|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
IP
|
$1,076.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.76 |
| Max. Negotiated Rate |
$807.00 |
| Rate for Payer: Adventist Health Commercial |
$215.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$739.21
|
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$728.45
|
| Rate for Payer: Heritage Provider Network Senior |
$728.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.00
|
| Rate for Payer: Multiplan Commercial |
$807.00
|
|
|
HC BX BREAST PERCUT W/O IMAGE
|
Facility
OP
|
$1,076.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
900501761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.76 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$215.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$739.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$699.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$728.45
|
| Rate for Payer: Heritage Provider Network Senior |
$728.45
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$518.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$807.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$390.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$359.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BX OR EXC OF LN OPEN, INGFEM NODES
|
Facility
OP
|
$8,840.00
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
909008531
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$587.18 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,768.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,073.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$3,978.00
|
| Rate for Payer: Cash Price |
$3,978.00
|
| Rate for Payer: Cash Price |
$3,978.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,746.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: Dignity Health Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,762.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,471.96
|
| Rate for Payer: Heritage Provider Network Senior |
$5,857.89
|
| Rate for Payer: Humana Medicare |
$4,762.51
|
| Rate for Payer: IEHP Medi-Cal |
$587.18
|
| Rate for Payer: IEHP Medicare Advantage |
$4,762.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,048.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,600.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,619.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,210.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,000.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,000.76
|
| Rate for Payer: Multiplan Commercial |
$6,630.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,238.76
|
| Rate for Payer: TriValley Medical Group Senior |
$5,238.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
HC BX OR EXC OF LN OPEN, INGFEM NODES
|
Facility
IP
|
$8,840.00
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
909008531
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,600.04 |
| Max. Negotiated Rate |
$6,630.00 |
| Rate for Payer: Adventist Health Commercial |
$1,768.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,073.08
|
| Rate for Payer: Cash Price |
$3,978.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,984.68
|
| Rate for Payer: Heritage Provider Network Senior |
$5,984.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,600.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,210.00
|
| Rate for Payer: Multiplan Commercial |
$6,630.00
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
OP
|
$1,827.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.41 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$365.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,255.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,187.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,130.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$78.41
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$1,370.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC BX SALIVARY GLAND; NEEDLE
|
Facility
IP
|
$1,827.00
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
900501748
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$330.69 |
| Max. Negotiated Rate |
$1,370.25 |
| Rate for Payer: Adventist Health Commercial |
$365.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,255.15
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,236.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,236.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.75
|
| Rate for Payer: Multiplan Commercial |
$1,370.25
|
|
|
HC C-14 UREA BREATH TEST ACQ
|
Facility
OP
|
$389.00
|
|
|
Service Code
|
CPT 78267
|
| Hospital Charge Code |
909301257
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$291.75 |
| Rate for Payer: Adventist Health Commercial |
$77.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$267.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.06
|
| Rate for Payer: Blue Shield of California Commercial |
$241.57
|
| Rate for Payer: Blue Shield of California EPN |
$228.34
|
| Rate for Payer: Cash Price |
$175.05
|
| Rate for Payer: Cash Price |
$175.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$252.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.17
|
| Rate for Payer: Dignity Health Senior |
$11.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$240.79
|
| Rate for Payer: Heritage Provider Network Senior |
$240.79
|
| Rate for Payer: Humana Medicare |
$11.06
|
| Rate for Payer: IEHP Medicare Advantage |
$11.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.94
|
| Rate for Payer: Multiplan Commercial |
$291.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.17
|
| Rate for Payer: TriValley Medical Group Senior |
$11.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.17
|
| Rate for Payer: Vantage Medical Group Senior |
$11.06
|
|
|
HC C-14 UREA BREATH TEST ACQ
|
Facility
IP
|
$389.00
|
|
|
Service Code
|
CPT 78267
|
| Hospital Charge Code |
909301257
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$70.41 |
| Max. Negotiated Rate |
$291.75 |
| Rate for Payer: Adventist Health Commercial |
$77.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$267.24
|
| Rate for Payer: Cash Price |
$175.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$263.35
|
| Rate for Payer: Heritage Provider Network Senior |
$263.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.25
|
| Rate for Payer: Multiplan Commercial |
$291.75
|
|
|
HC C-14 UREA BREATH TEST ANAL
|
Facility
OP
|
$433.00
|
|
|
Service Code
|
CPT 78268
|
| Hospital Charge Code |
909301258
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$78.37 |
| Max. Negotiated Rate |
$324.75 |
| Rate for Payer: Adventist Health Commercial |
$86.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$211.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$297.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$141.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$103.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$94.41
|
| Rate for Payer: Blue Shield of California Commercial |
$268.89
|
| Rate for Payer: Blue Shield of California EPN |
$254.17
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$281.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.85
|
| Rate for Payer: Dignity Health Senior |
$94.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$94.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.03
|
| Rate for Payer: Heritage Provider Network Senior |
$268.03
|
| Rate for Payer: Humana Medicare |
$94.41
|
| Rate for Payer: IEHP Medicare Advantage |
$94.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$179.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.96
|
| Rate for Payer: Multiplan Commercial |
$324.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$103.85
|
| Rate for Payer: TriValley Medical Group Senior |
$94.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.85
|
| Rate for Payer: Vantage Medical Group Senior |
$94.41
|
|
|
HC C-14 UREA BREATH TEST ANAL
|
Facility
IP
|
$433.00
|
|
|
Service Code
|
CPT 78268
|
| Hospital Charge Code |
909301258
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$78.37 |
| Max. Negotiated Rate |
$324.75 |
| Rate for Payer: Adventist Health Commercial |
$86.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$297.47
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$293.14
|
| Rate for Payer: Heritage Provider Network Senior |
$293.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.25
|
| Rate for Payer: Multiplan Commercial |
$324.75
|
|
|
HC CA CALCIUM IONIZED
|
Facility
IP
|
$342.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900910502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Adventist Health Commercial |
$68.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$234.95
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$231.53
|
| Rate for Payer: Heritage Provider Network Senior |
$231.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.50
|
| Rate for Payer: Multiplan Commercial |
$256.50
|
|
|
HC CA CALCIUM IONIZED
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900910502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$114.39 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.39
|
| Rate for Payer: Blue Shield of California Commercial |
$106.71
|
| Rate for Payer: Blue Shield of California EPN |
$83.42
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Senior |
$13.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Humana Medicare |
$13.68
|
| Rate for Payer: IEHP Medi-Cal |
$18.97
|
| Rate for Payer: IEHP Medicare Advantage |
$13.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.24
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.68
|
| Rate for Payer: TriValley Medical Group Senior |
$13.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
|
HC CAFFEINE SERUM
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910538
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$121.89 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.89
|
| Rate for Payer: Blue Shield of California Commercial |
$106.94
|
| Rate for Payer: Blue Shield of California EPN |
$83.60
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Humana Medicare |
$18.64
|
| Rate for Payer: IEHP Medi-Cal |
$19.64
|
| Rate for Payer: IEHP Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC CAFFEINE SERUM
|
Facility
IP
|
$162.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910538
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.29
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.67
|
| Rate for Payer: Heritage Provider Network Senior |
$109.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
|
|
HC CA IONIZED (POC)
|
Facility
OP
|
$292.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900912118
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$200.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.39
|
| Rate for Payer: Blue Shield of California Commercial |
$106.71
|
| Rate for Payer: Blue Shield of California EPN |
$83.42
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$189.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Senior |
$13.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.75
|
| Rate for Payer: Heritage Provider Network Senior |
$180.75
|
| Rate for Payer: Humana Medicare |
$13.68
|
| Rate for Payer: IEHP Medi-Cal |
$18.97
|
| Rate for Payer: IEHP Medicare Advantage |
$13.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.24
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.68
|
| Rate for Payer: TriValley Medical Group Senior |
$13.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
|
HC CA IONIZED (POC)
|
Facility
IP
|
$292.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900912118
|
|
Hospital Revenue Code
|
301
|
| 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 |
$200.60
|
| 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 Permanente of CA Medi-Cal |
$52.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
|
|
HC CALCIUM IONIZED CH
|
Facility
IP
|
$28.75
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900912178
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$21.56 |
| Rate for Payer: Adventist Health Commercial |
$5.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.75
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.46
|
| Rate for Payer: Heritage Provider Network Senior |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.19
|
| Rate for Payer: Multiplan Commercial |
$21.56
|
|
|
HC CALCIUM IONIZED CH
|
Facility
OP
|
$28.75
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900912178
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$114.39 |
| Rate for Payer: Adventist Health Commercial |
$5.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.39
|
| Rate for Payer: Blue Shield of California Commercial |
$106.71
|
| Rate for Payer: Blue Shield of California EPN |
$83.42
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Senior |
$13.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.69
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.80
|
| Rate for Payer: Heritage Provider Network Senior |
$17.80
|
| Rate for Payer: Humana Medicare |
$13.68
|
| Rate for Payer: IEHP Medi-Cal |
$18.97
|
| Rate for Payer: IEHP Medicare Advantage |
$13.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.24
|
| Rate for Payer: Multiplan Commercial |
$21.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.68
|
| Rate for Payer: TriValley Medical Group Senior |
$13.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
|
HC CALCIUM TOTAL
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
900910239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC CALCIUM TOTAL
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
900910239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$43.05 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.05
|
| Rate for Payer: Blue Shield of California Commercial |
$40.25
|
| Rate for Payer: Blue Shield of California EPN |
$31.46
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.68
|
| Rate for Payer: Dignity Health Senior |
$5.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$5.16
|
| Rate for Payer: IEHP Medi-Cal |
$6.40
|
| Rate for Payer: IEHP Medicare Advantage |
$5.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.50
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.16
|
| Rate for Payer: TriValley Medical Group Senior |
$5.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.68
|
| Rate for Payer: Vantage Medical Group Senior |
$5.16
|
|
|
HC CALCIUM URINE 24 HOURS
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$50.49 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.49
|
| Rate for Payer: Blue Shield of California Commercial |
$47.12
|
| Rate for Payer: Blue Shield of California EPN |
$36.84
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Senior |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$6.03
|
| Rate for Payer: IEHP Medi-Cal |
$8.36
|
| Rate for Payer: IEHP Medicare Advantage |
$6.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.03
|
| Rate for Payer: TriValley Medical Group Senior |
$6.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.03
|
|
|
HC CALCIUM URINE 24 HOURS
|
Facility
IP
|
$53.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.41
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.88
|
| Rate for Payer: Heritage Provider Network Senior |
$35.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
|
|
HC CALCIUM URINE RANDOM
|
Facility
IP
|
$53.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.41
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.88
|
| Rate for Payer: Heritage Provider Network Senior |
$35.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
|
|
HC CALCIUM URINE RANDOM
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
900912197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$50.49 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.49
|
| Rate for Payer: Blue Shield of California Commercial |
$47.12
|
| Rate for Payer: Blue Shield of California EPN |
$36.84
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.63
|
| Rate for Payer: Dignity Health Senior |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$6.03
|
| Rate for Payer: IEHP Medi-Cal |
$8.36
|
| Rate for Payer: IEHP Medicare Advantage |
$6.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.03
|
| Rate for Payer: TriValley Medical Group Senior |
$6.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.03
|
|
|
HC CANALITH REPOSITIONING PROC
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
905103410
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
