|
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: Aetna of CA Non-Gatekeeper |
$1,561.70
|
| 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 Foundation Hospitals Medi-Cal |
$438.93
|
| 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 |
$282.88 |
| Max. Negotiated Rate |
$2,282.53 |
| Rate for Payer: Adventist Health Commercial |
$485.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,498.65
|
| 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 |
$2,282.53
|
| 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 Medicare Advantage |
$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) Medicare Advantage |
$282.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,156.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$438.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$325.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$606.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$379.06
|
| 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
|
OP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915332
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$49.60 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.85
|
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| 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 |
$49.60
|
| 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 Medicare Advantage |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.31
|
| 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) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.48
|
| 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 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 |
$12.35
|
| 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 Foundation Hospitals 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
|
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 |
$12.35
|
| 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 Foundation Hospitals 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 |
$49.60 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.85
|
| 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 |
$49.60
|
| 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 Medicare Advantage |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.31
|
| 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) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.48
|
| 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
|
OP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$49.60 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.85
|
| 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 |
$49.60
|
| 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 Medicare Advantage |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.31
|
| 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) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.48
|
| 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 |
$12.35
|
| 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 Foundation Hospitals 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
|
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 |
$12.35
|
| 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 Foundation Hospitals 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 |
$49.60 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.85
|
| 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 |
$49.60
|
| 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 Medicare Advantage |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.31
|
| 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) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.48
|
| 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 |
$49.60 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.85
|
| 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 |
$49.60
|
| 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 Medicare Advantage |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.31
|
| 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) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.48
|
| 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: Aetna of CA Non-Gatekeeper |
$12.35
|
| 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 Foundation Hospitals 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 |
$49.60 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.85
|
| 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 |
$49.60
|
| 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 Medicare Advantage |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.31
|
| 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) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.48
|
| 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 |
$12.35
|
| 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 Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$12.35
|
| 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 Foundation Hospitals 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 |
$49.60 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.85
|
| 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 |
$49.60
|
| 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 Medicare Advantage |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.31
|
| 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) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.48
|
| 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: Aetna of CA Non-Gatekeeper |
$12.37
|
| 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 Foundation Hospitals 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 |
$49.60 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.87
|
| 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 |
$49.60
|
| 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 Medicare Advantage |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.33
|
| 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) Medicare Advantage |
$7.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.48
|
| 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
|
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: Aetna of CA Non-Gatekeeper |
$2,839.40
|
| 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 Foundation Hospitals 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 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 |
$604.06 |
| Max. Negotiated Rate |
$3,306.75 |
| Rate for Payer: Adventist Health Commercial |
$881.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,724.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$781.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$710.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,636.85
|
| 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 |
$1,065.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$781.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$710.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,865.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$710.66
|
| 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) Medicare Advantage |
$710.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,103.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$798.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$817.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$952.28
|
| Rate for Payer: Multiplan Commercial |
$3,306.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$604.06
|
| Rate for Payer: TriValley Medical Group Senior |
$604.06
|
| 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 |
$1,065.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$781.73
|
| Rate for Payer: Vantage Medical Group Senior |
$710.66
|
|
|
HC SPEC DOSIMETRY-TLD MICRO
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
904810814
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$83.53 |
| Max. Negotiated Rate |
$1,317.00 |
| Rate for Payer: Adventist Health Commercial |
$351.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,085.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.18
|
| Rate for Payer: Blue Shield of California Commercial |
$103.87
|
| Rate for Payer: Blue Shield of California EPN |
$83.53
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,141.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,141.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$172.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,086.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,086.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$837.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$317.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$231.65
|
| Rate for Payer: Multiplan Commercial |
$1,317.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$146.94
|
| Rate for Payer: TriValley Medical Group Senior |
$146.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$878.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$878.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Vantage Medical Group Senior |
$172.87
|
|
|
HC SPEC DOSIMETRY-TLD MICRO
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
904810814
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$317.84 |
| Max. Negotiated Rate |
$1,317.00 |
| Rate for Payer: Adventist Health Commercial |
$351.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,130.86
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$317.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.00
|
| Rate for Payer: Multiplan Commercial |
$1,317.00
|
|
|
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: Aetna of CA Non-Gatekeeper |
$51.52
|
| 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 Foundation Hospitals 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
|
$80.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910178
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.22
|
| 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 Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.56
|
| Rate for Payer: Blue Shield of California Commercial |
$20.56
|
| Rate for Payer: Blue Shield of California Commercial |
$20.56
|
| Rate for Payer: Blue Shield of California EPN |
$16.49
|
| Rate for Payer: Blue Shield of California EPN |
$16.49
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| 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: Cigna of CA HMO/PPO |
$52.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.52
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$49.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$38.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.48
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$3.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC SPECIAL STAINS, GROUP 1
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$91.46
|
| Rate for Payer: Adventist Health Commercial |
$106.40
|
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$328.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.25
|
| Rate for Payer: Blue Shield of California Commercial |
$225.65
|
| Rate for Payer: Blue Shield of California Commercial |
$225.65
|
| Rate for Payer: Blue Shield of California EPN |
$181.46
|
| Rate for Payer: Blue Shield of California EPN |
$181.46
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| 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: Cigna of CA HMO/PPO |
$345.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.31
|
| Rate for Payer: Heritage Provider Network Senior |
$91.61
|
| Rate for Payer: Heritage Provider Network Senior |
$329.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$70.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$253.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Multiplan Commercial |
$399.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.02
|
| Rate for Payer: TriValley Medical Group Senior |
$67.02
|
| Rate for Payer: TriValley Medical Group Senior |
$67.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.82
|
| 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: United Healthcare Navigate/Select/Select+ |
$54.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
