|
HC KNEE 1-2 VIEWS
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
909001621
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$366.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.78
|
| Rate for Payer: Blue Shield of California Commercial |
$107.90
|
| Rate for Payer: Blue Shield of California EPN |
$86.77
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$385.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$349.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.07
|
| Rate for Payer: Heritage Provider Network Senior |
$367.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$282.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC KNEE 1-2 VIEWS
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
909001621
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.89
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
|
|
HC KNEE 3 VIEWS
|
Facility
|
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
909001675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.35 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$652.37
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$685.80
|
| Rate for Payer: Heritage Provider Network Senior |
$685.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.25
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
|
|
HC KNEE 3 VIEWS
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
909001675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$626.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.88
|
| Rate for Payer: Blue Shield of California Commercial |
$120.91
|
| Rate for Payer: Blue Shield of California EPN |
$97.23
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$658.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$597.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$627.05
|
| Rate for Payer: Heritage Provider Network Senior |
$627.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$483.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC KNEE COMPLETE 4 VIEWS
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
909001622
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$719.25 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$592.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.88
|
| Rate for Payer: Blue Shield of California Commercial |
$131.04
|
| Rate for Payer: Blue Shield of California EPN |
$105.38
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$623.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$593.62
|
| Rate for Payer: Heritage Provider Network Senior |
$593.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$457.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC KNEE COMPLETE 4 VIEWS
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
909001622
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.58 |
| Max. Negotiated Rate |
$719.25 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$617.60
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$649.24
|
| Rate for Payer: Heritage Provider Network Senior |
$649.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.75
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
|
|
HC KNEE STANDING
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
909001624
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.44 |
| Max. Negotiated Rate |
$345.75 |
| Rate for Payer: Adventist Health Commercial |
$92.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$296.88
|
| Rate for Payer: Cash Price |
$207.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.10
|
| Rate for Payer: Heritage Provider Network Senior |
$312.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.25
|
| Rate for Payer: Multiplan Commercial |
$345.75
|
|
|
HC KNEE STANDING
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
909001624
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$345.75 |
| Rate for Payer: Adventist Health Commercial |
$92.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$284.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.04
|
| Rate for Payer: Blue Shield of California Commercial |
$101.86
|
| Rate for Payer: Blue Shield of California EPN |
$81.91
|
| Rate for Payer: Cash Price |
$207.45
|
| Rate for Payer: Cash Price |
$207.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$299.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$285.36
|
| Rate for Payer: Heritage Provider Network Senior |
$285.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$219.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$345.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC KO ADJ JTS CUSTOM FIT
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
905351832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$275.25 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$451.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$680.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$605.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$825.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$442.60
|
| Rate for Payer: Blue Shield of California EPN |
$442.60
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$506.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$935.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$935.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$509.76
|
| Rate for Payer: Heritage Provider Network Senior |
$509.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$550.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$550.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$550.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$770.70
|
| Rate for Payer: Multiplan Commercial |
$825.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$397.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$364.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.85
|
| Rate for Payer: Vantage Medical Group Senior |
$935.85
|
|
|
HC KO ADJ JTS CUSTOM FIT
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
905351832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.20 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$220.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$709.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$442.60
|
| Rate for Payer: Blue Shield of California EPN |
$442.60
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$506.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$509.76
|
| Rate for Payer: Heritage Provider Network Senior |
$509.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$550.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$550.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$550.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.25
|
| Rate for Payer: Multiplan Commercial |
$825.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$397.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$364.54
|
|
|
HC KRAS EXON 2
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 81275
|
| Hospital Charge Code |
903800316
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$125.61 |
| Max. Negotiated Rate |
$1,070.82 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$310.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$428.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$289.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$289.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$212.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$212.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$193.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$193.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,070.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,070.82
|
| Rate for Payer: Blue Shield of California Commercial |
$306.22
|
| Rate for Payer: Blue Shield of California Commercial |
$423.34
|
| Rate for Payer: Blue Shield of California EPN |
$338.67
|
| Rate for Payer: Blue Shield of California EPN |
$244.98
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$326.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$451.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$289.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$289.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$193.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$193.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$310.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.59
|
| Rate for Payer: Heritage Provider Network Senior |
$310.74
|
| Rate for Payer: Heritage Provider Network Senior |
$429.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$193.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$193.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$239.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$331.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$258.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$258.95
|
| Rate for Payer: Multiplan Commercial |
$376.50
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$193.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$193.25
|
| Rate for Payer: TriValley Medical Group Senior |
$193.25
|
| Rate for Payer: TriValley Medical Group Senior |
$193.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$208.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$208.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$208.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$208.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$289.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$289.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.57
|
| Rate for Payer: Vantage Medical Group Senior |
$193.25
|
| Rate for Payer: Vantage Medical Group Senior |
$193.25
|
|
|
HC KRAS EXON 2
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 81275
|
| Hospital Charge Code |
903800316
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$125.61 |
| Max. Negotiated Rate |
$520.50 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$446.94
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$469.84
|
| Rate for Payer: Heritage Provider Network Senior |
$469.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.50
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
|
|
HC KRAS EXON VARIANTS
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 81276
|
| Hospital Charge Code |
903800317
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$125.61 |
| Max. Negotiated Rate |
$1,459.98 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$310.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$428.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$289.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$289.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$212.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$212.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$193.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$193.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,459.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,459.98
|
| Rate for Payer: Blue Shield of California Commercial |
$1,135.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,135.81
|
| Rate for Payer: Blue Shield of California EPN |
$911.02
|
| Rate for Payer: Blue Shield of California EPN |
$911.02
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$326.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$451.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$289.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$289.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$193.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$193.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$310.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.59
|
| Rate for Payer: Heritage Provider Network Senior |
$310.74
|
| Rate for Payer: Heritage Provider Network Senior |
$429.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$193.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$193.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$239.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$331.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$258.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$258.95
|
| Rate for Payer: Multiplan Commercial |
$376.50
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$193.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$193.25
|
| Rate for Payer: TriValley Medical Group Senior |
$193.25
|
| Rate for Payer: TriValley Medical Group Senior |
$193.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$208.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$208.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$208.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$208.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$289.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$289.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.57
|
| Rate for Payer: Vantage Medical Group Senior |
$193.25
|
| Rate for Payer: Vantage Medical Group Senior |
$193.25
|
|
|
HC KRAS EXON VARIANTS
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 81276
|
| Hospital Charge Code |
903800317
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$125.61 |
| Max. Negotiated Rate |
$520.50 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$446.94
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$469.84
|
| Rate for Payer: Heritage Provider Network Senior |
$469.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.50
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
|
|
HC LAB REF ACANTHAMEOBA CULTURE
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
900911538
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$62.45 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.45
|
| Rate for Payer: Blue Shield of California Commercial |
$53.34
|
| Rate for Payer: Blue Shield of California EPN |
$42.78
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.88
|
| Rate for Payer: Heritage Provider Network Senior |
$5.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$7.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.63
|
| Rate for Payer: TriValley Medical Group Senior |
$6.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.29
|
| Rate for Payer: Vantage Medical Group Senior |
$6.63
|
|
|
HC LAB REF ACANTHAMEOBA CULTURE
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
900911538
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.12 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.12
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.43
|
| Rate for Payer: Heritage Provider Network Senior |
$6.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$7.12
|
|
|
HC LAB REF ADDITION KARYOTYPE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900910745
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$238.30 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.30
|
| Rate for Payer: Blue Shield of California Commercial |
$202.00
|
| Rate for Payer: Blue Shield of California EPN |
$162.02
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$33.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$44.85
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$33.47
|
| Rate for Payer: TriValley Medical Group Senior |
$33.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Vantage Medical Group Senior |
$33.47
|
|
|
HC LAB REF ADDITION KARYOTYPE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900910745
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.76
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC LAB REF ADENOVIRUS AB TITER (CF)
|
Facility
|
OP
|
$90.43
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
900911759
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: Adventist Health Commercial |
$18.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.22
|
| Rate for Payer: Blue Shield of California Commercial |
$103.56
|
| Rate for Payer: Blue Shield of California EPN |
$83.07
|
| Rate for Payer: Cash Price |
$40.69
|
| Rate for Payer: Cash Price |
$40.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.98
|
| Rate for Payer: Heritage Provider Network Senior |
$55.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$43.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$67.82
|
| 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 LAB REF ADENOVIRUS AB TITER (CF)
|
Facility
|
IP
|
$90.43
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
900911759
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$67.82 |
| Rate for Payer: Adventist Health Commercial |
$18.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.24
|
| Rate for Payer: Cash Price |
$40.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.22
|
| Rate for Payer: Heritage Provider Network Senior |
$61.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$67.82
|
|
|
HC LAB REF AEROBIC ROUTINE MIC PANEL
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900911299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$82.08 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.08
|
| Rate for Payer: Blue Shield of California Commercial |
$69.58
|
| Rate for Payer: Blue Shield of California EPN |
$55.81
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.67
|
| Rate for Payer: Heritage Provider Network Senior |
$8.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.65
|
| Rate for Payer: TriValley Medical Group Senior |
$8.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC LAB REF AEROBIC ROUTINE MIC PANEL
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900911299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.02
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.48
|
| Rate for Payer: Heritage Provider Network Senior |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
|
|
HC LAB REF ALBUMIN CHARGE - SO
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900910549
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$47.05 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.05
|
| Rate for Payer: Blue Shield of California Commercial |
$39.86
|
| Rate for Payer: Blue Shield of California EPN |
$31.97
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.95
|
| Rate for Payer: Heritage Provider Network Senior |
$4.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.63
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.95
|
| Rate for Payer: TriValley Medical Group Senior |
$4.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
|
|
HC LAB REF ALBUMIN CHARGE - SO
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900910549
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.15
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.42
|
| Rate for Payer: Heritage Provider Network Senior |
$5.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
|
|
HC LAB REF ALCOHOL METHYL
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.88
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
