|
HC URIC ACID URINE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900910216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.33
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Senior |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.76
|
| Rate for Payer: Heritage Provider Network Senior |
$76.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.08
|
| Rate for Payer: TriValley Medical Group Senior |
$5.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.08
|
|
|
HC URIC ACID URINE
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900910216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
|
|
HC URIC ACID URINE 24 HOURS
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
|
|
HC URIC ACID URINE 24 HOURS
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.33
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Senior |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.76
|
| Rate for Payer: Heritage Provider Network Senior |
$76.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.08
|
| Rate for Payer: TriValley Medical Group Senior |
$5.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.08
|
|
|
HC URIC ACID URINE RANDOM
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
|
|
HC URIC ACID URINE RANDOM
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
900912222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.33
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.59
|
| Rate for Payer: Dignity Health Senior |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.76
|
| Rate for Payer: Heritage Provider Network Senior |
$76.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.08
|
| Rate for Payer: TriValley Medical Group Senior |
$5.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.08
|
|
|
HC URINALYSIS NON AUTOMATED WO MICROSCOPY
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900510277
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$71.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.70
|
| Rate for Payer: Blue Shield of California Commercial |
$20.56
|
| Rate for Payer: Blue Shield of California EPN |
$16.49
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Senior |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$63.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.48
|
| Rate for Payer: TriValley Medical Group Senior |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC URINALYSIS NON AUTOMATED WO MICROSCOPY
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900510277
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
|
HC URINALYSIS NON AUTOMATED WO MICROSCOPY
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
906581002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
|
HC URINALYSIS NON AUTOMATED WO MICROSCOPY
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
906581002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$71.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.70
|
| Rate for Payer: Blue Shield of California Commercial |
$20.56
|
| Rate for Payer: Blue Shield of California EPN |
$16.49
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Senior |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$63.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.48
|
| Rate for Payer: TriValley Medical Group Senior |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC URINE CHEMISTRY SCREEN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910180
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.53
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.51
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Senior |
$2.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.85
|
| Rate for Payer: Heritage Provider Network Senior |
$53.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.83
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.25
|
| Rate for Payer: TriValley Medical Group Senior |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.25
|
|
|
HC URINE CHEMISTRY SCREEN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910180
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.90
|
| Rate for Payer: Heritage Provider Network Senior |
$58.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
|
|
HC URINE CHEM SCREEN POC
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900912015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.53
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.51
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Senior |
$2.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.85
|
| Rate for Payer: Heritage Provider Network Senior |
$53.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.83
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.25
|
| Rate for Payer: TriValley Medical Group Senior |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.25
|
|
|
HC URINE CHEM SCREEN POC
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900912015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.90
|
| Rate for Payer: Heritage Provider Network Senior |
$58.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
|
|
HC UROGRAPHY ANTEGRADE
|
Facility
|
IP
|
$2,226.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
909001935
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$402.91 |
| Max. Negotiated Rate |
$1,669.50 |
| Rate for Payer: Adventist Health Commercial |
$445.20
|
| Rate for Payer: Cash Price |
$1,224.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,507.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,507.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$556.50
|
| Rate for Payer: Multiplan Commercial |
$1,669.50
|
|
|
HC UROGRAPHY ANTEGRADE
|
Facility
|
OP
|
$2,226.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
909001935
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$1,669.50 |
| Rate for Payer: Adventist Health Commercial |
$445.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,189.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,529.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.48
|
| Rate for Payer: Blue Shield of California Commercial |
$274.70
|
| Rate for Payer: Blue Shield of California EPN |
$220.91
|
| Rate for Payer: Cash Price |
$1,224.30
|
| Rate for Payer: Cash Price |
$1,224.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,446.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,446.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,377.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,377.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,061.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$556.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$1,669.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$453.77
|
| Rate for Payer: TriValley Medical Group Senior |
$453.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
906601317
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$150.23 |
| Max. Negotiated Rate |
$622.50 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Cash Price |
$456.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$561.91
|
| Rate for Payer: Heritage Provider Network Senior |
$561.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.50
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
906601317
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$622.50 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$443.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$570.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$369.70
|
| Rate for Payer: Blue Shield of California EPN |
$297.30
|
| Rate for Payer: Cash Price |
$456.50
|
| Rate for Payer: Cash Price |
$456.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$539.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$539.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$513.77
|
| Rate for Payer: Heritage Provider Network Senior |
$513.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$395.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
OP
|
$872.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
910400120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$654.00 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$466.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$599.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$531.92
|
| Rate for Payer: Blue Shield of California EPN |
$425.54
|
| Rate for Payer: Cash Price |
$479.60
|
| Rate for Payer: Cash Price |
$479.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$539.77
|
| Rate for Payer: Heritage Provider Network Senior |
$539.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$415.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$654.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$436.00
|
| Rate for Payer: TriValley Medical Group Senior |
$436.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$436.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$436.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL
|
Facility
|
IP
|
$872.00
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
910400120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$157.83 |
| Max. Negotiated Rate |
$654.00 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Cash Price |
$479.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$590.34
|
| Rate for Payer: Heritage Provider Network Senior |
$590.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.00
|
| Rate for Payer: Multiplan Commercial |
$654.00
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$281.63
|
| Rate for Payer: Heritage Provider Network Senior |
$281.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
|
|
HC US 1ST TRI FETAL NUCHAL TRANSL ADDL FETUS
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
906601318
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$353.60 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$222.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$285.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$312.00
|
| Rate for Payer: Blue Shield of California Commercial |
$189.89
|
| Rate for Payer: Blue Shield of California EPN |
$152.70
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$270.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$353.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.60
|
| Rate for Payer: Dignity Health Senior |
$353.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$257.50
|
| Rate for Payer: Heritage Provider Network Senior |
$257.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$112.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$198.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.20
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.60
|
| Rate for Payer: Vantage Medical Group Senior |
$353.60
|
|
|
HC US ABD AORTA SCREENING AAA
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.03 |
| Max. Negotiated Rate |
$377.14 |
| Rate for Payer: Adventist Health Commercial |
$81.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$218.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$280.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$377.14
|
| Rate for Payer: Blue Shield of California EPN |
$303.28
|
| Rate for Payer: Cash Price |
$224.95
|
| Rate for Payer: Cash Price |
$224.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$265.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.17
|
| Rate for Payer: Heritage Provider Network Senior |
$253.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$138.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$195.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC US ABD AORTA SCREENING AAA
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
906676706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.03 |
| Max. Negotiated Rate |
$306.75 |
| Rate for Payer: Adventist Health Commercial |
$81.80
|
| Rate for Payer: Cash Price |
$224.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$276.89
|
| Rate for Payer: Heritage Provider Network Senior |
$276.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.25
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
|
|
HC US ABDOMINAL W CONTRAST
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
CPT C9744
|
| Hospital Charge Code |
906609744
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$149.87 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Adventist Health Commercial |
$165.60
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$560.56
|
| Rate for Payer: Heritage Provider Network Senior |
$560.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
|
