|
HC IMAGE GUIDED FLUID COLL DRAIN CATH VISCERAL, PERC
|
Facility
OP
|
$3,420.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
900100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$286.92 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$684.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,349.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,223.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,116.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$286.92
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$619.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$2,565.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC IMIPENEM E TEST
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912423
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.88
|
| Rate for Payer: Blue Shield of California Commercial |
$22.47
|
| Rate for Payer: Blue Shield of California EPN |
$17.57
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| 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 |
$11.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Humana Medicare |
$4.75
|
| Rate for Payer: IEHP Medi-Cal |
$1.81
|
| Rate for Payer: IEHP Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| 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 |
$13.50
|
| 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 IMIPENEM E TEST
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912423
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.14
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.08
|
| Rate for Payer: Heritage Provider Network Senior |
$71.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
900912028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.63
|
| Rate for Payer: Heritage Provider Network Senior |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
900912028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$224.95 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$53.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.95
|
| Rate for Payer: Blue Shield of California Commercial |
$209.12
|
| Rate for Payer: Blue Shield of California EPN |
$163.48
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.31
|
| Rate for Payer: Dignity Health Senior |
$35.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.95
|
| Rate for Payer: Heritage Provider Network Senior |
$17.95
|
| Rate for Payer: Humana Medicare |
$35.74
|
| Rate for Payer: IEHP Medi-Cal |
$44.60
|
| Rate for Payer: IEHP Medicare Advantage |
$35.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$67.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.03
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.74
|
| Rate for Payer: TriValley Medical Group Senior |
$35.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Vantage Medical Group Senior |
$35.74
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 20"
|
Facility
IP
|
$131.04
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698369
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$26.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.71
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$65.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.76
|
| Rate for Payer: Multiplan Commercial |
$98.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.78
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 20"
|
Facility
OP
|
$131.04
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698369
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$26.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$111.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$72.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$98.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$81.38
|
| Rate for Payer: Blue Shield of California EPN |
$76.92
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.38
|
| Rate for Payer: Dignity Health Senior |
$111.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.67
|
| Rate for Payer: Heritage Provider Network Senior |
$60.67
|
| Rate for Payer: IEHP Medi-Cal |
$109.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$65.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.76
|
| Rate for Payer: Multiplan Commercial |
$98.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.38
|
| Rate for Payer: Vantage Medical Group Senior |
$111.38
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 24"
|
Facility
OP
|
$161.63
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698368
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$88.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$121.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$100.37
|
| Rate for Payer: Blue Shield of California EPN |
$94.88
|
| Rate for Payer: Cash Price |
$72.73
|
| Rate for Payer: Cash Price |
$72.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.39
|
| Rate for Payer: Dignity Health Senior |
$137.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.83
|
| Rate for Payer: Heritage Provider Network Senior |
$74.83
|
| Rate for Payer: IEHP Medi-Cal |
$109.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.41
|
| Rate for Payer: Multiplan Commercial |
$121.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$58.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.39
|
| Rate for Payer: Vantage Medical Group Senior |
$137.39
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 24"
|
Facility
IP
|
$161.63
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698368
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$72.73
|
| Rate for Payer: Cash Price |
$72.73
|
| Rate for Payer: Cash Price |
$72.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.42
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.41
|
| Rate for Payer: Multiplan Commercial |
$121.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$58.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.00
|
|
|
HC IMMOBILIZER SHLDR LG
|
Facility
IP
|
$29.25
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698373
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.80
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.77
|
|
|
HC IMMOBILIZER SHLDR LG
|
Facility
OP
|
$29.25
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698373
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18.16
|
| Rate for Payer: Blue Shield of California EPN |
$17.17
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.86
|
| Rate for Payer: Dignity Health Senior |
$24.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: IEHP Medi-Cal |
$56.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.86
|
| Rate for Payer: Vantage Medical Group Senior |
$24.86
|
|
|
HC IMMOBILIZER SHLDR MD
|
Facility
OP
|
$29.25
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698372
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18.16
|
| Rate for Payer: Blue Shield of California EPN |
$17.17
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.86
|
| Rate for Payer: Dignity Health Senior |
$24.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: IEHP Medi-Cal |
$56.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.86
|
| Rate for Payer: Vantage Medical Group Senior |
$24.86
|
|
|
HC IMMOBILIZER SHLDR MD
|
Facility
IP
|
$29.25
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698372
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.80
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.77
|
|
|
HC IMMOBILIZER SHLDR SM
|
Facility
OP
|
$29.25
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698371
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18.16
|
| Rate for Payer: Blue Shield of California EPN |
$17.17
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.86
|
| Rate for Payer: Dignity Health Senior |
$24.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: IEHP Medi-Cal |
$56.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.86
|
| Rate for Payer: Vantage Medical Group Senior |
$24.86
|
|
|
HC IMMOBILIZER SHLDR SM
|
Facility
IP
|
$29.25
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698371
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.80
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.77
|
|
|
HC IMMUNE CELL LUMINESCENCE DET
|
Facility
IP
|
$194.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900912314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.28
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.34
|
| Rate for Payer: Heritage Provider Network Senior |
$131.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
|
|
HC IMMUNE CELL LUMINESCENCE DET
|
Facility
OP
|
$161.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900912314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.28
|
| Rate for Payer: Blue Shield of California Commercial |
$110.35
|
| Rate for Payer: Blue Shield of California EPN |
$86.26
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$104.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Senior |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.66
|
| Rate for Payer: Heritage Provider Network Senior |
$99.66
|
| Rate for Payer: Humana Medicare |
$14.12
|
| Rate for Payer: IEHP Medi-Cal |
$19.58
|
| Rate for Payer: IEHP Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.79
|
| Rate for Payer: Multiplan Commercial |
$120.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.12
|
| Rate for Payer: TriValley Medical Group Senior |
$14.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC IMMUNE CELL MITOGEN STIM
|
Facility
OP
|
$196.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
900912313
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$410.29 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$142.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$73.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$49.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$410.29
|
| Rate for Payer: Blue Shield of California Commercial |
$382.86
|
| Rate for Payer: Blue Shield of California EPN |
$299.30
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.93
|
| Rate for Payer: Dignity Health Senior |
$49.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$49.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.32
|
| Rate for Payer: Heritage Provider Network Senior |
$121.32
|
| Rate for Payer: Humana Medicare |
$49.03
|
| Rate for Payer: IEHP Medi-Cal |
$67.98
|
| Rate for Payer: IEHP Medicare Advantage |
$49.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.78
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$49.03
|
| Rate for Payer: TriValley Medical Group Senior |
$49.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$52.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.93
|
| Rate for Payer: Vantage Medical Group Senior |
$49.03
|
|
|
HC IMMUNE CELL MITOGEN STIM
|
Facility
IP
|
$237.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
900912313
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$177.75 |
| Rate for Payer: Adventist Health Commercial |
$47.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$162.82
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$160.45
|
| Rate for Payer: Heritage Provider Network Senior |
$160.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.25
|
| Rate for Payer: Multiplan Commercial |
$177.75
|
|
|
HC IMMUNOASSAY QUAN CA 125
|
Facility
IP
|
$250.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
900912122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.75
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$169.25
|
| Rate for Payer: Heritage Provider Network Senior |
$169.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.50
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
|
|
HC IMMUNOASSAY QUAN CA 125
|
Facility
OP
|
$72.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
900912122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$174.07 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.07
|
| Rate for Payer: Blue Shield of California Commercial |
$162.50
|
| Rate for Payer: Blue Shield of California EPN |
$127.04
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Senior |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.57
|
| Rate for Payer: Heritage Provider Network Senior |
$44.57
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: IEHP Medi-Cal |
$28.86
|
| Rate for Payer: IEHP Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC IMMUNOASSAY QUAN CA 15-3
|
Facility
IP
|
$216.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
900912123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Adventist Health Commercial |
$43.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.39
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$146.23
|
| Rate for Payer: Heritage Provider Network Senior |
$146.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
|
|
HC IMMUNOASSAY QUAN CA 15-3
|
Facility
OP
|
$72.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
900912123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$174.07 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.07
|
| Rate for Payer: Blue Shield of California Commercial |
$162.50
|
| Rate for Payer: Blue Shield of California EPN |
$127.04
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Senior |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.57
|
| Rate for Payer: Heritage Provider Network Senior |
$44.57
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: IEHP Medi-Cal |
$28.86
|
| Rate for Payer: IEHP Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC IMMUNOASSAY QUAN CA 19-9
|
Facility
OP
|
$72.00
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
900912124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$174.07 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.07
|
| Rate for Payer: Blue Shield of California Commercial |
$162.50
|
| Rate for Payer: Blue Shield of California EPN |
$127.04
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Senior |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.57
|
| Rate for Payer: Heritage Provider Network Senior |
$44.57
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: IEHP Medi-Cal |
$28.86
|
| Rate for Payer: IEHP Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC IMMUNOASSAY QUAN CA 19-9
|
Facility
IP
|
$250.00
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
900912124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.75
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$169.25
|
| Rate for Payer: Heritage Provider Network Senior |
$169.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.50
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
|
