|
HC LAB REF TRYPSINOGEN
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900910733
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.39
|
| Rate for Payer: Heritage Provider Network Senior |
$47.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
|
|
HC LAB REF VARICELLA-ZOSTER AB ACIF CSF
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.62
|
| Rate for Payer: Heritage Provider Network Senior |
$26.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC LAB REF VARICELLA-ZOSTER AB ACIF CSF
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Cash Price |
$23.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.11
|
| Rate for Payer: Heritage Provider Network Senior |
$29.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
|
|
HC LAB REF VITAMIN D 1 25-DIHYDROXY
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
900911098
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$273.39 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$273.39
|
| Rate for Payer: Blue Shield of California Commercial |
$260.58
|
| Rate for Payer: Blue Shield of California EPN |
$209.01
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.35
|
| Rate for Payer: Dignity Health Senior |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$38.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.51
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.50
|
| Rate for Payer: TriValley Medical Group Senior |
$38.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: Vantage Medical Group Senior |
$38.50
|
|
|
HC LAB REF VITAMIN D 1 25-DIHYDROXY
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
900911098
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
|
|
HC LAB REF VZV AB IMMUNITY SCREEN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912872
|
|
Hospital Revenue Code
|
302
|
| 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 LAB REF VZV AB IMMUNITY SCREEN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912872
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$117.64 |
| 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 |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.64
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| 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 |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| 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 |
$18.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| 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 |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC LAB REF WHITE BEAN IGE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912545
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$144.32 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.32
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.05
|
| Rate for Payer: Heritage Provider Network Senior |
$8.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC LAB REF WHITE BEAN IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912545
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.80
|
| Rate for Payer: Heritage Provider Network Senior |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
|
|
HC LACTATE CH
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
900912184
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$97.48 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.48
|
| Rate for Payer: Blue Shield of California Commercial |
$85.94
|
| Rate for Payer: Blue Shield of California EPN |
$68.93
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.73
|
| Rate for Payer: Dignity Health Senior |
$11.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.43
|
| Rate for Payer: Heritage Provider Network Senior |
$33.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.58
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.57
|
| Rate for Payer: TriValley Medical Group Senior |
$11.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Vantage Medical Group Senior |
$11.57
|
|
|
HC LACTATE CH
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
900912184
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.56
|
| Rate for Payer: Heritage Provider Network Senior |
$36.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
|
|
HC LACTATE (CSF/POC)
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
900910245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Cash Price |
$169.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.52
|
| Rate for Payer: Heritage Provider Network Senior |
$208.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
|
|
HC LACTATE (CSF/POC)
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
900910245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$164.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.48
|
| Rate for Payer: Blue Shield of California Commercial |
$85.94
|
| Rate for Payer: Blue Shield of California EPN |
$68.93
|
| Rate for Payer: Cash Price |
$169.40
|
| Rate for Payer: Cash Price |
$169.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$200.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.73
|
| Rate for Payer: Dignity Health Senior |
$11.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.65
|
| Rate for Payer: Heritage Provider Network Senior |
$190.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$146.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.58
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.57
|
| Rate for Payer: TriValley Medical Group Senior |
$11.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Vantage Medical Group Senior |
$11.57
|
|
|
HC LACTATE DEHYDROGENASE
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900910229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.90
|
| Rate for Payer: Heritage Provider Network Senior |
$102.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
|
|
HC LACTATE DEHYDROGENASE
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900910229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$81.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.95
|
| Rate for Payer: Blue Shield of California Commercial |
$48.61
|
| Rate for Payer: Blue Shield of California EPN |
$38.99
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$98.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.64
|
| Rate for Payer: Dignity Health Senior |
$6.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.09
|
| Rate for Payer: Heritage Provider Network Senior |
$94.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$72.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.61
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.04
|
| Rate for Payer: TriValley Medical Group Senior |
$6.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Vantage Medical Group Senior |
$6.04
|
|
|
HC LACTATE DEHYDROGENASE BODY FL
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900912243
|
|
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: Cash Price |
$30.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.91
|
| Rate for Payer: Heritage Provider Network Senior |
$37.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
|
|
HC LACTATE DEHYDROGENASE BODY FL
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900912243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$54.95 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.95
|
| Rate for Payer: Blue Shield of California Commercial |
$48.61
|
| Rate for Payer: Blue Shield of California EPN |
$38.99
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.64
|
| Rate for Payer: Dignity Health Senior |
$6.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.66
|
| Rate for Payer: Heritage Provider Network Senior |
$34.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.61
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.04
|
| Rate for Payer: TriValley Medical Group Senior |
$6.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Vantage Medical Group Senior |
$6.04
|
|
|
HC LACTOSE TOLERANCE
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910313
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$120.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.52
|
| Rate for Payer: Blue Shield of California Commercial |
$103.62
|
| Rate for Payer: Blue Shield of California EPN |
$83.11
|
| Rate for Payer: Cash Price |
$124.30
|
| Rate for Payer: Cash Price |
$124.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.89
|
| Rate for Payer: Heritage Provider Network Senior |
$139.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$107.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.87
|
| Rate for Payer: TriValley Medical Group Senior |
$12.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC LACTOSE TOLERANCE
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910313
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.91 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Cash Price |
$124.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$153.00
|
| Rate for Payer: Heritage Provider Network Senior |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.50
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
|
|
HC LAMELLAR BODY COUNT AMNIOTIC
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 83664
|
| Hospital Charge Code |
900912027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$152.24 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$68.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.09
|
| Rate for Payer: Blue Shield of California Commercial |
$152.24
|
| Rate for Payer: Blue Shield of California EPN |
$122.11
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$83.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Senior |
$19.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.23
|
| Rate for Payer: Heritage Provider Network Senior |
$79.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$61.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.34
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.32
|
| Rate for Payer: TriValley Medical Group Senior |
$19.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$19.32
|
|
|
HC LAMELLAR BODY COUNT AMNIOTIC
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 83664
|
| Hospital Charge Code |
900912027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.17 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.66
|
| Rate for Payer: Heritage Provider Network Senior |
$86.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
|
|
HC LANG COMP CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9159
|
| Hospital Charge Code |
900018124
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC LANG COMP CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9159
|
| Hospital Charge Code |
900018224
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC LANG COMP CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9159
|
| Hospital Charge Code |
900018124
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC LANG COMP CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9159
|
| Hospital Charge Code |
900018224
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
