|
HC PROSTHETIC TRAIN 15 MIN PT
|
Facility
IP
|
$188.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
900417520
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.03 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Adventist Health Commercial |
$37.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.16
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.28
|
| Rate for Payer: Heritage Provider Network Senior |
$127.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
|
|
HC PROSTHETIC TRAINING 15 MIN MCAL
|
Facility
IP
|
$188.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
900400052
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.03 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Adventist Health Commercial |
$37.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.16
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.28
|
| Rate for Payer: Heritage Provider Network Senior |
$127.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
|
|
HC PROSTHETIC TRAINING 15 MIN MCAL
|
Facility
OP
|
$188.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
901300079
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$34.03 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$37.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$159.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$103.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$141.00
|
| 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 |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.80
|
| Rate for Payer: Dignity Health Senior |
$159.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.37
|
| Rate for Payer: Heritage Provider Network Senior |
$116.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$90.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| 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 |
$159.80
|
| Rate for Payer: Vantage Medical Group Senior |
$159.80
|
|
|
HC PROSTHETIC TRAINING 15 MIN MCAL
|
Facility
OP
|
$188.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
900400052
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.03 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$37.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$159.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$103.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$141.00
|
| 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 |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.80
|
| Rate for Payer: Dignity Health Senior |
$159.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.37
|
| Rate for Payer: Heritage Provider Network Senior |
$116.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$90.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| 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 |
$159.80
|
| Rate for Payer: Vantage Medical Group Senior |
$159.80
|
|
|
HC PROSTHETIC TRAINING 15 MIN MCAL
|
Facility
IP
|
$188.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
901300079
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$34.03 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Adventist Health Commercial |
$37.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.16
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.28
|
| Rate for Payer: Heritage Provider Network Senior |
$127.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
|
|
HC PROSTHETIC TRAINING 15 MIN OT
|
Facility
OP
|
$68.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
905104520
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$57.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$37.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$51.00
|
| 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 |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.80
|
| Rate for Payer: Dignity Health Senior |
$57.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.09
|
| Rate for Payer: Heritage Provider Network Senior |
$42.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| 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 |
$57.80
|
| Rate for Payer: Vantage Medical Group Senior |
$57.80
|
|
|
HC PROSTHETIC TRAINING 15 MIN OT
|
Facility
IP
|
$68.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
905104520
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.04
|
| Rate for Payer: Heritage Provider Network Senior |
$46.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
|
|
HC PROSTH SHRINKER UPPER LIMB EA
|
Facility
IP
|
$91.00
|
|
|
Service Code
|
CPT L8465
|
| Hospital Charge Code |
905358465
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.61
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.75
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.40
|
|
|
HC PROSTH SHRINKER UPPER LIMB EA
|
Facility
OP
|
$91.00
|
|
|
Service Code
|
CPT L8465
|
| Hospital Charge Code |
905358465
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$77.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$50.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$68.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$56.51
|
| Rate for Payer: Blue Shield of California EPN |
$53.42
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.35
|
| Rate for Payer: Dignity Health Senior |
$77.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.13
|
| Rate for Payer: Heritage Provider Network Senior |
$42.13
|
| Rate for Payer: IEHP Medi-Cal |
$29.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.75
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.35
|
| Rate for Payer: Vantage Medical Group Senior |
$77.35
|
|
|
HC PROTEIN BODY FLUID
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900910248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$30.77 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.77
|
| Rate for Payer: Blue Shield of California Commercial |
$28.62
|
| Rate for Payer: Blue Shield of California EPN |
$22.37
|
| 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 |
$6.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.40
|
| Rate for Payer: Dignity Health Senior |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: IEHP Medi-Cal |
$4.66
|
| Rate for Payer: IEHP Medicare Advantage |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.00
|
| Rate for Payer: TriValley Medical Group Senior |
$4.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4.00
|
|
|
HC PROTEIN BODY FLUID
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900910248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.98
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
|
|
HC PROTEIN C ACTIVITY
|
Facility
IP
|
$440.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
900912012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$79.64 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$302.28
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$297.88
|
| Rate for Payer: Heritage Provider Network Senior |
$297.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Multiplan Commercial |
$330.00
|
|
|
HC PROTEIN C ACTIVITY
|
Facility
OP
|
$53.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
900912012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$115.86 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.86
|
| Rate for Payer: Blue Shield of California Commercial |
$108.00
|
| Rate for Payer: Blue Shield of California EPN |
$84.43
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.22
|
| Rate for Payer: Dignity Health Senior |
$13.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.81
|
| Rate for Payer: Heritage Provider Network Senior |
$32.81
|
| Rate for Payer: Humana Medicare |
$13.84
|
| Rate for Payer: IEHP Medi-Cal |
$19.19
|
| Rate for Payer: IEHP Medicare Advantage |
$13.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.44
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.84
|
| Rate for Payer: TriValley Medical Group Senior |
$13.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.22
|
| Rate for Payer: Vantage Medical Group Senior |
$13.84
|
|
|
HC PROTEIN CSF
|
Facility
OP
|
$11.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900912250
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$30.77 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.77
|
| Rate for Payer: Blue Shield of California Commercial |
$28.62
|
| Rate for Payer: Blue Shield of California EPN |
$22.37
|
| 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 |
$6.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.40
|
| Rate for Payer: Dignity Health Senior |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.81
|
| Rate for Payer: Heritage Provider Network Senior |
$6.81
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: IEHP Medi-Cal |
$4.66
|
| Rate for Payer: IEHP Medicare Advantage |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.00
|
| Rate for Payer: TriValley Medical Group Senior |
$4.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4.00
|
|
|
HC PROTEIN CSF
|
Facility
IP
|
$20.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900912250
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC PROTEIN ELECT CSF/URINE
|
Facility
OP
|
$68.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900910849
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$146.23 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.23
|
| Rate for Payer: Blue Shield of California Commercial |
$139.30
|
| Rate for Payer: Blue Shield of California EPN |
$108.90
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Senior |
$17.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.09
|
| Rate for Payer: Heritage Provider Network Senior |
$42.09
|
| Rate for Payer: Humana Medicare |
$17.83
|
| Rate for Payer: IEHP Medi-Cal |
$24.73
|
| Rate for Payer: IEHP Medicare Advantage |
$17.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.47
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.83
|
| Rate for Payer: TriValley Medical Group Senior |
$17.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC PROTEIN ELECT CSF/URINE
|
Facility
IP
|
$230.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900910849
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$158.01
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.71
|
| Rate for Payer: Heritage Provider Network Senior |
$155.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
|
|
HC PROTEIN ELECT SERUM
|
Facility
OP
|
$31.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
900910850
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$89.99 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.99
|
| Rate for Payer: Blue Shield of California Commercial |
$83.91
|
| Rate for Payer: Blue Shield of California EPN |
$65.59
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Senior |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Humana Medicare |
$10.74
|
| Rate for Payer: IEHP Medi-Cal |
$14.90
|
| Rate for Payer: IEHP Medicare Advantage |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Senior |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC PROTEIN ELECT SERUM
|
Facility
IP
|
$230.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
900910850
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$158.01
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.71
|
| Rate for Payer: Heritage Provider Network Senior |
$155.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
|
|
HC PROTEIN TOTAL
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900910249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$30.65 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.65
|
| Rate for Payer: Blue Shield of California Commercial |
$28.62
|
| Rate for Payer: Blue Shield of California EPN |
$22.37
|
| 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 |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$3.67
|
| Rate for Payer: IEHP Medi-Cal |
$4.62
|
| Rate for Payer: IEHP Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.67
|
| Rate for Payer: TriValley Medical Group Senior |
$3.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC PROTEIN TOTAL
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900910249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC PROTEIN TOTAL SPE ONLY
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900912163
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC PROTEIN TOTAL SPE ONLY
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900912163
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$30.65 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.65
|
| Rate for Payer: Blue Shield of California Commercial |
$28.62
|
| Rate for Payer: Blue Shield of California EPN |
$22.37
|
| 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 |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$3.67
|
| Rate for Payer: IEHP Medi-Cal |
$4.62
|
| Rate for Payer: IEHP Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.67
|
| Rate for Payer: TriValley Medical Group Senior |
$3.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC PROTEIN URINE
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900910290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.82
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.76
|
| Rate for Payer: Heritage Provider Network Senior |
$71.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
|
|
HC PROTEIN URINE
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900910290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$30.77 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.77
|
| Rate for Payer: Blue Shield of California Commercial |
$28.62
|
| Rate for Payer: Blue Shield of California EPN |
$22.37
|
| 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 |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$3.67
|
| Rate for Payer: IEHP Medi-Cal |
$5.09
|
| Rate for Payer: IEHP Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.67
|
| Rate for Payer: TriValley Medical Group Senior |
$3.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
