|
HC AMPUTATION FINGER/THUMB SNGL
|
Facility
|
OP
|
$6,591.00
|
|
|
Service Code
|
CPT 26910
|
| Hospital Charge Code |
900501259
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,318.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,528.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$3,625.05
|
| Rate for Payer: Cash Price |
$3,625.05
|
| Rate for Payer: Cash Price |
$3,625.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,284.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Senior |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,122.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,462.11
|
| Rate for Payer: Heritage Provider Network Senior |
$4,462.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,143.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,192.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,740.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,647.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,194.48
|
| Rate for Payer: Multiplan Commercial |
$4,943.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,371.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,182.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC AMPUTATION FINGER/THUMB SNGL
|
Facility
|
IP
|
$6,591.00
|
|
|
Service Code
|
CPT 26910
|
| Hospital Charge Code |
900501259
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,192.97 |
| Max. Negotiated Rate |
$4,943.25 |
| Rate for Payer: Adventist Health Commercial |
$1,318.20
|
| Rate for Payer: Cash Price |
$3,625.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,462.11
|
| Rate for Payer: Heritage Provider Network Senior |
$4,462.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,192.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,647.75
|
| Rate for Payer: Multiplan Commercial |
$4,943.25
|
|
|
HC AMPUTATION FINGER/THUMB W/V-Y
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
900501462
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
|
|
HC AMPUTATION FINGER/THUMB W/V-Y
|
Facility
|
OP
|
$3,990.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
900501462
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,741.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,593.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Senior |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,122.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,903.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,740.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,194.48
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,435.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,321.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC AMPUTATION OF TOE
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
900501402
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,503.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,315.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Senior |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,122.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,452.70
|
| Rate for Payer: Heritage Provider Network Senior |
$3,452.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,432.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,740.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,194.48
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,834.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,688.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC AMPUTATION OF TOE
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
900501402
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$923.10 |
| Max. Negotiated Rate |
$3,825.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,452.70
|
| Rate for Payer: Heritage Provider Network Senior |
$3,452.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.00
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
|
|
HC AMYLASE
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.67
|
| Rate for Payer: Heritage Provider Network Senior |
$174.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
|
|
HC AMYLASE
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$137.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.25
|
| Rate for Payer: Blue Shield of California Commercial |
$52.19
|
| Rate for Payer: Blue Shield of California EPN |
$41.86
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$167.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Senior |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.70
|
| Rate for Payer: Heritage Provider Network Senior |
$159.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$123.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE BODY FLUID
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910242
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.25
|
| Rate for Payer: Blue Shield of California Commercial |
$52.19
|
| Rate for Payer: Blue Shield of California EPN |
$41.86
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Senior |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.66
|
| Rate for Payer: Heritage Provider Network Senior |
$34.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE BODY FLUID
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910242
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.91
|
| Rate for Payer: Heritage Provider Network Senior |
$37.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
|
|
HC AMYLASE URINE
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.67
|
| Rate for Payer: Heritage Provider Network Senior |
$174.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
|
|
HC AMYLASE URINE
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$137.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.25
|
| Rate for Payer: Blue Shield of California Commercial |
$52.19
|
| Rate for Payer: Blue Shield of California EPN |
$41.86
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$167.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Senior |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.70
|
| Rate for Payer: Heritage Provider Network Senior |
$159.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$123.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE URINE 24 HOURS
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900912194
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$137.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.25
|
| Rate for Payer: Blue Shield of California Commercial |
$52.19
|
| Rate for Payer: Blue Shield of California EPN |
$41.86
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$167.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Senior |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.70
|
| Rate for Payer: Heritage Provider Network Senior |
$159.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$123.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE URINE 24 HOURS
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900912194
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.67
|
| Rate for Payer: Heritage Provider Network Senior |
$174.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
|
|
HC AMYLASE URINE RANDOM
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900912193
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.67
|
| Rate for Payer: Heritage Provider Network Senior |
$174.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
|
|
HC AMYLASE URINE RANDOM
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900912193
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$137.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.25
|
| Rate for Payer: Blue Shield of California Commercial |
$52.19
|
| Rate for Payer: Blue Shield of California EPN |
$41.86
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$167.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Senior |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.70
|
| Rate for Payer: Heritage Provider Network Senior |
$159.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$123.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC ANAEROBIC MIC PANEL
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.65 |
| Max. Negotiated Rate |
$234.75 |
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Cash Price |
$172.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.90
|
| Rate for Payer: Heritage Provider Network Senior |
$211.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.25
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
|
|
HC ANAEROBIC MIC PANEL
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$234.75 |
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$167.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$215.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.92
|
| Rate for Payer: Blue Shield of California Commercial |
$69.58
|
| Rate for Payer: Blue Shield of California EPN |
$55.81
|
| Rate for Payer: Cash Price |
$172.15
|
| Rate for Payer: Cash Price |
$172.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$203.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Senior |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.75
|
| Rate for Payer: Heritage Provider Network Senior |
$193.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$149.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.90
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.65
|
| Rate for Payer: TriValley Medical Group Senior |
$8.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC ANA PANEL
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913646
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$144.35 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.03
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.85
|
| Rate for Payer: Heritage Provider Network Senior |
$105.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.59
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC ANA PANEL
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913646
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.77
|
| Rate for Payer: Heritage Provider Network Senior |
$115.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
|
|
HC ANESTHESIA LEVEL I 1ST 15MIN
|
Facility
|
IP
|
$1,089.00
|
|
| Hospital Charge Code |
904900400
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$197.11 |
| Max. Negotiated Rate |
$816.75 |
| Rate for Payer: Adventist Health Commercial |
$217.80
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.25
|
| Rate for Payer: Heritage Provider Network Senior |
$737.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.25
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
|
|
HC ANESTHESIA LEVEL I 1ST 15MIN
|
Facility
|
OP
|
$1,089.00
|
|
| Hospital Charge Code |
904900400
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$197.11 |
| Max. Negotiated Rate |
$925.65 |
| Rate for Payer: Adventist Health Commercial |
$217.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$582.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$748.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$925.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$598.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$816.75
|
| Rate for Payer: Blue Shield of California Commercial |
$664.29
|
| Rate for Payer: Blue Shield of California EPN |
$531.43
|
| Rate for Payer: Cash Price |
$598.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$707.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$925.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$925.65
|
| Rate for Payer: Dignity Health Senior |
$925.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$707.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$674.09
|
| Rate for Payer: Heritage Provider Network Senior |
$674.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$519.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$762.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$762.30
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$544.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$544.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$925.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$925.65
|
| Rate for Payer: Vantage Medical Group Senior |
$925.65
|
|
|
HC ANESTHESIA LEVEL I ADD'L 15MIN
|
Facility
|
IP
|
$268.00
|
|
| Hospital Charge Code |
904900401
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.44
|
| Rate for Payer: Heritage Provider Network Senior |
$181.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
|
|
HC ANESTHESIA LEVEL I ADD'L 15MIN
|
Facility
|
OP
|
$268.00
|
|
| Hospital Charge Code |
904900401
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$143.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Blue Shield of California Commercial |
$163.48
|
| Rate for Payer: Blue Shield of California EPN |
$130.78
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$174.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Senior |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.89
|
| Rate for Payer: Heritage Provider Network Senior |
$165.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$127.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$134.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$134.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC ANESTHESIA LEVEL II 1ST 15MIN
|
Facility
|
OP
|
$2,597.00
|
|
| Hospital Charge Code |
904900402
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$470.06 |
| Max. Negotiated Rate |
$2,207.45 |
| Rate for Payer: Adventist Health Commercial |
$519.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,388.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,784.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,207.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,428.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,947.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,584.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,267.34
|
| Rate for Payer: Cash Price |
$1,428.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,688.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,207.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,207.45
|
| Rate for Payer: Dignity Health Senior |
$2,207.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,688.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,607.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,607.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,238.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,817.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,817.90
|
| Rate for Payer: Multiplan Commercial |
$1,947.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,298.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,298.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,207.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,207.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,207.45
|
|
