|
HC SO ACROMIO/CLAVICULAR
|
Facility
OP
|
$249.00
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
901309109
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$119.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$154.63
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$114.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Senior |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.29
|
| Rate for Payer: Heritage Provider Network Senior |
$115.29
|
| Rate for Payer: IEHP Medi-Cal |
$138.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$124.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$124.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$90.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$83.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC SOCC FANCONI COMPLEM ASSAY
|
Facility
IP
|
$1,699.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914675
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$307.52 |
| Max. Negotiated Rate |
$1,274.25 |
| Rate for Payer: Adventist Health Commercial |
$339.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,167.21
|
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,150.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,150.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.75
|
| Rate for Payer: Multiplan Commercial |
$1,274.25
|
|
|
HC SOCC FANCONI COMPLEM ASSAY
|
Facility
OP
|
$1,699.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914675
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$109.45 |
| Max. Negotiated Rate |
$1,444.15 |
| Rate for Payer: Adventist Health Commercial |
$339.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,167.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,444.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$934.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,274.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,055.08
|
| Rate for Payer: Blue Shield of California EPN |
$997.31
|
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,104.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,444.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,444.15
|
| Rate for Payer: Dignity Health Senior |
$1,444.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,104.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,051.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,051.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$818.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.75
|
| Rate for Payer: Multiplan Commercial |
$1,274.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,444.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,444.15
|
|
|
HC SOCDX ALLOSURE COLLECTION
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900915321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$82.10 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.10
|
| Rate for Payer: Blue Shield of California Commercial |
$18.63
|
| Rate for Payer: Blue Shield of California EPN |
$17.61
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Senior |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC SOCDX ALLOSURE COLLECTION
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900915321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC SOCIDEM PDC 82657
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900915254
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC SOCIDEM PDC 82657
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900915254
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$150.51 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Senior |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| Rate for Payer: Humana Medicare |
$22.17
|
| Rate for Payer: IEHP Medi-Cal |
$27.67
|
| Rate for Payer: IEHP Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.93
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.17
|
| Rate for Payer: TriValley Medical Group Senior |
$22.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOCIDEM PDC 82658
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT 82658
|
| Hospital Charge Code |
900915255
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC SOCIDEM PDC 82658
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT 82658
|
| Hospital Charge Code |
900915255
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$150.51 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$48.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$44.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.43
|
| Rate for Payer: Dignity Health Senior |
$44.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$44.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: IEHP Medi-Cal |
$30.67
|
| Rate for Payer: IEHP Medicare Advantage |
$44.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.48
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$44.03
|
| Rate for Payer: TriValley Medical Group Senior |
$44.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$47.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.43
|
| Rate for Payer: Vantage Medical Group Senior |
$44.03
|
|
|
HC SOCIDEM PDC 84157
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900915256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| 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 |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| 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 |
$97.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| 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 |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| 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 |
$112.50
|
| 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 SOCIDEM PDC 84157
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900915256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC SOCIDEM PDC 84999
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900915253
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
|
HC SOCIDEM PDC 84999
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900915253
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Blue Shield of California Commercial |
$74.52
|
| Rate for Payer: Blue Shield of California EPN |
$70.44
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Senior |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC SOCINN 558 PRF1 GENE
|
Facility
OP
|
$2,371.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914743
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$109.45 |
| Max. Negotiated Rate |
$2,015.35 |
| Rate for Payer: Adventist Health Commercial |
$474.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,628.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,015.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,304.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,778.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,472.39
|
| Rate for Payer: Blue Shield of California EPN |
$1,391.78
|
| Rate for Payer: Cash Price |
$1,066.95
|
| Rate for Payer: Cash Price |
$1,066.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,541.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,015.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,015.35
|
| Rate for Payer: Dignity Health Senior |
$2,015.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,467.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,467.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,142.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.75
|
| Rate for Payer: Multiplan Commercial |
$1,778.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,015.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,015.35
|
|
|
HC SOCINN 558 PRF1 GENE
|
Facility
IP
|
$2,371.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914743
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$429.15 |
| Max. Negotiated Rate |
$1,778.25 |
| Rate for Payer: Adventist Health Commercial |
$474.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,628.88
|
| Rate for Payer: Cash Price |
$1,066.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,605.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,605.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.75
|
| Rate for Payer: Multiplan Commercial |
$1,778.25
|
|
|
HC SODIUM
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900910269
|
|
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 SODIUM
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900910269
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$40.12 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.12
|
| Rate for Payer: Blue Shield of California Commercial |
$37.56
|
| Rate for Payer: Blue Shield of California EPN |
$29.37
|
| 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 |
$7.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: Dignity Health Senior |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: IEHP Medi-Cal |
$5.48
|
| Rate for Payer: IEHP Medicare Advantage |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.81
|
| Rate for Payer: TriValley Medical Group Senior |
$4.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC SODIUM BODY FLUID
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
900912246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$40.52 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.52
|
| Rate for Payer: Blue Shield of California Commercial |
$37.96
|
| Rate for Payer: Blue Shield of California EPN |
$29.67
|
| 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 |
$7.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.35
|
| Rate for Payer: Dignity Health Senior |
$4.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$4.86
|
| Rate for Payer: IEHP Medi-Cal |
$6.74
|
| Rate for Payer: IEHP Medicare Advantage |
$4.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.86
|
| Rate for Payer: TriValley Medical Group Senior |
$4.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.86
|
|
|
HC SODIUM BODY FLUID
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
900912246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SODIUM CH
|
Facility
OP
|
$88.55
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900912186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Adventist Health Commercial |
$17.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.12
|
| Rate for Payer: Blue Shield of California Commercial |
$37.56
|
| Rate for Payer: Blue Shield of California EPN |
$29.37
|
| Rate for Payer: Cash Price |
$39.85
|
| Rate for Payer: Cash Price |
$39.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: Dignity Health Senior |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.81
|
| Rate for Payer: Heritage Provider Network Senior |
$54.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: IEHP Medi-Cal |
$5.48
|
| Rate for Payer: IEHP Medicare Advantage |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$66.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.81
|
| Rate for Payer: TriValley Medical Group Senior |
$4.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC SODIUM CH
|
Facility
IP
|
$88.55
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900912186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.03 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Adventist Health Commercial |
$17.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.83
|
| Rate for Payer: Cash Price |
$39.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.95
|
| Rate for Payer: Heritage Provider Network Senior |
$59.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.14
|
| Rate for Payer: Multiplan Commercial |
$66.41
|
|
|
HC SODIUM FLUORIDE F-18 UP TO 30
|
Facility
IP
|
$1,869.00
|
|
|
Service Code
|
CPT A9580
|
| Hospital Charge Code |
909301573
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$338.29 |
| Max. Negotiated Rate |
$1,401.75 |
| Rate for Payer: Adventist Health Commercial |
$373.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,284.00
|
| Rate for Payer: Cash Price |
$841.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$859.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,009.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,265.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,265.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.25
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$681.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$624.43
|
|
|
HC SODIUM FLUORIDE F-18 UP TO 30
|
Facility
OP
|
$1,869.00
|
|
|
Service Code
|
CPT A9580
|
| Hospital Charge Code |
909301573
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$338.29 |
| Max. Negotiated Rate |
$1,588.65 |
| Rate for Payer: Adventist Health Commercial |
$373.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,588.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,027.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,401.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,160.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,097.10
|
| Rate for Payer: Cash Price |
$841.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$859.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,588.65
|
| Rate for Payer: Dignity Health Senior |
$1,588.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,196.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$865.35
|
| Rate for Payer: Heritage Provider Network Senior |
$865.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$900.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.25
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$681.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$624.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,588.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,588.65
|
|
|
HC SODIUM STOOL
|
Facility
IP
|
$179.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
900910418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.97
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.18
|
| Rate for Payer: Heritage Provider Network Senior |
$121.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.75
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
|
|
HC SODIUM STOOL
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
900910418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$40.52 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.52
|
| Rate for Payer: Blue Shield of California Commercial |
$37.96
|
| Rate for Payer: Blue Shield of California EPN |
$29.67
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.35
|
| Rate for Payer: Dignity Health Senior |
$4.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$4.86
|
| Rate for Payer: IEHP Medi-Cal |
$6.74
|
| Rate for Payer: IEHP Medicare Advantage |
$4.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.86
|
| Rate for Payer: TriValley Medical Group Senior |
$4.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.86
|
|
