate for Payer: IEHP Medi-Cal |
$8.86
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.23
|
| 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: Aetna of CA Non-Gatekeeper |
$13.17
|
| 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 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: Aetna of CA Non-Gatekeeper |
$13.17
|
| 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 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 |
$43.73 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.73
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| 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: Humana Medicare |
$7.82
|
| Rate for Payer: IEHP Medi-Cal |
$8.86
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.23
|
| 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
OP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$43.73 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.73
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| 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: Humana Medicare |
$7.82
|
| Rate for Payer: IEHP Medi-Cal |
$8.86
|
| Rate for Payer: IEHP Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.23
|
| 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: Aetna of CA Non-Gatekeeper |
$13.17
|
| 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
|
|
