|
HC TREATMENT ROOM
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
912900120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$416.02
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.34
|
| Rate for Payer: Heritage Provider Network Senior |
$437.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
|
|
HC TREATMENT ROOM
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
912900120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$399.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.13
|
| Rate for Payer: Blue Shield of California Commercial |
$394.06
|
| Rate for Payer: Blue Shield of California EPN |
$315.25
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$419.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$399.87
|
| Rate for Payer: Heritage Provider Network Senior |
$399.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$308.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.36
|
| Rate for Payer: TriValley Medical Group Senior |
$188.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$323.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$323.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC TREAT PELVIC RING FX
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
900501652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.76 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.24
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$649.92
|
| Rate for Payer: Heritage Provider Network Senior |
$649.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
|
|
HC TREAT PELVIC RING FX
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
900501652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.76 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$593.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$456.00
|
| Rate for Payer: Blue Shield of California EPN |
$362.88
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$624.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$649.92
|
| Rate for Payer: Heritage Provider Network Senior |
$649.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$457.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$576.00
|
| Rate for Payer: TriValley Medical Group Senior |
$576.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC TREAT SPLIT WOUND CLOS, SIMP
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
900501539
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$227.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$251.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$776.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$596.60
|
| Rate for Payer: Blue Shield of California EPN |
$474.77
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$816.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$950.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$850.31
|
| Rate for Payer: Heritage Provider Network Senior |
$850.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$599.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$942.00
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$753.60
|
| Rate for Payer: TriValley Medical Group Senior |
$753.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC TREAT SPLIT WOUND CLOS, SIMP
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
900501539
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$227.34 |
| Max. Negotiated Rate |
$942.00 |
| Rate for Payer: Adventist Health Commercial |
$251.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$808.86
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$850.31
|
| Rate for Payer: Heritage Provider Network Senior |
$850.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.00
|
| Rate for Payer: Multiplan Commercial |
$942.00
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
OP
|
$803.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$160.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$496.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$381.43
|
| Rate for Payer: Blue Shield of California EPN |
$303.53
|
| Rate for Payer: Cash Price |
$361.35
|
| Rate for Payer: Cash Price |
$361.35
|
| Rate for Payer: Cash Price |
$361.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$521.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$543.63
|
| Rate for Payer: Heritage Provider Network Senior |
$543.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$383.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$602.25
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$481.80
|
| Rate for Payer: TriValley Medical Group Senior |
$481.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
IP
|
$803.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.34 |
| Max. Negotiated Rate |
$602.25 |
| Rate for Payer: Adventist Health Commercial |
$160.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$517.13
|
| Rate for Payer: Cash Price |
$361.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$543.63
|
| Rate for Payer: Heritage Provider Network Senior |
$543.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.75
|
| Rate for Payer: Multiplan Commercial |
$602.25
|
|
|
HC TREAT TARSAL BONE FX, W/O MANI
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
900501478
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$215.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$666.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$512.52
|
| Rate for Payer: Blue Shield of California EPN |
$407.86
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$701.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$730.48
|
| Rate for Payer: Heritage Provider Network Senior |
$730.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$514.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$809.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$647.40
|
| Rate for Payer: TriValley Medical Group Senior |
$647.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC TREAT TARSAL BONE FX, W/O MANI
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
900501478
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$809.25 |
| Rate for Payer: Adventist Health Commercial |
$215.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$694.88
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$730.48
|
| Rate for Payer: Heritage Provider Network Senior |
$730.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.75
|
| Rate for Payer: Multiplan Commercial |
$809.25
|
|
|
HC TREAT WRIST BONE FX, W/O MANIP
|
Facility
|
IP
|
$1,311.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
900501374
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.29 |
| Max. Negotiated Rate |
$983.25 |
| Rate for Payer: Adventist Health Commercial |
$262.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$844.28
|
| Rate for Payer: Cash Price |
$589.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$887.55
|
| Rate for Payer: Heritage Provider Network Senior |
$887.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.75
|
| Rate for Payer: Multiplan Commercial |
$983.25
|
|
|
HC TREAT WRIST BONE FX, W/O MANIP
|
Facility
|
OP
|
$1,311.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
900501374
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$262.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$810.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$622.73
|
| Rate for Payer: Blue Shield of California EPN |
$495.56
|
| Rate for Payer: Cash Price |
$589.95
|
| Rate for Payer: Cash Price |
$589.95
|
| Rate for Payer: Cash Price |
$589.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$852.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$887.55
|
| Rate for Payer: Heritage Provider Network Senior |
$887.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$625.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$983.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$786.60
|
| Rate for Payer: TriValley Medical Group Senior |
$786.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC TRI A 14 (WHEAT), IGE
|
Facility
|
OP
|
$16.46
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913732
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$3.29
|
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.19
|
| Rate for Payer: Heritage Provider Network Senior |
$8.49
|
| Rate for Payer: Heritage Provider Network Senior |
$10.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$12.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC TRI A 14 (WHEAT), IGE
|
Facility
|
IP
|
$16.46
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913732
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Adventist Health Commercial |
$3.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.60
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Multiplan Commercial |
$12.35
|
|
|
HC TRI A 19 (WHEAT), IGE
|
Facility
|
OP
|
$16.46
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913733
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$3.29
|
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.19
|
| Rate for Payer: Heritage Provider Network Senior |
$8.49
|
| Rate for Payer: Heritage Provider Network Senior |
$10.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$12.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC TRI A 19 (WHEAT), IGE
|
Facility
|
IP
|
$16.46
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913733
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Adventist Health Commercial |
$3.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.60
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Multiplan Commercial |
$12.35
|
|
|
HC TRICHROME TEST
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900911728
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Adventist Health Commercial |
$19.40
|
| Rate for Payer: Adventist Health Commercial |
$110.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$341.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.61
|
| Rate for Payer: Blue Shield of California Commercial |
$199.39
|
| Rate for Payer: Blue Shield of California Commercial |
$199.39
|
| Rate for Payer: Blue Shield of California EPN |
$160.34
|
| Rate for Payer: Blue Shield of California EPN |
$160.34
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$358.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$341.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.04
|
| Rate for Payer: Heritage Provider Network Senior |
$341.69
|
| Rate for Payer: Heritage Provider Network Senior |
$60.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$263.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$171.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$171.12
|
| Rate for Payer: TriValley Medical Group Senior |
$171.12
|
| Rate for Payer: TriValley Medical Group Senior |
$171.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC TRICHROME TEST
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900911728
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$99.91 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Adventist Health Commercial |
$110.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$355.49
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$373.70
|
| Rate for Payer: Heritage Provider Network Senior |
$373.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$414.00
|
|
|
HC TRIGLYCERIDES
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
900910234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.33
|
| Rate for Payer: Blue Shield of California Commercial |
$46.31
|
| Rate for Payer: Blue Shield of California Commercial |
$46.31
|
| Rate for Payer: Blue Shield of California EPN |
$37.14
|
| Rate for Payer: Blue Shield of California EPN |
$37.14
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.69
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.74
|
| Rate for Payer: TriValley Medical Group Senior |
$5.74
|
| Rate for Payer: TriValley Medical Group Senior |
$5.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: Vantage Medical Group Senior |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.74
|
|
|
HC TRIGLYCERIDES
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
900910234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.11
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC TRIGLYCERIDES BODY FLUID
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
900912247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.06
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.91
|
| Rate for Payer: Heritage Provider Network Senior |
$37.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
|
|
HC TRIGLYCERIDES BODY FLUID
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
900912247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$54.33 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.33
|
| Rate for Payer: Blue Shield of California Commercial |
$46.31
|
| Rate for Payer: Blue Shield of California Commercial |
$46.31
|
| Rate for Payer: Blue Shield of California EPN |
$37.14
|
| Rate for Payer: Blue Shield of California EPN |
$37.14
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.66
|
| Rate for Payer: Heritage Provider Network Senior |
$33.43
|
| Rate for Payer: Heritage Provider Network Senior |
$34.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.69
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.74
|
| Rate for Payer: TriValley Medical Group Senior |
$5.74
|
| Rate for Payer: TriValley Medical Group Senior |
$5.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: Vantage Medical Group Senior |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.74
|
|
|
HC TRIGLYCERIDES INDIVIDUAL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
900910526
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.11
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC TRIGLYCERIDES INDIVIDUAL
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
900910526
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.33
|
| Rate for Payer: Blue Shield of California Commercial |
$46.31
|
| Rate for Payer: Blue Shield of California Commercial |
$46.31
|
| Rate for Payer: Blue Shield of California EPN |
$37.14
|
| Rate for Payer: Blue Shield of California EPN |
$37.14
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.69
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.74
|
| Rate for Payer: TriValley Medical Group Senior |
$5.74
|
| Rate for Payer: TriValley Medical Group Senior |
$5.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: Vantage Medical Group Senior |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.74
|
|
|
HC TRIIODOTHYRONINE, FREE
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
900912135
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$228.75 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$196.42
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$206.49
|
| Rate for Payer: Heritage Provider Network Senior |
$206.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.25
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
|
