|
HC AMPUTATION OF TOE
|
Facility
IP
|
$4,668.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
900501402
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$844.91 |
| Max. Negotiated Rate |
$3,501.00 |
| Rate for Payer: Adventist Health Commercial |
$933.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,206.92
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,160.24
|
| Rate for Payer: Heritage Provider Network Senior |
$3,160.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$844.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,167.00
|
| Rate for Payer: Multiplan Commercial |
$3,501.00
|
|
|
HC AMYLASE
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.32
|
| Rate for Payer: Blue Shield of California Commercial |
$50.65
|
| Rate for Payer: Blue Shield of California EPN |
$39.59
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| 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 |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$6.48
|
| Rate for Payer: IEHP Medi-Cal |
$8.94
|
| Rate for Payer: IEHP Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| 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 |
$12.75
|
| 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
|
Facility
IP
|
$233.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$174.75 |
| Rate for Payer: Adventist Health Commercial |
$46.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.07
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.74
|
| Rate for Payer: Heritage Provider Network Senior |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.25
|
| Rate for Payer: Multiplan Commercial |
$174.75
|
|
|
HC AMYLASE BODY FLUID
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910242
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC AMYLASE BODY FLUID
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910242
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.32
|
| Rate for Payer: Blue Shield of California Commercial |
$50.65
|
| Rate for Payer: Blue Shield of California EPN |
$39.59
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| 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 |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$6.48
|
| Rate for Payer: IEHP Medi-Cal |
$8.94
|
| Rate for Payer: IEHP Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| 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 |
$12.75
|
| 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
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.32
|
| Rate for Payer: Blue Shield of California Commercial |
$50.65
|
| Rate for Payer: Blue Shield of California EPN |
$39.59
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$6.48
|
| Rate for Payer: IEHP Medi-Cal |
$8.94
|
| Rate for Payer: IEHP Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| 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 |
$18.75
|
| 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
|
Facility
IP
|
$233.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$174.75 |
| Rate for Payer: Adventist Health Commercial |
$46.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.07
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.74
|
| Rate for Payer: Heritage Provider Network Senior |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.25
|
| Rate for Payer: Multiplan Commercial |
$174.75
|
|
|
HC AMYLASE URINE 24 HOURS
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900912194
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.32
|
| Rate for Payer: Blue Shield of California Commercial |
$50.65
|
| Rate for Payer: Blue Shield of California EPN |
$39.59
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$6.48
|
| Rate for Payer: IEHP Medi-Cal |
$8.94
|
| Rate for Payer: IEHP Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| 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 |
$18.75
|
| 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
|
$233.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900912194
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$174.75 |
| Rate for Payer: Adventist Health Commercial |
$46.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.07
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.74
|
| Rate for Payer: Heritage Provider Network Senior |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.25
|
| Rate for Payer: Multiplan Commercial |
$174.75
|
|
|
HC AMYLASE URINE RANDOM
|
Facility
IP
|
$233.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900912193
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$174.75 |
| Rate for Payer: Adventist Health Commercial |
$46.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.07
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.74
|
| Rate for Payer: Heritage Provider Network Senior |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.25
|
| Rate for Payer: Multiplan Commercial |
$174.75
|
|
|
HC AMYLASE URINE RANDOM
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900912193
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.32
|
| Rate for Payer: Blue Shield of California Commercial |
$50.65
|
| Rate for Payer: Blue Shield of California EPN |
$39.59
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$6.48
|
| Rate for Payer: IEHP Medi-Cal |
$8.94
|
| Rate for Payer: IEHP Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| 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 |
$18.75
|
| 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
|
$320.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.92 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$219.84
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.64
|
| Rate for Payer: Heritage Provider Network Senior |
$216.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
|
|
HC ANAEROBIC MIC PANEL
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$72.35 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.35
|
| Rate for Payer: Blue Shield of California Commercial |
$67.53
|
| Rate for Payer: Blue Shield of California EPN |
$52.79
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Senior |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Humana Medicare |
$8.65
|
| Rate for Payer: IEHP Medi-Cal |
$11.72
|
| Rate for Payer: IEHP Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| 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 |
$25.50
|
| 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 |
$12.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC ANA PANEL
|
Facility
OP
|
$185.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913646
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$140.09 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.47
|
| Rate for Payer: Blue Shield of California Commercial |
$140.09
|
| Rate for Payer: Blue Shield of California EPN |
$109.51
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: IEHP Medi-Cal |
$22.76
|
| Rate for Payer: IEHP Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| 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 |
$138.75
|
| 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 |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC ANA PANEL
|
Facility
IP
|
$264.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913646
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.78 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$181.37
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.73
|
| Rate for Payer: Heritage Provider Network Senior |
$178.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
|
|
HC ANESTHESIA LEVEL I 1ST 15MIN
|
Facility
OP
|
$1,057.00
|
|
| Hospital Charge Code |
904900400
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$191.32 |
| Max. Negotiated Rate |
$898.45 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$564.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$726.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$898.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$581.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$792.75
|
| Rate for Payer: Blue Shield of California Commercial |
$656.40
|
| Rate for Payer: Blue Shield of California EPN |
$620.46
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$687.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$898.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$898.45
|
| Rate for Payer: Dignity Health Senior |
$898.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$654.28
|
| Rate for Payer: Heritage Provider Network Senior |
$654.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$509.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.25
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$898.45
|
| Rate for Payer: Vantage Medical Group Senior |
$898.45
|
|
|
HC ANESTHESIA LEVEL I 1ST 15MIN
|
Facility
IP
|
$1,057.00
|
|
| Hospital Charge Code |
904900400
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$191.32 |
| Max. Negotiated Rate |
$792.75 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$726.16
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$715.59
|
| Rate for Payer: Heritage Provider Network Senior |
$715.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.25
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
|
|
HC ANESTHESIA LEVEL I ADD'L 15MIN
|
Facility
IP
|
$260.00
|
|
| Hospital Charge Code |
904900401
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Adventist Health Commercial |
$52.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$178.62
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$176.02
|
| Rate for Payer: Heritage Provider Network Senior |
$176.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
|
|
HC ANESTHESIA LEVEL I ADD'L 15MIN
|
Facility
OP
|
$260.00
|
|
| Hospital Charge Code |
904900401
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Adventist Health Commercial |
$52.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$138.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$178.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$221.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$143.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.00
|
| Rate for Payer: Blue Shield of California Commercial |
$161.46
|
| Rate for Payer: Blue Shield of California EPN |
$152.62
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$169.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$221.00
|
| Rate for Payer: Dignity Health Senior |
$221.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$160.94
|
| Rate for Payer: Heritage Provider Network Senior |
$160.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$125.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$221.00
|
| Rate for Payer: Vantage Medical Group Senior |
$221.00
|
|
|
HC ANESTHESIA LEVEL II 1ST 15MIN
|
Facility
OP
|
$2,521.00
|
|
| Hospital Charge Code |
904900402
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$456.30 |
| Max. Negotiated Rate |
$2,142.85 |
| Rate for Payer: Adventist Health Commercial |
$504.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,347.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,731.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,142.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,386.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,890.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,565.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,479.83
|
| Rate for Payer: Cash Price |
$1,134.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,638.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,142.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,142.85
|
| Rate for Payer: Dignity Health Senior |
$2,142.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,638.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,560.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1,560.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,215.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.25
|
| Rate for Payer: Multiplan Commercial |
$1,890.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,142.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,142.85
|
|
|
HC ANESTHESIA LEVEL II 1ST 15MIN
|
Facility
IP
|
$2,521.00
|
|
| Hospital Charge Code |
904900402
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$456.30 |
| Max. Negotiated Rate |
$1,890.75 |
| Rate for Payer: Adventist Health Commercial |
$504.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,731.93
|
| Rate for Payer: Cash Price |
$1,134.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,706.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,706.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.25
|
| Rate for Payer: Multiplan Commercial |
$1,890.75
|
|
|
HC ANESTHESIA LEVEL II ADD'L 15MIN
|
Facility
OP
|
$416.00
|
|
| Hospital Charge Code |
904900403
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$353.60 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$222.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$285.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$228.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$312.00
|
| Rate for Payer: Blue Shield of California Commercial |
$258.34
|
| Rate for Payer: Blue Shield of California EPN |
$244.19
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$270.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$353.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.60
|
| Rate for Payer: Dignity Health Senior |
$353.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$257.50
|
| Rate for Payer: Heritage Provider Network Senior |
$257.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$200.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.60
|
| Rate for Payer: Vantage Medical Group Senior |
$353.60
|
|
|
HC ANESTHESIA LEVEL II ADD'L 15MIN
|
Facility
IP
|
$416.00
|
|
| Hospital Charge Code |
904900403
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$285.79
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$281.63
|
| Rate for Payer: Heritage Provider Network Senior |
$281.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
|
|
HC ANESTHESIA LEVEL III 1ST 15MIN
|
Facility
IP
|
$3,784.00
|
|
| Hospital Charge Code |
904900404
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$684.90 |
| Max. Negotiated Rate |
$2,838.00 |
| Rate for Payer: Adventist Health Commercial |
$756.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,599.61
|
| Rate for Payer: Cash Price |
$1,702.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,561.77
|
| Rate for Payer: Heritage Provider Network Senior |
$2,561.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$684.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.00
|
| Rate for Payer: Multiplan Commercial |
$2,838.00
|
|
|
HC ANESTHESIA LEVEL III 1ST 15MIN
|
Facility
OP
|
$3,784.00
|
|
| Hospital Charge Code |
904900404
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$684.90 |
| Max. Negotiated Rate |
$3,216.40 |
| Rate for Payer: Adventist Health Commercial |
$756.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,022.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,599.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,216.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,081.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,838.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,349.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,221.21
|
| Rate for Payer: Cash Price |
$1,702.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,459.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,216.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,216.40
|
| Rate for Payer: Dignity Health Senior |
$3,216.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,459.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,342.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,342.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,823.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$684.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.00
|
| Rate for Payer: Multiplan Commercial |
$2,838.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,216.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,216.40
|
|
