|
HC SOM CAH PROGESTERONE
|
Facility
|
OP
|
$54.83
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$174.63 |
| Rate for Payer: Adventist Health Commercial |
$10.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.63
|
| Rate for Payer: Blue Shield of California Commercial |
$162.95
|
| Rate for Payer: Blue Shield of California EPN |
$127.39
|
| Rate for Payer: Cash Price |
$24.67
|
| Rate for Payer: Cash Price |
$24.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Senior |
$20.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.94
|
| Rate for Payer: Heritage Provider Network Senior |
$33.94
|
| Rate for Payer: Humana Medicare |
$20.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.28
|
| Rate for Payer: Multiplan Commercial |
$41.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.86
|
| Rate for Payer: TriValley Medical Group Senior |
$20.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$20.86
|
|
|
HC SOM CAH PROGESTERONE
|
Facility
|
IP
|
$54.83
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$41.12 |
| Rate for Payer: Adventist Health Commercial |
$10.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.67
|
| Rate for Payer: Cash Price |
$24.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.12
|
| Rate for Payer: Heritage Provider Network Senior |
$37.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.71
|
| Rate for Payer: Multiplan Commercial |
$41.12
|
|
|
HC SOM CAH TESTOSTERONE
|
Facility
|
OP
|
$67.83
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912779
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$216.05 |
| Rate for Payer: Adventist Health Commercial |
$13.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$75.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.05
|
| Rate for Payer: Blue Shield of California Commercial |
$201.69
|
| Rate for Payer: Blue Shield of California EPN |
$157.67
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: Dignity Health Senior |
$25.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.99
|
| Rate for Payer: Heritage Provider Network Senior |
$41.99
|
| Rate for Payer: Humana Medicare |
$25.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.52
|
| Rate for Payer: Multiplan Commercial |
$50.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.81
|
| Rate for Payer: TriValley Medical Group Senior |
$25.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC SOM CAH TESTOSTERONE
|
Facility
|
IP
|
$67.83
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912779
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$50.87 |
| Rate for Payer: Adventist Health Commercial |
$13.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.60
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.92
|
| Rate for Payer: Heritage Provider Network Senior |
$45.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.96
|
| Rate for Payer: Multiplan Commercial |
$50.87
|
|
|
HC SOM CALCITONIN
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
900911003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$224.16 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.16
|
| Rate for Payer: Blue Shield of California Commercial |
$209.12
|
| Rate for Payer: Blue Shield of California EPN |
$163.48
|
| 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 |
$40.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.47
|
| Rate for Payer: Dignity Health Senior |
$26.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$26.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.76
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.79
|
| Rate for Payer: TriValley Medical Group Senior |
$26.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.47
|
| Rate for Payer: Vantage Medical Group Senior |
$26.79
|
|
|
HC SOM CALCITONIN
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
900911003
|
|
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 CALPROTECTIN
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
900912938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$164.26 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$57.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.26
|
| Rate for Payer: Blue Shield of California Commercial |
$153.28
|
| Rate for Payer: Blue Shield of California EPN |
$119.83
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.59
|
| Rate for Payer: Dignity Health Senior |
$19.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.71
|
| Rate for Payer: Heritage Provider Network Senior |
$55.71
|
| Rate for Payer: Humana Medicare |
$19.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.73
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.63
|
| Rate for Payer: TriValley Medical Group Senior |
$19.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.59
|
| Rate for Payer: Vantage Medical Group Senior |
$19.63
|
|
|
HC SOM CALPROTECTIN
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
900912938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.93
|
| Rate for Payer: Heritage Provider Network Senior |
$60.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
|
|
HC SOM CARBAPEN MOD HODGE TEST
|
Facility
|
IP
|
$164.70
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900914208
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.81 |
| Max. Negotiated Rate |
$123.52 |
| Rate for Payer: Adventist Health Commercial |
$32.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.15
|
| Rate for Payer: Cash Price |
$74.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.50
|
| Rate for Payer: Heritage Provider Network Senior |
$111.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.18
|
| Rate for Payer: Multiplan Commercial |
$123.52
|
|
|
HC SOM CARBAPEN MOD HODGE TEST
|
Facility
|
OP
|
$164.70
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900914208
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$123.52 |
| Rate for Payer: Adventist Health Commercial |
$32.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.12
|
| Rate for Payer: Blue Shield of California Commercial |
$22.47
|
| Rate for Payer: Blue Shield of California EPN |
$17.57
|
| Rate for Payer: Cash Price |
$74.12
|
| Rate for Payer: Cash Price |
$74.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.95
|
| Rate for Payer: Heritage Provider Network Senior |
$101.95
|
| Rate for Payer: Humana Medicare |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$123.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC SOM CARB DEF TRANS CONGENITAL
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912514
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC SOM CARB DEF TRANS CONGENITAL
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912514
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.24
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.87
|
| Rate for Payer: Dignity Health Senior |
$18.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Humana Medicare |
$18.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.76
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.06
|
| Rate for Payer: TriValley Medical Group Senior |
$18.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.06
|
|
|
HC SOM CARB DEF TRANSFERRIN ADULT
|
Facility
|
OP
|
$342.30
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$256.72 |
| Rate for Payer: Adventist Health Commercial |
$68.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$235.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.24
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$154.04
|
| Rate for Payer: Cash Price |
$154.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$222.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.87
|
| Rate for Payer: Dignity Health Senior |
$18.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$222.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.88
|
| Rate for Payer: Heritage Provider Network Senior |
$211.88
|
| Rate for Payer: Humana Medicare |
$18.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.76
|
| Rate for Payer: Multiplan Commercial |
$256.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.06
|
| Rate for Payer: TriValley Medical Group Senior |
$18.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.06
|
|
|
HC SOM CARB DEF TRANSFERRIN ADULT
|
Facility
|
IP
|
$342.30
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.96 |
| Max. Negotiated Rate |
$256.72 |
| Rate for Payer: Adventist Health Commercial |
$68.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$235.16
|
| Rate for Payer: Cash Price |
$154.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$231.74
|
| Rate for Payer: Heritage Provider Network Senior |
$231.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.58
|
| Rate for Payer: Multiplan Commercial |
$256.72
|
|
|
HC SOM CARBOXYHEMOGLOBIN
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
900911041
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$103.18 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.18
|
| Rate for Payer: Blue Shield of California Commercial |
$96.26
|
| Rate for Payer: Blue Shield of California EPN |
$75.25
|
| 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 |
$18.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.55
|
| Rate for Payer: Dignity Health Senior |
$12.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Humana Medicare |
$12.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.52
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.32
|
| Rate for Payer: TriValley Medical Group Senior |
$12.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.55
|
| Rate for Payer: Vantage Medical Group Senior |
$12.32
|
|
|
HC SOM CARBOXYHEMOGLOBIN
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
900911041
|
|
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 CARNITINE PLASMA
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
900911103
|
|
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
|
|
|
HC SOM CARNITINE PLASMA
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
900911103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$140.54 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.54
|
| Rate for Payer: Blue Shield of California Commercial |
$131.76
|
| Rate for Payer: Blue Shield of California EPN |
$103.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Senior |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$16.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.26
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.87
|
| Rate for Payer: TriValley Medical Group Senior |
$16.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOM CARNITINE URINE
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
900910730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$140.54 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.54
|
| Rate for Payer: Blue Shield of California Commercial |
$131.76
|
| Rate for Payer: Blue Shield of California EPN |
$103.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Senior |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.14
|
| Rate for Payer: Heritage Provider Network Senior |
$37.14
|
| Rate for Payer: Humana Medicare |
$16.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.26
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.87
|
| Rate for Payer: TriValley Medical Group Senior |
$16.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOM CARNITINE URINE
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
900910730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.22
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.62
|
| Rate for Payer: Heritage Provider Network Senior |
$40.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
|
|
HC SOM CAROTENE
|
Facility
|
OP
|
$23.21
|
|
|
Service Code
|
CPT 82380
|
| Hospital Charge Code |
900911303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$77.26 |
| Rate for Payer: Adventist Health Commercial |
$4.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.26
|
| Rate for Payer: Blue Shield of California Commercial |
$72.06
|
| Rate for Payer: Blue Shield of California EPN |
$56.33
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.14
|
| Rate for Payer: Dignity Health Senior |
$9.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.37
|
| Rate for Payer: Heritage Provider Network Senior |
$14.37
|
| Rate for Payer: Humana Medicare |
$9.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.62
|
| Rate for Payer: Multiplan Commercial |
$17.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.22
|
| Rate for Payer: TriValley Medical Group Senior |
$9.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.14
|
| Rate for Payer: Vantage Medical Group Senior |
$9.22
|
|
|
HC SOM CAROTENE
|
Facility
|
IP
|
$23.21
|
|
|
Service Code
|
CPT 82380
|
| Hospital Charge Code |
900911303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$17.41 |
| Rate for Payer: Adventist Health Commercial |
$4.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.95
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.71
|
| Rate for Payer: Heritage Provider Network Senior |
$15.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$17.41
|
|
|
HC SOM CATECHOLAMINE FRACT FREE UR
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900914081
|
|
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 CATECHOLAMINE FRACT FREE UR
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900914081
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$211.37 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.37
|
| Rate for Payer: Blue Shield of California Commercial |
$197.22
|
| Rate for Payer: Blue Shield of California EPN |
$154.17
|
| 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 |
$37.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.78
|
| Rate for Payer: Dignity Health Senior |
$25.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Humana Medicare |
$25.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.82
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.25
|
| Rate for Payer: TriValley Medical Group Senior |
$25.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.78
|
| Rate for Payer: Vantage Medical Group Senior |
$25.25
|
|
|
HC SOM CATECHOLAMINES PL
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900910483
|
|
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
|
|
