|
HC LAB REF TISSUE INSITU INTERP & REPORT
|
Facility
OP
|
$48.10
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
900910703
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$405.48 |
| Rate for Payer: Adventist Health Commercial |
$9.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$241.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.98
|
| Rate for Payer: Blue Shield of California Commercial |
$29.87
|
| Rate for Payer: Blue Shield of California EPN |
$28.23
|
| Rate for Payer: Cash Price |
$21.65
|
| Rate for Payer: Cash Price |
$21.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.77
|
| Rate for Payer: Heritage Provider Network Senior |
$29.77
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: IEHP Medi-Cal |
$136.62
|
| Rate for Payer: IEHP Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$36.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$213.41
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC LAB REF TRYPSINOGEN
|
Facility
IP
|
$62.33
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900910733
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Adventist Health Commercial |
$12.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.82
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.20
|
| Rate for Payer: Heritage Provider Network Senior |
$42.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.58
|
| Rate for Payer: Multiplan Commercial |
$46.75
|
|
|
HC LAB REF TRYPSINOGEN
|
Facility
OP
|
$62.33
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900910733
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Adventist Health Commercial |
$12.47
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.10
|
| Rate for Payer: Blue Shield of California Commercial |
$105.54
|
| Rate for Payer: Blue Shield of California EPN |
$82.51
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.51
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.58
|
| Rate for Payer: Heritage Provider Network Senior |
$38.58
|
| Rate for Payer: Humana Medicare |
$18.40
|
| Rate for Payer: IEHP Medi-Cal |
$19.14
|
| Rate for Payer: IEHP Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$46.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC LAB REF VARICELLA-ZOSTER AB ACIF CSF
|
Facility
IP
|
$38.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.11
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.73
|
| Rate for Payer: Heritage Provider Network Senior |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
|
|
HC LAB REF VARICELLA-ZOSTER AB ACIF CSF
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.23
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: IEHP Medi-Cal |
$47.03
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| 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 |
$28.50
|
| 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 |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC LAB REF VITAMIN D 1 25-DIHYDROXY
|
Facility
IP
|
$21.58
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
900911098
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.83
|
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.61
|
| Rate for Payer: Heritage Provider Network Senior |
$14.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$16.18
|
|
|
HC LAB REF VITAMIN D 1 25-DIHYDROXY
|
Facility
OP
|
$21.58
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
900911098
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$252.89 |
| Rate for Payer: Adventist Health Commercial |
$4.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$112.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$57.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$38.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.65
|
| Rate for Payer: Blue Shield of California Commercial |
$252.89
|
| Rate for Payer: Blue Shield of California EPN |
$197.70
|
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.03
|
| 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 |
$14.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$38.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.36
|
| Rate for Payer: Heritage Provider Network Senior |
$13.36
|
| Rate for Payer: Humana Medicare |
$38.50
|
| Rate for Payer: IEHP Medi-Cal |
$51.76
|
| Rate for Payer: IEHP Medicare Advantage |
$38.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$73.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| 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 |
$16.18
|
| 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 E
|
Facility
OP
|
$19.57
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
900911174
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$118.62 |
| Rate for Payer: Adventist Health Commercial |
$3.91
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.62
|
| Rate for Payer: Blue Shield of California Commercial |
$110.74
|
| Rate for Payer: Blue Shield of California EPN |
$86.57
|
| Rate for Payer: Cash Price |
$8.81
|
| Rate for Payer: Cash Price |
$8.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.60
|
| Rate for Payer: Dignity Health Senior |
$14.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.11
|
| Rate for Payer: Heritage Provider Network Senior |
$12.11
|
| Rate for Payer: Humana Medicare |
$14.18
|
| Rate for Payer: IEHP Medi-Cal |
$18.72
|
| Rate for Payer: IEHP Medicare Advantage |
$14.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.87
|
| Rate for Payer: Multiplan Commercial |
$14.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.18
|
| Rate for Payer: TriValley Medical Group Senior |
$14.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.60
|
| Rate for Payer: Vantage Medical Group Senior |
$14.18
|
|
|
HC LAB REF VITAMIN E
|
Facility
IP
|
$19.57
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
900911174
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$14.68 |
| Rate for Payer: Adventist Health Commercial |
$3.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.44
|
| Rate for Payer: Cash Price |
$8.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Heritage Provider Network Senior |
$13.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Multiplan Commercial |
$14.68
|
|
|
HC LAB REF VITAMIN K
|
Facility
IP
|
$45.65
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
900911429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$34.24 |
| Rate for Payer: Adventist Health Commercial |
$9.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.36
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.91
|
| Rate for Payer: Heritage Provider Network Senior |
$30.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.41
|
| Rate for Payer: Multiplan Commercial |
$34.24
|
|
|
HC LAB REF VITAMIN K
|
Facility
OP
|
$45.65
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
900911429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$111.01 |
| Rate for Payer: Adventist Health Commercial |
$9.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.01
|
| Rate for Payer: Blue Shield of California Commercial |
$107.05
|
| Rate for Payer: Blue Shield of California EPN |
$83.69
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.09
|
| Rate for Payer: Dignity Health Senior |
$13.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.26
|
| Rate for Payer: Heritage Provider Network Senior |
$28.26
|
| Rate for Payer: Humana Medicare |
$13.72
|
| Rate for Payer: IEHP Medi-Cal |
$19.03
|
| Rate for Payer: IEHP Medicare Advantage |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$34.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.72
|
| Rate for Payer: TriValley Medical Group Senior |
$13.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.09
|
| Rate for Payer: Vantage Medical Group Senior |
$13.72
|
|
|
HC LAB REF VZV AB IMMUNITY SCREEN
|
Facility
OP
|
$77.39
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912872
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Adventist Health Commercial |
$15.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.86
|
| Rate for Payer: Blue Shield of California Commercial |
$100.62
|
| Rate for Payer: Blue Shield of California EPN |
$78.66
|
| Rate for Payer: Cash Price |
$34.83
|
| Rate for Payer: Cash Price |
$34.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.30
|
| 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 |
$50.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.90
|
| Rate for Payer: Heritage Provider Network Senior |
$47.90
|
| Rate for Payer: Humana Medicare |
$12.88
|
| Rate for Payer: IEHP Medi-Cal |
$17.75
|
| Rate for Payer: IEHP Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.35
|
| 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 |
$58.04
|
| 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 VZV AB IMMUNITY SCREEN
|
Facility
IP
|
$77.39
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912872
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$58.04 |
| Rate for Payer: Adventist Health Commercial |
$15.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.17
|
| Rate for Payer: Cash Price |
$34.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.39
|
| Rate for Payer: Heritage Provider Network Senior |
$52.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.35
|
| Rate for Payer: Multiplan Commercial |
$58.04
|
|
|
HC LAB REF WHITE BEAN IGE
|
Facility
IP
|
$11.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912545
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$8.92 |
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.18
|
| Rate for Payer: Cash Price |
$5.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.06
|
| Rate for Payer: Heritage Provider Network Senior |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$8.92
|
|
|
HC LAB REF WHITE BEAN IGE
|
Facility
OP
|
$11.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912545
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$2.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$5.36
|
| Rate for Payer: Cash Price |
$5.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.74
|
| 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 |
$7.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.37
|
| Rate for Payer: Heritage Provider Network Senior |
$7.37
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: IEHP Medi-Cal |
$7.24
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| 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 |
$8.92
|
| 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 ZINC URINE
|
Facility
IP
|
$22.75
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$17.06 |
| Rate for Payer: Adventist Health Commercial |
$4.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.63
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.40
|
| Rate for Payer: Heritage Provider Network Senior |
$15.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Multiplan Commercial |
$17.06
|
|
|
HC LAB REF ZINC URINE
|
Facility
OP
|
$22.75
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$95.35 |
| Rate for Payer: Adventist Health Commercial |
$4.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$33.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.35
|
| Rate for Payer: Blue Shield of California Commercial |
$88.94
|
| Rate for Payer: Blue Shield of California EPN |
$69.53
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.53
|
| Rate for Payer: Dignity Health Senior |
$11.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.79
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.08
|
| Rate for Payer: Heritage Provider Network Senior |
$14.08
|
| Rate for Payer: Humana Medicare |
$11.39
|
| Rate for Payer: IEHP Medi-Cal |
$15.79
|
| Rate for Payer: IEHP Medicare Advantage |
$11.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.35
|
| Rate for Payer: Multiplan Commercial |
$17.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.39
|
| Rate for Payer: TriValley Medical Group Senior |
$11.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Vantage Medical Group Senior |
$11.39
|
|
|
HC LACTATE CH
|
Facility
IP
|
$25.40
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
900912184
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Adventist Health Commercial |
$5.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.45
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.20
|
| Rate for Payer: Heritage Provider Network Senior |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.35
|
| Rate for Payer: Multiplan Commercial |
$19.05
|
|
|
HC LACTATE CH
|
Facility
OP
|
$25.40
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
900912184
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$89.37 |
| Rate for Payer: Adventist Health Commercial |
$5.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.37
|
| Rate for Payer: Blue Shield of California Commercial |
$83.40
|
| Rate for Payer: Blue Shield of California EPN |
$65.20
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.51
|
| 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 |
$16.51
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.72
|
| Rate for Payer: Heritage Provider Network Senior |
$15.72
|
| Rate for Payer: Humana Medicare |
$11.57
|
| Rate for Payer: IEHP Medi-Cal |
$14.68
|
| Rate for Payer: IEHP Medicare Advantage |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.35
|
| 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 |
$19.05
|
| 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 (CSF/POC)
|
Facility
OP
|
$31.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
900910245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$89.37 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.37
|
| Rate for Payer: Blue Shield of California Commercial |
$83.40
|
| Rate for Payer: Blue Shield of California EPN |
$65.20
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Humana Medicare |
$11.57
|
| Rate for Payer: IEHP Medi-Cal |
$14.68
|
| Rate for Payer: IEHP Medicare Advantage |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| 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 |
$23.25
|
| 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 (CSF/POC)
|
Facility
IP
|
$278.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
900910245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$208.50 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.99
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.21
|
| Rate for Payer: Heritage Provider Network Senior |
$188.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.50
|
| Rate for Payer: Multiplan Commercial |
$208.50
|
|
|
HC LACTATE DEHYDROGENASE
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900910229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$50.38 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.38
|
| Rate for Payer: Blue Shield of California Commercial |
$47.18
|
| Rate for Payer: Blue Shield of California EPN |
$36.88
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| 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 |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$6.04
|
| Rate for Payer: IEHP Medi-Cal |
$8.38
|
| Rate for Payer: IEHP Medicare Advantage |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| 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 |
$15.00
|
| 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
|
Facility
IP
|
$137.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900910229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.12
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.75
|
| Rate for Payer: Heritage Provider Network Senior |
$92.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.25
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
|
|
HC LACTATE DEHYDROGENASE BODY FL
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900912243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$50.38 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.38
|
| Rate for Payer: Blue Shield of California Commercial |
$47.18
|
| Rate for Payer: Blue Shield of California EPN |
$36.88
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$6.04
|
| Rate for Payer: IEHP Medi-Cal |
$8.38
|
| Rate for Payer: IEHP Medicare Advantage |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| 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 |
$12.75
|
| 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
|
$25.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900912243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
