|
HC AMPLATZ TORQUEWIRE
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$188.05
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.68
|
| Rate for Payer: Heritage Provider Network Senior |
$197.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
|
|
HC AMPLATZ TORQUEWIRE
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.06
|
| Rate for Payer: Blue Shield of California Commercial |
$178.12
|
| Rate for Payer: Blue Shield of California EPN |
$142.50
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$189.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$248.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.75
|
| Rate for Payer: Heritage Provider Network Senior |
$180.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$139.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$204.40
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$146.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$146.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.20
|
| Rate for Payer: Vantage Medical Group Senior |
$248.20
|
|
|
HC AMPLATZ TRACT MASTER
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909001099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$489.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$594.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$318.38
|
| Rate for Payer: Blue Shield of California EPN |
$318.38
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$364.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$673.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$673.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$366.70
|
| Rate for Payer: Heritage Provider Network Senior |
$366.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$396.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$396.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$396.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$554.40
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$286.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$262.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$673.20
|
| Rate for Payer: Vantage Medical Group Senior |
$673.20
|
|
|
HC AMPLATZ TRACT MASTER
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909001099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$510.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$318.38
|
| Rate for Payer: Blue Shield of California EPN |
$318.38
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$364.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$366.70
|
| Rate for Payer: Heritage Provider Network Senior |
$366.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$396.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$396.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$396.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$286.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$262.23
|
|
|
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: Aetna of CA Non-Gatekeeper |
$4,244.60
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,462.11
|
| Rate for Payer: Heritage Provider Network Senior |
$4,462.11
|
| Rate for Payer: Kaiser Foundation Hospitals 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 SNGL
|
Facility
|
OP
|
$6,591.00
|
|
|
Service Code
|
CPT 26910
|
| Hospital Charge Code |
900501259
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,192.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Adventist Health Commercial |
$1,318.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,073.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,130.72
|
| Rate for Payer: Blue Shield of California EPN |
$2,491.40
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,284.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| 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) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,143.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,192.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,647.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$4,943.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,954.60
|
| Rate for Payer: TriValley Medical Group Senior |
$3,954.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
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 |
$722.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,465.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,895.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,508.22
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,593.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| 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) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,903.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,394.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,394.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
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: Aetna of CA Non-Gatekeeper |
$2,569.56
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Kaiser Foundation Hospitals 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 OF TOE
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
900501402
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$923.10 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,151.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,422.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,927.80
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,315.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| 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) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,432.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$923.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,060.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,060.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
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: Aetna of CA Non-Gatekeeper |
$3,284.40
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,452.70
|
| Rate for Payer: Heritage Provider Network Senior |
$3,452.70
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$61.62 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| 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 Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.62
|
| Rate for Payer: Blue Shield of California Commercial |
$52.19
|
| Rate for Payer: Blue Shield of California Commercial |
$52.19
|
| Rate for Payer: Blue Shield of California EPN |
$41.86
|
| Rate for Payer: Blue Shield of California EPN |
$41.86
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$167.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$159.70
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$123.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$7.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
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: Aetna of CA Non-Gatekeeper |
$166.15
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.67
|
| Rate for Payer: Heritage Provider Network Senior |
$174.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
|
|
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 |
$61.62 |
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| 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 Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.62
|
| Rate for Payer: Blue Shield of California Commercial |
$52.19
|
| Rate for Payer: Blue Shield of California Commercial |
$52.19
|
| Rate for Payer: Blue Shield of California EPN |
$41.86
|
| Rate for Payer: Blue Shield of California EPN |
$41.86
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.66
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$34.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$7.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| 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: Aetna of CA Non-Gatekeeper |
$36.06
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.91
|
| Rate for Payer: Heritage Provider Network Senior |
$37.91
|
| Rate for Payer: Kaiser Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$166.15
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.67
|
| Rate for Payer: Heritage Provider Network Senior |
$174.67
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$56.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$61.62 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| 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 Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.62
|
| Rate for Payer: Blue Shield of California Commercial |
$52.19
|
| Rate for Payer: Blue Shield of California Commercial |
$52.19
|
| Rate for Payer: Blue Shield of California EPN |
$41.86
|
| Rate for Payer: Blue Shield of California EPN |
$41.86
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$167.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.66
|
| Rate for Payer: Heritage Provider Network Senior |
$159.70
|
| Rate for Payer: Heritage Provider Network Senior |
$34.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$123.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$7.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
| 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: Aetna of CA Non-Gatekeeper |
$166.15
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.67
|
| Rate for Payer: Heritage Provider Network Senior |
$174.67
|
| Rate for Payer: Kaiser Foundation Hospitals 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 24 HOURS
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900912194
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$61.62 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| 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 Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.62
|
| Rate for Payer: Blue Shield of California Commercial |
$52.19
|
| Rate for Payer: Blue Shield of California Commercial |
$52.19
|
| Rate for Payer: Blue Shield of California EPN |
$41.86
|
| Rate for Payer: Blue Shield of California EPN |
$41.86
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$167.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.66
|
| Rate for Payer: Heritage Provider Network Senior |
$159.70
|
| Rate for Payer: Heritage Provider Network Senior |
$34.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$123.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$7.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE URINE RANDOM
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900912193
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$61.62 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Adventist Health Commercial |
$51.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| 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 Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.62
|
| Rate for Payer: Blue Shield of California Commercial |
$52.19
|
| Rate for Payer: Blue Shield of California Commercial |
$52.19
|
| Rate for Payer: Blue Shield of California EPN |
$41.86
|
| Rate for Payer: Blue Shield of California EPN |
$41.86
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$167.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.66
|
| Rate for Payer: Heritage Provider Network Senior |
$159.70
|
| Rate for Payer: Heritage Provider Network Senior |
$34.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$123.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$7.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
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: Aetna of CA Non-Gatekeeper |
$166.15
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.67
|
| Rate for Payer: Heritage Provider Network Senior |
$174.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
|
|
HC ANAEROBIC MIC PANEL
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$82.08 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| 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 Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.08
|
| Rate for Payer: Blue Shield of California Commercial |
$69.58
|
| Rate for Payer: Blue Shield of California Commercial |
$69.58
|
| Rate for Payer: Blue Shield of California EPN |
$55.81
|
| Rate for Payer: Blue Shield of California EPN |
$55.81
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$203.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.47
|
| Rate for Payer: Heritage Provider Network Senior |
$193.75
|
| Rate for Payer: Heritage Provider Network Senior |
$54.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$149.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.65
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$9.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
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: Aetna of CA Non-Gatekeeper |
$201.57
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.90
|
| Rate for Payer: Heritage Provider Network Senior |
$211.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.25
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
|
|
HC ANA O 3 (CASHEW), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913734
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.91
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.52
|
| Rate for Payer: Heritage Provider Network Senior |
$12.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
|
|
HC ANA O 3 (CASHEW), IGE
|
Facility
|
OP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913734
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| 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 Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.45
|
| Rate for Payer: Heritage Provider Network Senior |
$9.54
|
| Rate for Payer: Heritage Provider Network Senior |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| 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: Aetna of CA Non-Gatekeeper |
$110.12
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.77
|
| Rate for Payer: Heritage Provider Network Senior |
$115.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
|
