|
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: AlphaCare Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$17.58
|
| Rate for Payer: 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
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: AlphaCare Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$5.13
|
| Rate for Payer: 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
|
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 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 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: AlphaCare Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$5.13
|
| Rate for Payer: 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 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: AlphaCare Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: AlphaCare 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: IEHP Medi-Cal |
$5.13
|
| Rate for Payer: 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 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 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 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: AlphaCare Medical Group Commercial/Exchange |
$327.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$211.75
|
| Rate for Payer: AlphaCare 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: 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: 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 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 |
$222.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$285.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$228.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$312.00
|
| Rate for Payer: Blue Shield of California Commercial |
$258.34
|
| Rate for Payer: Blue Shield of California EPN |
$244.19
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$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: 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: 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: AlphaCare Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$228.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$312.00
|
| Rate for Payer: 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: 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: 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: AlphaCare Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$59.95
|
| Rate for Payer: AlphaCare 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: 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: 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
|
|
|
HC GRAFT COMPOSITE EAR OR NASAL
|
Facility
IP
|
$7,462.00
|
|
|
Service Code
|
CPT 15760
|
| Hospital Charge Code |
900515760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,350.62 |
| Max. Negotiated Rate |
$5,596.50 |
| Rate for Payer: Adventist Health Commercial |
$1,492.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,126.39
|
| Rate for Payer: Cash Price |
$3,357.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,051.77
|
| Rate for Payer: Heritage Provider Network Senior |
$5,051.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,350.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,865.50
|
| Rate for Payer: Multiplan Commercial |
$5,596.50
|
|
|
HC GRAFT COMPOSITE EAR OR NASAL
|
Facility
OP
|
$7,462.00
|
|
|
Service Code
|
CPT 15760
|
| Hospital Charge Code |
900515760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,492.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,126.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$3,357.90
|
| Rate for Payer: Cash Price |
$3,357.90
|
| Rate for Payer: Cash Price |
$3,357.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,850.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,051.77
|
| Rate for Payer: Heritage Provider Network Senior |
$5,051.77
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,596.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,350.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,865.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: Multiplan Commercial |
$5,596.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,709.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,493.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC GRAFT DERMA-FAT-FASCIA
|
Facility
IP
|
$7,185.00
|
|
|
Service Code
|
CPT 15770
|
| Hospital Charge Code |
900501750
|
|
Hospital Revenue Code
|
451
|
| Min. Negotiated Rate |
$1,300.48 |
| Max. Negotiated Rate |
$5,388.75 |
| Rate for Payer: Adventist Health Commercial |
$1,437.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,936.10
|
| Rate for Payer: Cash Price |
$3,233.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,864.24
|
| Rate for Payer: Heritage Provider Network Senior |
$4,864.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,300.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,796.25
|
| Rate for Payer: Multiplan Commercial |
$5,388.75
|
|
|
HC GRAFT DERMA-FAT-FASCIA
|
Facility
OP
|
$7,185.00
|
|
|
Service Code
|
CPT 15770
|
| Hospital Charge Code |
900501750
|
|
Hospital Revenue Code
|
451
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,437.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,936.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,723.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,930.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,482.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$3,233.25
|
| Rate for Payer: Cash Price |
$3,233.25
|
| Rate for Payer: Cash Price |
$3,233.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,670.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,723.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,930.75
|
| Rate for Payer: Dignity Health Senior |
$4,482.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,482.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,864.24
|
| Rate for Payer: Heritage Provider Network Senior |
$4,864.24
|
| Rate for Payer: Humana Medicare |
$4,482.50
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,482.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,463.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,300.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,289.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,796.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,647.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,647.95
|
| Rate for Payer: Multiplan Commercial |
$5,388.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,608.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,400.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,723.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,482.50
|
|
|
HC GRAFT, IM, CONDUIT
|
Facility
OP
|
$27,338.00
|
|
|
Service Code
|
CPT 93564
|
| Hospital Charge Code |
906811413
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$74.30 |
| Max. Negotiated Rate |
$23,237.30 |
| Rate for Payer: Adventist Health Commercial |
$5,467.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,781.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23,237.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,035.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20,503.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$12,302.10
|
| Rate for Payer: Cash Price |
$12,302.10
|
| Rate for Payer: Cash Price |
$12,302.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,237.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,237.30
|
| Rate for Payer: Dignity Health Senior |
$23,237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,769.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,922.22
|
| Rate for Payer: Heritage Provider Network Senior |
$16,922.22
|
| Rate for Payer: IEHP Medi-Cal |
$74.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,176.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,948.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,834.50
|
| Rate for Payer: Multiplan Commercial |
$20,503.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,237.30
|
| Rate for Payer: Vantage Medical Group Senior |
$23,237.30
|
|
|
HC GRAFT, IM, CONDUIT
|
Facility
OP
|
$737.00
|
|
|
Service Code
|
CPT 93564
|
| Hospital Charge Code |
906820070
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$74.30 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$405.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$552.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$626.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$626.45
|
| Rate for Payer: Dignity Health Senior |
$626.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$479.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.20
|
| Rate for Payer: Heritage Provider Network Senior |
$456.20
|
| Rate for Payer: IEHP Medi-Cal |
$74.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$355.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$626.45
|
| Rate for Payer: Vantage Medical Group Senior |
$626.45
|
|
|
HC GRAFT, IM, CONDUIT
|
Facility
IP
|
$737.00
|
|
|
Service Code
|
CPT 93564
|
| Hospital Charge Code |
906820070
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.32
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
|
|
HC GRAFT, IM, CONDUIT
|
Facility
IP
|
$27,338.00
|
|
|
Service Code
|
CPT 93564
|
| Hospital Charge Code |
906811413
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,948.18 |
| Max. Negotiated Rate |
$20,503.50 |
| Rate for Payer: Adventist Health Commercial |
$5,467.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,781.21
|
| Rate for Payer: Cash Price |
$12,302.10
|
| Rate for Payer: Cash Price |
$12,302.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,948.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,834.50
|
| Rate for Payer: Multiplan Commercial |
$20,503.50
|
|
|
HC GRAFTJACKET PER SQ CM
|
Facility
IP
|
$12,303.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
900101462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,226.84 |
| Max. Negotiated Rate |
$9,227.25 |
| Rate for Payer: Adventist Health Commercial |
$2,460.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,452.16
|
| Rate for Payer: Cash Price |
$5,536.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,659.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,643.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,329.13
|
| Rate for Payer: Heritage Provider Network Senior |
$8,329.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,226.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,075.75
|
| Rate for Payer: Multiplan Commercial |
$9,227.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,485.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,110.43
|
|
|
HC GRAFTJACKET PER SQ CM
|
Facility
OP
|
$12,303.00
|
|
|
Service Code
|
CPT Q4107
|
| Hospital Charge Code |
900101462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$149.32 |
| Max. Negotiated Rate |
$10,457.55 |
| Rate for Payer: Adventist Health Commercial |
$2,460.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$204.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,452.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,457.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,766.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,227.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.21
|
| Rate for Payer: Blue Shield of California Commercial |
$7,640.16
|
| Rate for Payer: Blue Shield of California EPN |
$7,221.86
|
| Rate for Payer: Cash Price |
$5,536.35
|
| Rate for Payer: Cash Price |
$5,536.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,659.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,457.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,457.55
|
| Rate for Payer: Dignity Health Senior |
$10,457.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,873.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,696.29
|
| Rate for Payer: Heritage Provider Network Senior |
$5,696.29
|
| Rate for Payer: IEHP Medi-Cal |
$149.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,930.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,226.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,075.75
|
| Rate for Payer: Multiplan Commercial |
$9,227.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,485.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,110.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,457.55
|
| Rate for Payer: Vantage Medical Group Senior |
$10,457.55
|
|
