|
HC GLUCOSE FASTING
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
900910306
|
|
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 GLUCOSE LOADING 1 HR
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
900910314
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.26
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.32
|
| Rate for Payer: Heritage Provider Network Senior |
$64.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.75
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
|
|
HC GLUCOSE LOADING 1 HR
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
900910314
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.73
|
| Rate for Payer: Blue Shield of California Commercial |
$37.12
|
| Rate for Payer: Blue Shield of California EPN |
$29.02
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC GLUCOSE RANDOM
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
900910307
|
|
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 GLUCOSE RANDOM
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
900910307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$32.91 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.91
|
| Rate for Payer: Blue Shield of California Commercial |
$30.63
|
| Rate for Payer: Blue Shield of California EPN |
$23.95
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: Dignity Health Senior |
$3.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$3.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.93
|
| Rate for Payer: TriValley Medical Group Senior |
$3.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
|
|
HC GLUCOSE TESTING POC
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
900910468
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$18.28 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.28
|
| Rate for Payer: Blue Shield of California Commercial |
$18.28
|
| Rate for Payer: Blue Shield of California EPN |
$14.29
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.61
|
| Rate for Payer: Dignity Health Senior |
$3.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Humana Medicare |
$3.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.28
|
| Rate for Payer: TriValley Medical Group Senior |
$3.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.61
|
| Rate for Payer: Vantage Medical Group Senior |
$3.28
|
|
|
HC GLUCOSE TESTING POC
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
900910468
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.19
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
|
|
HC GLUCOSE TOLERANCE TEST 2 HR
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$107.74 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.74
|
| Rate for Payer: Blue Shield of California Commercial |
$100.56
|
| Rate for Payer: Blue Shield of California EPN |
$78.62
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.33
|
| Rate for Payer: Heritage Provider Network Senior |
$30.33
|
| Rate for Payer: Humana Medicare |
$12.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.87
|
| Rate for Payer: TriValley Medical Group Senior |
$12.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC GLUCOSE TOLERANCE TEST 2 HR
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.15
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.11
|
| Rate for Payer: Heritage Provider Network Senior |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
|
|
HC GLUCOSE TOLERANCE TEST 3 HR
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.15
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.11
|
| Rate for Payer: Heritage Provider Network Senior |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
|
|
HC GLUCOSE TOLERANCE TEST 3 HR
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$107.74 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.74
|
| Rate for Payer: Blue Shield of California Commercial |
$100.56
|
| Rate for Payer: Blue Shield of California EPN |
$78.62
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.33
|
| Rate for Payer: Heritage Provider Network Senior |
$30.33
|
| Rate for Payer: Humana Medicare |
$12.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.87
|
| Rate for Payer: TriValley Medical Group Senior |
$12.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC GLUCOSE URINE
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900910311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.66
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.17
|
| Rate for Payer: Heritage Provider Network Senior |
$33.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
|
|
HC GLUCOSE URINE
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900910311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$32.80 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.80
|
| Rate for Payer: Blue Shield of California Commercial |
$30.63
|
| Rate for Payer: Blue Shield of California EPN |
$23.95
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: Dignity Health Senior |
$3.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$3.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.93
|
| Rate for Payer: TriValley Medical Group Senior |
$3.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
|
|
HC GLUCOSE URINE 24 HOURS
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900912205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$32.80 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.80
|
| Rate for Payer: Blue Shield of California Commercial |
$30.63
|
| Rate for Payer: Blue Shield of California EPN |
$23.95
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: Dignity Health Senior |
$3.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$3.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.93
|
| Rate for Payer: TriValley Medical Group Senior |
$3.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
|
|
HC GLUCOSE URINE 24 HOURS
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900912205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.66
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.17
|
| Rate for Payer: Heritage Provider Network Senior |
$33.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
|
|
HC GLUCOSE URINE RANDOM
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900912204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.66
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.17
|
| Rate for Payer: Heritage Provider Network Senior |
$33.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
|
|
HC GLUCOSE URINE RANDOM
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900912204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$32.80 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.80
|
| Rate for Payer: Blue Shield of California Commercial |
$30.63
|
| Rate for Payer: Blue Shield of California EPN |
$23.95
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: Dignity Health Senior |
$3.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$3.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.93
|
| Rate for Payer: TriValley Medical Group Senior |
$3.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
|
|
HC GRAFIX CORE 5X5
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT Q4132
|
| Hospital Charge Code |
900101472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.68 |
| Max. Negotiated Rate |
$388.73 |
| Rate for Payer: Adventist Health Commercial |
$77.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$388.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$264.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$327.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$211.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$288.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.29
|
| Rate for Payer: Blue Shield of California Commercial |
$239.08
|
| Rate for Payer: Blue Shield of California EPN |
$226.00
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$177.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$327.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$327.25
|
| Rate for Payer: Dignity Health Senior |
$327.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.26
|
| Rate for Payer: Heritage Provider Network Senior |
$178.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$205.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$185.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.25
|
| Rate for Payer: Multiplan Commercial |
$288.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$154.00
|
| Rate for Payer: TriValley Medical Group Senior |
$154.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$140.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$128.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$327.25
|
| Rate for Payer: Vantage Medical Group Senior |
$327.25
|
|
|
HC GRAFIX CORE 5X5
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT Q4132
|
| Hospital Charge Code |
900101472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.68 |
| Max. Negotiated Rate |
$288.75 |
| Rate for Payer: Adventist Health Commercial |
$77.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$264.50
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$177.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$260.64
|
| Rate for Payer: Heritage Provider Network Senior |
$260.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.25
|
| Rate for Payer: Multiplan Commercial |
$288.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$140.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$128.63
|
|
|
HC GRAFIX PRIME 3X4
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT Q4133 JW
|
| Hospital Charge Code |
900101475
|
|
Hospital Revenue Code
|
636
|
| 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: Cigna of CA HMO/PPO |
$191.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.64
|
| 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
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$151.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$138.99
|
|
|
HC GRAFIX PRIME 3X4
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT Q4133 JW
|
| Hospital Charge Code |
900101475
|
|
Hospital Revenue Code
|
636
|
| 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 |
$334.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$285.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$312.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.29
|
| 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: Cash Price |
$187.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$191.36
|
| 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 |
$266.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$192.61
|
| Rate for Payer: Heritage Provider Network Senior |
$192.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$209.13
|
| 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: TriValley Medical Group Commercial |
$166.40
|
| Rate for Payer: TriValley Medical Group Senior |
$166.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$151.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$138.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.60
|
| Rate for Payer: Vantage Medical Group Senior |
$353.60
|
|
|
HC GRAFIX PRIME 5X5
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900101474
|
|
Hospital Revenue Code
|
636
|
| 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: Cigna of CA HMO/PPO |
$191.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.64
|
| 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
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$151.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$138.99
|
|
|
HC GRAFIX PRIME 5X5
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900101474
|
|
Hospital Revenue Code
|
636
|
| 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 |
$334.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$285.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$312.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.29
|
| 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: Cash Price |
$187.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$191.36
|
| 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 |
$266.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$192.61
|
| Rate for Payer: Heritage Provider Network Senior |
$192.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$209.13
|
| 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: TriValley Medical Group Commercial |
$166.40
|
| Rate for Payer: TriValley Medical Group Senior |
$166.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$151.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$138.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.60
|
| Rate for Payer: Vantage Medical Group Senior |
$353.60
|
|
|
HC GRAFT APLIGRAF 7.5 CM
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT Q4101
|
| Hospital Charge Code |
900101456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$92.65 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.41
|
| Rate for Payer: Blue Shield of California Commercial |
$67.69
|
| Rate for Payer: Blue Shield of California EPN |
$63.98
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.65
|
| Rate for Payer: Dignity Health Senior |
$92.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.47
|
| Rate for Payer: Heritage Provider Network Senior |
$50.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$52.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.25
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$43.60
|
| Rate for Payer: TriValley Medical Group Senior |
$43.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$39.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.65
|
| Rate for Payer: Vantage Medical Group Senior |
$92.65
|
|
|
HC GRAFT APLIGRAF 7.5 CM
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT Q4101
|
| Hospital Charge Code |
900101456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$81.75 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.88
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.79
|
| Rate for Payer: Heritage Provider Network Senior |
$73.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.25
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$39.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.42
|
|
