|
HC TOMOGRAPHY SINGLE PLANE BODY SEC
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
CPT 76100
|
| Hospital Charge Code |
909001551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$648.75 |
| Rate for Payer: Adventist Health Commercial |
$173.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$534.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$341.60
|
| Rate for Payer: Blue Shield of California Commercial |
$262.61
|
| Rate for Payer: Blue Shield of California EPN |
$211.18
|
| Rate for Payer: Cash Price |
$389.25
|
| Rate for Payer: Cash Price |
$389.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$562.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$535.43
|
| Rate for Payer: Heritage Provider Network Senior |
$535.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$412.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$648.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC TOTAL BODY THYROID SCAN
|
Facility
|
IP
|
$3,016.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
909301317
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$545.90 |
| Max. Negotiated Rate |
$2,262.00 |
| Rate for Payer: Adventist Health Commercial |
$603.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,942.30
|
| Rate for Payer: Cash Price |
$1,357.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,041.83
|
| Rate for Payer: Heritage Provider Network Senior |
$2,041.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$545.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.00
|
| Rate for Payer: Multiplan Commercial |
$2,262.00
|
|
|
HC TOTAL BODY THYROID SCAN
|
Facility
|
OP
|
$3,016.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
909301317
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$545.90 |
| Max. Negotiated Rate |
$2,262.00 |
| Rate for Payer: Adventist Health Commercial |
$603.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,863.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,508.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,142.78
|
| Rate for Payer: Blue Shield of California EPN |
$918.99
|
| Rate for Payer: Cash Price |
$1,357.20
|
| Rate for Payer: Cash Price |
$1,357.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,960.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,960.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$698.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,866.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,866.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,438.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$545.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$803.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$2,262.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$768.18
|
| Rate for Payer: TriValley Medical Group Senior |
$698.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,508.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,508.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC TOTAL CONTACT CAST LEG
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
900101505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.98
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.91
|
| Rate for Payer: Heritage Provider Network Senior |
$408.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
|
|
HC TOTAL CONTACT CAST LEG
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
900101505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$368.44
|
| Rate for Payer: Blue Shield of California EPN |
$294.75
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$392.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$395.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$359.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$373.88
|
| Rate for Payer: Heritage Provider Network Senior |
$373.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$359.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$288.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$413.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$395.70
|
| Rate for Payer: TriValley Medical Group Senior |
$395.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$302.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$302.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Vantage Medical Group Senior |
$359.73
|
|
|
HC TOTAL HEMOGLOBIN
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
900912031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.44
|
| Rate for Payer: Blue Shield of California Commercial |
$19.07
|
| Rate for Payer: Blue Shield of California Commercial |
$19.07
|
| Rate for Payer: Blue Shield of California EPN |
$15.29
|
| Rate for Payer: Blue Shield of California EPN |
$15.29
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.37
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.76
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$11.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.37
|
| Rate for Payer: TriValley Medical Group Senior |
$2.37
|
| Rate for Payer: TriValley Medical Group Senior |
$2.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Vantage Medical Group Senior |
$2.37
|
| Rate for Payer: Vantage Medical Group Senior |
$2.37
|
|
|
HC TOTAL HEMOGLOBIN
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
900912031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.24
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.86
|
| Rate for Payer: Heritage Provider Network Senior |
$12.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
|
|
HC TOTAL LUNG LAVAGE UNILATERAL
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
CPT 32997
|
| Hospital Charge Code |
900803550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$356.21 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Adventist Health Commercial |
$393.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,267.39
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,332.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,332.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$356.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.00
|
| Rate for Payer: Multiplan Commercial |
$1,476.00
|
|
|
HC TOTAL LUNG LAVAGE UNILATERAL
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
CPT 32997
|
| Hospital Charge Code |
900803550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$356.21 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$393.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,216.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,672.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,082.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,476.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,200.48
|
| Rate for Payer: Blue Shield of California EPN |
$960.38
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,279.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,672.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,672.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,672.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,218.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,218.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$938.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$356.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,377.60
|
| Rate for Payer: Multiplan Commercial |
$1,476.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$984.00
|
| Rate for Payer: TriValley Medical Group Senior |
$984.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,672.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,672.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,672.80
|
|
|
HC TOXOABG
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900913713
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.59
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
|
|
HC TOXOABG
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900913713
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$142.35 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.35
|
| Rate for Payer: Blue Shield of California Commercial |
$120.67
|
| Rate for Payer: Blue Shield of California Commercial |
$120.67
|
| Rate for Payer: Blue Shield of California EPN |
$96.79
|
| Rate for Payer: Blue Shield of California EPN |
$96.79
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.99
|
| Rate for Payer: TriValley Medical Group Senior |
$14.99
|
| Rate for Payer: TriValley Medical Group Senior |
$14.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC TOXOABM
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900913714
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$141.40 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.40
|
| Rate for Payer: Blue Shield of California Commercial |
$115.89
|
| Rate for Payer: Blue Shield of California Commercial |
$115.89
|
| Rate for Payer: Blue Shield of California EPN |
$92.95
|
| Rate for Payer: Blue Shield of California EPN |
$92.95
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.31
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Senior |
$14.41
|
| Rate for Payer: TriValley Medical Group Senior |
$14.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC TOXOABM
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900913714
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.59
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
|
|
HC TOXOPLASMA AB IGG
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900910989
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$208.50 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.03
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.21
|
| Rate for Payer: Heritage Provider Network Senior |
$188.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.50
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
|
|
HC TOXOPLASMA AB IGG
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900910989
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$208.50 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$80.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.22
|
| Rate for Payer: Blue Shield of California Commercial |
$115.83
|
| Rate for Payer: Blue Shield of California Commercial |
$115.83
|
| Rate for Payer: Blue Shield of California EPN |
$92.91
|
| Rate for Payer: Blue Shield of California EPN |
$92.91
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$180.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.08
|
| Rate for Payer: Heritage Provider Network Senior |
$80.47
|
| Rate for Payer: Heritage Provider Network Senior |
$172.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$62.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$132.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC TOXOPLASMA AB IGM
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900912320
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$208.50 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$179.03
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.21
|
| Rate for Payer: Heritage Provider Network Senior |
$188.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.50
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
|
|
HC TOXOPLASMA AB IGM
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900912320
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$208.50 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$80.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.40
|
| Rate for Payer: Blue Shield of California Commercial |
$115.89
|
| Rate for Payer: Blue Shield of California Commercial |
$115.89
|
| Rate for Payer: Blue Shield of California EPN |
$92.95
|
| Rate for Payer: Blue Shield of California EPN |
$92.95
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$180.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.08
|
| Rate for Payer: Heritage Provider Network Senior |
$80.47
|
| Rate for Payer: Heritage Provider Network Senior |
$172.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$62.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$132.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.31
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Senior |
$14.41
|
| Rate for Payer: TriValley Medical Group Senior |
$14.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC TOXOPLASMA ANTIBODY IGG
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900913667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$136.22 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.22
|
| Rate for Payer: Blue Shield of California Commercial |
$115.83
|
| Rate for Payer: Blue Shield of California Commercial |
$115.83
|
| Rate for Payer: Blue Shield of California EPN |
$92.91
|
| Rate for Payer: Blue Shield of California EPN |
$92.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC TOXOPLASMA ANTIBODY IGG
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900913667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
|
HC TOXOPLASMA ANTIBODY IGM
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900913668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
|
HC TOXOPLASMA ANTIBODY IGM
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900913668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$141.40 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.40
|
| Rate for Payer: Blue Shield of California Commercial |
$115.89
|
| Rate for Payer: Blue Shield of California Commercial |
$115.89
|
| Rate for Payer: Blue Shield of California EPN |
$92.95
|
| Rate for Payer: Blue Shield of California EPN |
$92.95
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.31
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Senior |
$14.41
|
| Rate for Payer: TriValley Medical Group Senior |
$14.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC TPN/QUINTON CATH DUAL
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$255.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$351.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$227.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$166.43
|
| Rate for Payer: Blue Shield of California EPN |
$166.43
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$190.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$351.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$351.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$351.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$191.68
|
| Rate for Payer: Heritage Provider Network Senior |
$191.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$207.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$207.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$289.80
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$149.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$351.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$351.90
|
| Rate for Payer: Vantage Medical Group Senior |
$351.90
|
|
|
HC TPN/QUINTON CATH DUAL
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$266.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$166.43
|
| Rate for Payer: Blue Shield of California EPN |
$166.43
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$190.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$191.68
|
| Rate for Payer: Heritage Provider Network Senior |
$191.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$207.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$207.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$149.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.08
|
|
|
HC TPN/QUINTON CATH SIMPLE
|
Facility
|
IP
|
$393.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$78.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$253.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$158.23
|
| Rate for Payer: Blue Shield of California EPN |
$158.23
|
| Rate for Payer: Cash Price |
$177.12
|
| Rate for Payer: Cash Price |
$177.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$181.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.24
|
| Rate for Payer: Heritage Provider Network Senior |
$182.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$196.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Multiplan Commercial |
$295.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$142.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$130.32
|
|
|
HC TPN/QUINTON CATH SIMPLE
|
Facility
|
OP
|
$393.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Cash Price |
$177.12
|
| Rate for Payer: Adventist Health Commercial |
$78.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$243.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$334.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$158.23
|
| Rate for Payer: Blue Shield of California EPN |
$158.23
|
| Rate for Payer: Cash Price |
$177.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$181.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$334.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$334.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$334.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$251.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.24
|
| Rate for Payer: Heritage Provider Network Senior |
$182.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$196.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$275.52
|
| Rate for Payer: Multiplan Commercial |
$295.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$142.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$130.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$334.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$334.56
|
| Rate for Payer: Vantage Medical Group Senior |
$334.56
|
|
