|
HC MICRO EXAM/SPERM
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
900910155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$100.81 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.81
|
| Rate for Payer: Blue Shield of California Commercial |
$94.14
|
| Rate for Payer: Blue Shield of California EPN |
$73.59
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC MICRO EXAM/SPERM
|
Facility
IP
|
$164.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
900910155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$123.00 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.67
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.03
|
| Rate for Payer: Heritage Provider Network Senior |
$111.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Multiplan Commercial |
$123.00
|
|
|
HC MICRO EXAM/TRICHOMONAS
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900910156
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$35.73 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.73
|
| Rate for Payer: Blue Shield of California Commercial |
$33.32
|
| Rate for Payer: Blue Shield of California EPN |
$26.05
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Senior |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$5.82
|
| Rate for Payer: IEHP Medi-Cal |
$5.55
|
| Rate for Payer: IEHP Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.33
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC MICRO EXAM/TRICHOMONAS
|
Facility
IP
|
$160.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900910156
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.92
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
|
|
HC MICROFIL LARVA
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911659
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$50.15 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.15
|
| Rate for Payer: Blue Shield of California Commercial |
$46.79
|
| Rate for Payer: Blue Shield of California EPN |
$36.58
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Senior |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Humana Medicare |
$5.99
|
| Rate for Payer: IEHP Medi-Cal |
$8.31
|
| Rate for Payer: IEHP Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.55
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.99
|
| Rate for Payer: TriValley Medical Group Senior |
$5.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC MICROFIL LARVA
|
Facility
IP
|
$200.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911659
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC MICROGLOBULIN
|
Facility
IP
|
$194.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900912121
|
|
Hospital Revenue Code
|
301
|
| 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 MICROGLOBULIN
|
Facility
OP
|
$62.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
900912121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$135.47 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.47
|
| Rate for Payer: Blue Shield of California Commercial |
$126.39
|
| Rate for Payer: Blue Shield of California EPN |
$98.81
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.80
|
| Rate for Payer: Dignity Health Senior |
$16.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.38
|
| Rate for Payer: Heritage Provider Network Senior |
$38.38
|
| Rate for Payer: Humana Medicare |
$16.18
|
| Rate for Payer: IEHP Medi-Cal |
$22.43
|
| Rate for Payer: IEHP Medicare Advantage |
$16.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.39
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.18
|
| Rate for Payer: TriValley Medical Group Senior |
$16.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16.18
|
|
|
HC MICROGUIDEWIRE
|
Facility
OP
|
$594.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.51 |
| Max. Negotiated Rate |
$504.90 |
| Rate for Payer: Adventist Health Commercial |
$118.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$504.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$326.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$445.50
|
| Rate for Payer: Blue Shield of California Commercial |
$368.87
|
| Rate for Payer: Blue Shield of California EPN |
$348.68
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$386.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$504.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$504.90
|
| Rate for Payer: Dignity Health Senior |
$504.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$386.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.69
|
| Rate for Payer: Heritage Provider Network Senior |
$367.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$286.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.50
|
| Rate for Payer: Multiplan Commercial |
$445.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$504.90
|
| Rate for Payer: Vantage Medical Group Senior |
$504.90
|
|
|
HC MICROGUIDEWIRE
|
Facility
IP
|
$594.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.51 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Adventist Health Commercial |
$118.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.08
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$402.14
|
| Rate for Payer: Heritage Provider Network Senior |
$402.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.50
|
| Rate for Payer: Multiplan Commercial |
$445.50
|
|
|
HC MICROHEMATOCRIT SPUN
|
Facility
OP
|
$11.00
|
|
|
Service Code
|
CPT 85013
|
| Hospital Charge Code |
900910790
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.78
|
| Rate for Payer: Blue Shield of California Commercial |
$18.50
|
| Rate for Payer: Blue Shield of California EPN |
$14.46
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.70
|
| Rate for Payer: Dignity Health Senior |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.81
|
| Rate for Payer: Heritage Provider Network Senior |
$6.81
|
| Rate for Payer: Humana Medicare |
$7.00
|
| Rate for Payer: IEHP Medi-Cal |
$3.17
|
| Rate for Payer: IEHP Medicare Advantage |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.00
|
| Rate for Payer: TriValley Medical Group Senior |
$7.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Vantage Medical Group Senior |
$7.00
|
|
|
HC MICROHEMATOCRIT SPUN
|
Facility
IP
|
$116.00
|
|
|
Service Code
|
CPT 85013
|
| Hospital Charge Code |
900910790
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.69
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.53
|
| Rate for Payer: Heritage Provider Network Senior |
$78.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
|
|
HC MICROHEMATOCRIT SPUN BODY FLUID
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 85013
|
| Hospital Charge Code |
900910159
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.78
|
| Rate for Payer: Blue Shield of California Commercial |
$18.50
|
| Rate for Payer: Blue Shield of California EPN |
$14.46
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.70
|
| Rate for Payer: Dignity Health Senior |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$7.00
|
| Rate for Payer: IEHP Medi-Cal |
$3.17
|
| Rate for Payer: IEHP Medicare Advantage |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.00
|
| Rate for Payer: TriValley Medical Group Senior |
$7.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Vantage Medical Group Senior |
$7.00
|
|
|
HC MICROHEMATOCRIT SPUN BODY FLUID
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT 85013
|
| Hospital Charge Code |
900910159
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.18
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
|
HC MICROWIRE MIRAGE
|
Facility
IP
|
$2,254.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.97 |
| Max. Negotiated Rate |
$1,690.50 |
| Rate for Payer: Adventist Health Commercial |
$450.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,548.50
|
| Rate for Payer: Cash Price |
$1,014.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,525.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,525.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.50
|
| Rate for Payer: Multiplan Commercial |
$1,690.50
|
|
|
HC MICROWIRE MIRAGE
|
Facility
OP
|
$2,254.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.10 |
| Max. Negotiated Rate |
$1,915.90 |
| Rate for Payer: Adventist Health Commercial |
$450.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,548.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,915.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,239.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,690.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,399.73
|
| Rate for Payer: Blue Shield of California EPN |
$1,323.10
|
| Rate for Payer: Cash Price |
$1,014.30
|
| Rate for Payer: Cash Price |
$1,014.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,465.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,915.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,915.90
|
| Rate for Payer: Dignity Health Senior |
$1,915.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,465.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,395.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,395.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,086.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.50
|
| Rate for Payer: Multiplan Commercial |
$1,690.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,915.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,915.90
|
|
|
HC MOD/TRAIN IN USE VOICE PROSTHE
|
Facility
IP
|
$234.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
905601759
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Adventist Health Commercial |
$46.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.76
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$158.42
|
| Rate for Payer: Heritage Provider Network Senior |
$158.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$175.50
|
|
|
HC MOD/TRAIN IN USE VOICE PROSTHE
|
Facility
OP
|
$234.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
905601759
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$46.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$269.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$198.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$128.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$175.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$152.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$198.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.90
|
| Rate for Payer: Dignity Health Senior |
$198.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.85
|
| Rate for Payer: Heritage Provider Network Senior |
$144.85
|
| Rate for Payer: IEHP Medi-Cal |
$81.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$112.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$175.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.90
|
| Rate for Payer: Vantage Medical Group Senior |
$198.90
|
|
|
HC MOD/TRAIN IN USE VOICE PROSTHE MCAL
|
Facility
OP
|
$301.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
907000029
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$269.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$255.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$225.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$195.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.85
|
| Rate for Payer: Dignity Health Senior |
$255.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.32
|
| Rate for Payer: Heritage Provider Network Senior |
$186.32
|
| Rate for Payer: IEHP Medi-Cal |
$81.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.25
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.85
|
| Rate for Payer: Vantage Medical Group Senior |
$255.85
|
|
|
HC MOD/TRAIN IN USE VOICE PROSTHE MCAL
|
Facility
IP
|
$301.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
907000029
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$225.75 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.79
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.78
|
| Rate for Payer: Heritage Provider Network Senior |
$203.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.25
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
|
|
HC MOD VOICE/AUG DVC MCAL
|
Facility
IP
|
$229.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000027
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.45 |
| Max. Negotiated Rate |
$171.75 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.32
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.03
|
| Rate for Payer: Heritage Provider Network Senior |
$155.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.25
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
|
|
HC MOD VOICE/AUG DVC MCAL
|
Facility
OP
|
$229.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000027
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.45 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$161.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$194.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$125.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$171.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$148.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.65
|
| Rate for Payer: Dignity Health Senior |
$194.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.75
|
| Rate for Payer: Heritage Provider Network Senior |
$141.75
|
| Rate for Payer: IEHP Medi-Cal |
$54.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.25
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.65
|
| Rate for Payer: Vantage Medical Group Senior |
$194.65
|
|
|
HC MOHC LNAR DISK
|
Facility
OP
|
$34.00
|
|
| Hospital Charge Code |
909001084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.50
|
| Rate for Payer: Blue Shield of California Commercial |
$21.11
|
| Rate for Payer: Blue Shield of California EPN |
$19.96
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.90
|
| Rate for Payer: Dignity Health Senior |
$28.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.90
|
| Rate for Payer: Vantage Medical Group Senior |
$28.90
|
|
|
HC MOHC LNAR DISK
|
Facility
IP
|
$34.00
|
|
| Hospital Charge Code |
909001084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.36
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.02
|
| Rate for Payer: Heritage Provider Network Senior |
$23.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
|
|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
IP
|
$580.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.66
|
| Rate for Payer: Heritage Provider Network Senior |
$392.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
|
