|
HC C-REACTIVE PROTEIN
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
900910887
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.05
|
| Rate for Payer: Heritage Provider Network Senior |
$61.90
|
| Rate for Payer: Heritage Provider Network Senior |
$34.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC C-REACTIVE PROTEIN HI SENSITIVITY
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
900912102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$122.86 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$194.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.86
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.76
|
| Rate for Payer: Heritage Provider Network Senior |
$194.99
|
| Rate for Payer: Heritage Provider Network Senior |
$50.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$150.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$39.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.35
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.95
|
| Rate for Payer: TriValley Medical Group Senior |
$12.95
|
| Rate for Payer: TriValley Medical Group Senior |
$12.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
|
|
HC C-REACTIVE PROTEIN HI SENSITIVITY
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
900912102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$202.86
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.25
|
| Rate for Payer: Heritage Provider Network Senior |
$213.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
|
|
HC CREATINE KINASE
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
900910222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$62.26 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.26
|
| Rate for Payer: Blue Shield of California Commercial |
$52.42
|
| Rate for Payer: Blue Shield of California Commercial |
$52.42
|
| Rate for Payer: Blue Shield of California EPN |
$42.04
|
| Rate for Payer: Blue Shield of California EPN |
$42.04
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$99.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.51
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.62
|
| Rate for Payer: Heritage Provider Network Senior |
$94.71
|
| Rate for Payer: Heritage Provider Network Senior |
$26.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$72.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.72
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.51
|
| Rate for Payer: TriValley Medical Group Senior |
$6.51
|
| Rate for Payer: TriValley Medical Group Senior |
$6.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.16
|
| Rate for Payer: Vantage Medical Group Senior |
$6.51
|
| Rate for Payer: Vantage Medical Group Senior |
$6.51
|
|
|
HC CREATINE KINASE
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
900910222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.53
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.58
|
| Rate for Payer: Heritage Provider Network Senior |
$103.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
|
|
HC CREATININE
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
900910247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.58
|
| Rate for Payer: Blue Shield of California Commercial |
$41.24
|
| Rate for Payer: Blue Shield of California Commercial |
$41.24
|
| Rate for Payer: Blue Shield of California EPN |
$33.08
|
| Rate for Payer: Blue Shield of California EPN |
$33.08
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.86
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.12
|
| Rate for Payer: TriValley Medical Group Senior |
$5.12
|
| Rate for Payer: TriValley Medical Group Senior |
$5.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.63
|
| Rate for Payer: Vantage Medical Group Senior |
$5.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.12
|
|
|
HC CREATININE
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
900910247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.11
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC CREATININE BODY FLUID
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900910377
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$95.25 |
| Rate for Payer: Adventist Health Commercial |
$25.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.79
|
| Rate for Payer: Cash Price |
$57.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.98
|
| Rate for Payer: Heritage Provider Network Senior |
$85.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.75
|
| Rate for Payer: Multiplan Commercial |
$95.25
|
|
|
HC CREATININE BODY FLUID
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900910377
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Commercial |
$25.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$78.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$57.15
|
| Rate for Payer: Cash Price |
$57.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$78.61
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$60.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$95.25
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC CREATININE CH
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
900912181
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.58
|
| Rate for Payer: Blue Shield of California Commercial |
$41.24
|
| Rate for Payer: Blue Shield of California EPN |
$33.08
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.62
|
| Rate for Payer: Heritage Provider Network Senior |
$52.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$40.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.86
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.12
|
| Rate for Payer: TriValley Medical Group Senior |
$5.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.63
|
| Rate for Payer: Vantage Medical Group Senior |
$5.12
|
|
|
HC CREATININE CH
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
900912181
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.74
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Heritage Provider Network Senior |
$57.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
|
|
HC CREATININE CLEARAN
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
900910260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$89.55 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$161.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.55
|
| Rate for Payer: Blue Shield of California Commercial |
$76.03
|
| Rate for Payer: Blue Shield of California Commercial |
$76.03
|
| Rate for Payer: Blue Shield of California EPN |
$60.98
|
| Rate for Payer: Blue Shield of California EPN |
$60.98
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$169.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$161.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.95
|
| Rate for Payer: Heritage Provider Network Senior |
$161.56
|
| Rate for Payer: Heritage Provider Network Senior |
$56.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$124.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$43.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.68
|
| Rate for Payer: Multiplan Commercial |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.46
|
| Rate for Payer: TriValley Medical Group Senior |
$9.46
|
| Rate for Payer: TriValley Medical Group Senior |
$9.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.41
|
| Rate for Payer: Vantage Medical Group Senior |
$9.46
|
| Rate for Payer: Vantage Medical Group Senior |
$9.46
|
|
|
HC CREATININE CLEARAN
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
900910260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.24 |
| Max. Negotiated Rate |
$195.75 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$168.08
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$176.70
|
| Rate for Payer: Heritage Provider Network Senior |
$176.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.25
|
| Rate for Payer: Multiplan Commercial |
$195.75
|
|
|
HC CREATININE INDIVIDUAL
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
900910493
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.58
|
| Rate for Payer: Blue Shield of California Commercial |
$41.24
|
| Rate for Payer: Blue Shield of California Commercial |
$41.24
|
| Rate for Payer: Blue Shield of California EPN |
$33.08
|
| Rate for Payer: Blue Shield of California EPN |
$33.08
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.86
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.12
|
| Rate for Payer: TriValley Medical Group Senior |
$5.12
|
| Rate for Payer: TriValley Medical Group Senior |
$5.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.63
|
| Rate for Payer: Vantage Medical Group Senior |
$5.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.12
|
|
|
HC CREATININE INDIVIDUAL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
900910493
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.11
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC CREATININE URINE 24 HOURS
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900912203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$95.25 |
| Rate for Payer: Adventist Health Commercial |
$25.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.79
|
| Rate for Payer: Cash Price |
$57.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.98
|
| Rate for Payer: Heritage Provider Network Senior |
$85.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.75
|
| Rate for Payer: Multiplan Commercial |
$95.25
|
|
|
HC CREATININE URINE 24 HOURS
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900912203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Commercial |
$25.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$78.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$57.15
|
| Rate for Payer: Cash Price |
$57.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$78.61
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$60.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$95.25
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC CREATININE URINE RANDOM
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900912202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Adventist Health Commercial |
$25.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$78.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$57.15
|
| Rate for Payer: Cash Price |
$57.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$78.61
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$60.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$95.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC CREATININE URINE RANDOM
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900912202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$95.25 |
| Rate for Payer: Adventist Health Commercial |
$25.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.79
|
| Rate for Payer: Cash Price |
$57.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.98
|
| Rate for Payer: Heritage Provider Network Senior |
$85.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.75
|
| Rate for Payer: Multiplan Commercial |
$95.25
|
|
|
HC CRITICAL CARE ADDL 30 MIN
|
Facility
|
IP
|
$2,959.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
900501641
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$535.58 |
| Max. Negotiated Rate |
$2,219.25 |
| Rate for Payer: Adventist Health Commercial |
$591.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,905.60
|
| Rate for Payer: Cash Price |
$1,331.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,003.24
|
| Rate for Payer: Heritage Provider Network Senior |
$2,003.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$535.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$739.75
|
| Rate for Payer: Multiplan Commercial |
$2,219.25
|
|
|
HC CRITICAL CARE ADDL 30 MIN
|
Facility
|
OP
|
$2,959.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
900501641
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$535.58 |
| Max. Negotiated Rate |
$2,515.15 |
| Rate for Payer: Adventist Health Commercial |
$591.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,828.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,515.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,627.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,219.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,405.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,118.50
|
| Rate for Payer: Cash Price |
$1,331.55
|
| Rate for Payer: Cash Price |
$1,331.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,923.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,515.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,515.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,515.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,923.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,003.24
|
| Rate for Payer: Heritage Provider Network Senior |
$2,003.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,411.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$535.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$739.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,071.30
|
| Rate for Payer: Multiplan Commercial |
$2,219.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,775.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1,775.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,515.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,515.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,515.15
|
|
|
HC CRITICAL CARE E&M 30-74 MIN
|
Facility
|
IP
|
$5,893.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
900509291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,066.63 |
| Max. Negotiated Rate |
$4,419.75 |
| Rate for Payer: Adventist Health Commercial |
$1,178.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,795.09
|
| Rate for Payer: Cash Price |
$2,651.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,989.56
|
| Rate for Payer: Heritage Provider Network Senior |
$3,989.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,066.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,473.25
|
| Rate for Payer: Multiplan Commercial |
$4,419.75
|
|
|
HC CRITICAL CARE E&M 30-74 MIN
|
Facility
|
OP
|
$5,893.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
900509291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,062.41 |
| Max. Negotiated Rate |
$4,419.75 |
| Rate for Payer: Adventist Health Commercial |
$1,178.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,641.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,593.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,168.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,062.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,799.18
|
| Rate for Payer: Blue Shield of California EPN |
$2,227.55
|
| Rate for Payer: Cash Price |
$2,651.85
|
| Rate for Payer: Cash Price |
$2,651.85
|
| Rate for Payer: Cash Price |
$2,651.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,830.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,593.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,168.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,062.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,830.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,062.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,989.56
|
| Rate for Payer: Heritage Provider Network Senior |
$3,989.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,062.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,810.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,066.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,473.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,423.63
|
| Rate for Payer: Multiplan Commercial |
$4,419.75
|
| Rate for Payer: Multiplan WC |
$1,705.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,535.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,535.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,593.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,168.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,062.41
|
|
|
HC CROSSMATCH COMP
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
900904766
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$328.68 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.54
|
| Rate for Payer: Blue Shield of California Commercial |
$164.09
|
| Rate for Payer: Blue Shield of California EPN |
$131.27
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$174.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$166.51
|
| Rate for Payer: Heritage Provider Network Senior |
$166.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$128.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC CROSSMATCH COMP
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
900904766
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.24
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.11
|
| Rate for Payer: Heritage Provider Network Senior |
$182.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.25
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
|
