|
HC SOM AFP & TOTAL AFT, SERUM
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 82107
|
| Hospital Charge Code |
900913812
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$527.39 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$527.39
|
| Rate for Payer: Blue Shield of California Commercial |
$503.04
|
| Rate for Payer: Blue Shield of California EPN |
$393.26
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.85
|
| Rate for Payer: Dignity Health Senior |
$64.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$64.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Humana Medicare |
$64.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$89.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.16
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$64.41
|
| Rate for Payer: TriValley Medical Group Senior |
$64.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Vantage Medical Group Senior |
$64.41
|
|
|
HC SOM ALBUMIN LEVEL BODY FLUID
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900914481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$43.28 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.28
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Senior |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Humana Medicare |
$7.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.78
|
| Rate for Payer: TriValley Medical Group Senior |
$7.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
|
|
HC SOM ALBUMIN LEVEL BODY FLUID
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900914481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.77
|
| Rate for Payer: Heritage Provider Network Senior |
$6.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
|
|
HC SOM ALDOLASE
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
900910218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$81.26 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$28.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.26
|
| Rate for Payer: Blue Shield of California Commercial |
$75.80
|
| Rate for Payer: Blue Shield of California EPN |
$59.26
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.68
|
| Rate for Payer: Dignity Health Senior |
$9.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.57
|
| Rate for Payer: Heritage Provider Network Senior |
$5.57
|
| Rate for Payer: Humana Medicare |
$9.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.23
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.71
|
| Rate for Payer: TriValley Medical Group Senior |
$9.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.68
|
| Rate for Payer: Vantage Medical Group Senior |
$9.71
|
|
|
HC SOM ALDOLASE
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
900910218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.09
|
| Rate for Payer: Heritage Provider Network Senior |
$6.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$6.75
|
|
|
HC SOM ALDOSTERONE
|
Facility
|
OP
|
$19.50
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
900910965
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$341.15 |
| Rate for Payer: Adventist Health Commercial |
$3.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$118.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$341.15
|
| Rate for Payer: Blue Shield of California Commercial |
$318.29
|
| Rate for Payer: Blue Shield of California EPN |
$248.83
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.82
|
| Rate for Payer: Dignity Health Senior |
$40.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$40.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.07
|
| Rate for Payer: Heritage Provider Network Senior |
$12.07
|
| Rate for Payer: Humana Medicare |
$40.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.34
|
| Rate for Payer: Multiplan Commercial |
$14.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$40.75
|
| Rate for Payer: TriValley Medical Group Senior |
$40.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$44.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.82
|
| Rate for Payer: Vantage Medical Group Senior |
$40.75
|
|
|
HC SOM ALDOSTERONE
|
Facility
|
IP
|
$19.50
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
900910965
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Adventist Health Commercial |
$3.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.40
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.20
|
| Rate for Payer: Heritage Provider Network Senior |
$13.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$14.62
|
|
|
HC SOM ALDOSTERONE URINE
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
900910945
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.46
|
| Rate for Payer: Heritage Provider Network Senior |
$30.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
|
|
HC SOM ALDOSTERONE URINE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
900910945
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$341.15 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$118.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$341.15
|
| Rate for Payer: Blue Shield of California Commercial |
$318.29
|
| Rate for Payer: Blue Shield of California EPN |
$248.83
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.82
|
| Rate for Payer: Dignity Health Senior |
$40.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$40.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Humana Medicare |
$40.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.34
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$40.75
|
| Rate for Payer: TriValley Medical Group Senior |
$40.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$44.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.82
|
| Rate for Payer: Vantage Medical Group Senior |
$40.75
|
|
|
HC SOM ALKALINE PHOSPHATSE ISO
|
Facility
|
IP
|
$16.35
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
900911249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$12.26 |
| Rate for Payer: Adventist Health Commercial |
$3.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.23
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.07
|
| Rate for Payer: Heritage Provider Network Senior |
$11.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.09
|
| Rate for Payer: Multiplan Commercial |
$12.26
|
|
|
HC SOM ALKALINE PHOSPHATSE ISO
|
Facility
|
OP
|
$16.35
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
900911249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$123.80 |
| Rate for Payer: Adventist Health Commercial |
$3.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.80
|
| Rate for Payer: Blue Shield of California Commercial |
$115.49
|
| Rate for Payer: Blue Shield of California EPN |
$90.28
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.26
|
| Rate for Payer: Dignity Health Senior |
$14.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.12
|
| Rate for Payer: Heritage Provider Network Senior |
$10.12
|
| Rate for Payer: Humana Medicare |
$14.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.62
|
| Rate for Payer: Multiplan Commercial |
$12.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.78
|
| Rate for Payer: TriValley Medical Group Senior |
$14.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14.78
|
|
|
HC SOM ALK PHOS TOTAL (SO)
|
Facility
|
OP
|
$5.72
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
900912824
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$43.28 |
| Rate for Payer: Adventist Health Commercial |
$1.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.28
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.54
|
| Rate for Payer: Heritage Provider Network Senior |
$3.54
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$4.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC SOM ALK PHOS TOTAL (SO)
|
Facility
|
IP
|
$5.72
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
900912824
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Adventist Health Commercial |
$1.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.93
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.87
|
| Rate for Payer: Heritage Provider Network Senior |
$3.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$4.29
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN PHENO A1AT
|
Facility
|
IP
|
$12.77
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900912818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$9.58 |
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.77
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.65
|
| Rate for Payer: Heritage Provider Network Senior |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$9.58
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN PHENO A1AT
|
Facility
|
OP
|
$12.77
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900912818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$112.36 |
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.36
|
| Rate for Payer: Blue Shield of California Commercial |
$104.92
|
| Rate for Payer: Blue Shield of California EPN |
$82.02
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.78
|
| Rate for Payer: Dignity Health Senior |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.90
|
| Rate for Payer: Heritage Provider Network Senior |
$7.90
|
| Rate for Payer: Humana Medicare |
$13.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.93
|
| Rate for Payer: Multiplan Commercial |
$9.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.44
|
| Rate for Payer: TriValley Medical Group Senior |
$13.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Vantage Medical Group Senior |
$13.44
|
|
|
HC SOM ALPHA 1-ANTITRYPSIN PHENOTYPE
|
Facility
|
OP
|
$12.77
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
900911068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$120.99 |
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.99
|
| Rate for Payer: Blue Shield of California Commercial |
$112.92
|
| Rate for Payer: Blue Shield of California EPN |
$88.27
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.91
|
| Rate for Payer: Dignity Health Senior |
$14.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.90
|
| Rate for Payer: Heritage Provider Network Senior |
$7.90
|
| Rate for Payer: Humana Medicare |
$14.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$9.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.46
|
| Rate for Payer: TriValley Medical Group Senior |
$14.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.91
|
| Rate for Payer: Vantage Medical Group Senior |
$14.46
|
|
|
HC SOM ALPHA 1-ANTITRYPSIN PHENOTYPE
|
Facility
|
IP
|
$12.77
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
900911068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$9.58 |
| Rate for Payer: Adventist Health Commercial |
$2.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.77
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.65
|
| Rate for Payer: Heritage Provider Network Senior |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$9.58
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN, STOOL
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900910858
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC SOM ALPHA-1-ANTITRYPSIN, STOOL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900910858
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$112.36 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.36
|
| Rate for Payer: Blue Shield of California Commercial |
$104.92
|
| Rate for Payer: Blue Shield of California EPN |
$82.02
|
| 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 |
$20.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.78
|
| Rate for Payer: Dignity Health Senior |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$13.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.93
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.44
|
| Rate for Payer: TriValley Medical Group Senior |
$13.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Vantage Medical Group Senior |
$13.44
|
|
|
HC SOM ALPHA-2-MACROGLOBULIN
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911487
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$113.94 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.94
|
| Rate for Payer: Blue Shield of California Commercial |
$106.21
|
| Rate for Payer: Blue Shield of California EPN |
$83.03
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.96
|
| Rate for Payer: Dignity Health Senior |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Humana Medicare |
$13.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.14
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.60
|
| Rate for Payer: TriValley Medical Group Senior |
$13.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
|
HC SOM ALPHA-2-MACROGLOBULIN
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911487
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC SOM ALPHA-FETOPROTEIN, AMNIOTIC FL
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
900910946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.04
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.70
|
| Rate for Payer: Heritage Provider Network Senior |
$23.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
|
|
HC SOM ALPHA-FETOPROTEIN, AMNIOTIC FL
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
900910946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$140.43 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.43
|
| Rate for Payer: Blue Shield of California Commercial |
$131.03
|
| Rate for Payer: Blue Shield of California EPN |
$102.43
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.70
|
| Rate for Payer: Dignity Health Senior |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Humana Medicare |
$17.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.42
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.00
|
| Rate for Payer: TriValley Medical Group Senior |
$17.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC SOM ALPHA FETOPROTEIN CSF
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900910585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.16
|
| Rate for Payer: Heritage Provider Network Senior |
$10.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
|
|
HC SOM ALPHA FETOPROTEIN CSF
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900910585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$174.18 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.18
|
| Rate for Payer: Blue Shield of California Commercial |
$162.50
|
| Rate for Payer: Blue Shield of California EPN |
$127.04
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Senior |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
