|
HC SOM ANTI-DIURETIC HORMONE
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
900911035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$311.06 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$311.06
|
| Rate for Payer: Blue Shield of California Commercial |
$273.20
|
| Rate for Payer: Blue Shield of California EPN |
$219.13
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.33
|
| Rate for Payer: Dignity Health Senior |
$33.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$33.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.52
|
| Rate for Payer: Heritage Provider Network Senior |
$49.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.76
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$33.94
|
| Rate for Payer: TriValley Medical Group Senior |
$33.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.33
|
| Rate for Payer: Vantage Medical Group Senior |
$33.94
|
|
|
HC SOM ANTI-GBM TITER AB
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.60
|
| Rate for Payer: Heritage Provider Network Senior |
$17.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
|
|
HC SOM ANTI-GBM TITER AB
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$213.58 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.58
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Senior |
$16.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM ANTI-LIVERKIDNEY MICROSOMAL AB
|
Facility
|
IP
|
$21.76
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
900911453
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Adventist Health Commercial |
$4.35
|
| Rate for Payer: Cash Price |
$21.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.73
|
| Rate for Payer: Heritage Provider Network Senior |
$14.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.44
|
| Rate for Payer: Multiplan Commercial |
$16.32
|
|
|
HC SOM ANTI-LIVERKIDNEY MICROSOMAL AB
|
Facility
|
OP
|
$21.76
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
900911453
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$133.68 |
| Rate for Payer: Adventist Health Commercial |
$4.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.68
|
| Rate for Payer: Blue Shield of California Commercial |
$117.10
|
| Rate for Payer: Blue Shield of California EPN |
$93.92
|
| Rate for Payer: Cash Price |
$21.76
|
| Rate for Payer: Cash Price |
$21.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.00
|
| Rate for Payer: Dignity Health Senior |
$14.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.47
|
| Rate for Payer: Heritage Provider Network Senior |
$13.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$16.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.55
|
| Rate for Payer: TriValley Medical Group Senior |
$14.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14.55
|
|
|
HC SOM ANTIMULLERIAN HORMONE, S
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912908
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.23
|
| Rate for Payer: Heritage Provider Network Senior |
$37.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC SOM ANTIMULLERIAN HORMONE, S
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912908
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$118.19 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.19
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.05
|
| Rate for Payer: Heritage Provider Network Senior |
$34.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.76
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM ANTI-NEUTROPHIL AB
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
900911211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.04
|
| Rate for Payer: Heritage Provider Network Senior |
$46.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
|
|
HC SOM ANTI-NEUTROPHIL AB
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
900911211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$137.43 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.43
|
| Rate for Payer: Blue Shield of California Commercial |
$121.13
|
| Rate for Payer: Blue Shield of California EPN |
$97.16
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.55
|
| Rate for Payer: Dignity Health Senior |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.09
|
| Rate for Payer: Heritage Provider Network Senior |
$42.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.05
|
| Rate for Payer: TriValley Medical Group Senior |
$15.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SOM ANTI-NEUTROPHIL CYTOPLASM ANTI
|
Facility
|
OP
|
$23.15
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900910287
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$4.63
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.08
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.33
|
| Rate for Payer: Heritage Provider Network Senior |
$14.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ANTI-NEUTROPHIL CYTOPLASM ANTI
|
Facility
|
IP
|
$23.15
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900910287
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Adventist Health Commercial |
$4.63
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.67
|
| Rate for Payer: Heritage Provider Network Senior |
$15.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.79
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
|
|
HC SOM ANTINUCLEAR AB,HEP-2 SUB,S
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
900912903
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$101.78 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.78
|
| Rate for Payer: Blue Shield of California Commercial |
$89.86
|
| Rate for Payer: Blue Shield of California EPN |
$72.07
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.28
|
| Rate for Payer: Dignity Health Senior |
$11.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.06
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.16
|
| Rate for Payer: TriValley Medical Group Senior |
$11.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.28
|
| Rate for Payer: Vantage Medical Group Senior |
$11.16
|
|
|
HC SOM ANTINUCLEAR AB,HEP-2 SUB,S
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
900912903
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.00
|
| 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 ANTINUCLEAR ANTIBODY(MULTI
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
900912906
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.44
|
| Rate for Payer: Heritage Provider Network Senior |
$116.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
|
|
HC SOM ANTINUCLEAR ANTIBODY(MULTI
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
900912906
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.78
|
| Rate for Payer: Blue Shield of California Commercial |
$89.86
|
| Rate for Payer: Blue Shield of California EPN |
$72.07
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.28
|
| Rate for Payer: Dignity Health Senior |
$11.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.47
|
| Rate for Payer: Heritage Provider Network Senior |
$106.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.06
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.16
|
| Rate for Payer: TriValley Medical Group Senior |
$11.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.28
|
| Rate for Payer: Vantage Medical Group Senior |
$11.16
|
|
|
HC SOM ANTI-SMOOTH MUSCLE
|
Facility
|
IP
|
$12.90
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900911176
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: Adventist Health Commercial |
$2.58
|
| Rate for Payer: Cash Price |
$12.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.73
|
| Rate for Payer: Heritage Provider Network Senior |
$8.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.23
|
| Rate for Payer: Multiplan Commercial |
$9.68
|
|
|
HC SOM ANTI-SMOOTH MUSCLE
|
Facility
|
OP
|
$12.90
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900911176
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Adventist Health Commercial |
$2.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.56
|
| Rate for Payer: Blue Shield of California Commercial |
$66.41
|
| Rate for Payer: Blue Shield of California EPN |
$53.27
|
| Rate for Payer: Cash Price |
$12.90
|
| Rate for Payer: Cash Price |
$12.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.99
|
| Rate for Payer: Heritage Provider Network Senior |
$7.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$9.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ANTI-STRIATED MUSCLE AB
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900911368
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$118.19 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.19
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.76
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM ANTI-STRIATED MUSCLE AB
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900911368
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
|
|
HC SOM APOLIPOPROTEIN A-1
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
900910800
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$120.27 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.13
|
| Rate for Payer: Blue Shield of California Commercial |
$120.27
|
| Rate for Payer: Blue Shield of California EPN |
$96.47
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.20
|
| Rate for Payer: Dignity Health Senior |
$21.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.57
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.09
|
| Rate for Payer: TriValley Medical Group Senior |
$21.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.20
|
| Rate for Payer: Vantage Medical Group Senior |
$21.09
|
|
|
HC SOM APOLIPOPROTEIN A-1
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
900910800
|
|
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: Cash Price |
$20.00
|
| 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 APOLIPOPROTEIN B
|
Facility
|
IP
|
$16.77
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
900910801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$12.58 |
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.35
|
| Rate for Payer: Heritage Provider Network Senior |
$11.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: Multiplan Commercial |
$12.58
|
|
|
HC SOM APOLIPOPROTEIN B
|
Facility
|
OP
|
$16.77
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
900910801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$120.27 |
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.13
|
| Rate for Payer: Blue Shield of California Commercial |
$120.27
|
| Rate for Payer: Blue Shield of California EPN |
$96.47
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.20
|
| Rate for Payer: Dignity Health Senior |
$21.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.38
|
| Rate for Payer: Heritage Provider Network Senior |
$10.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.57
|
| Rate for Payer: Multiplan Commercial |
$12.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.09
|
| Rate for Payer: TriValley Medical Group Senior |
$21.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.20
|
| Rate for Payer: Vantage Medical Group Senior |
$21.09
|
|
|
HC SOM APOLIPOPROTEIN E GENOTYPING
|
Facility
|
OP
|
$203.61
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900914646
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$288.88 |
| Rate for Payer: Adventist Health Commercial |
$40.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$108.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.88
|
| Rate for Payer: Blue Shield of California Commercial |
$124.20
|
| Rate for Payer: Blue Shield of California EPN |
$99.36
|
| Rate for Payer: Cash Price |
$203.61
|
| Rate for Payer: Cash Price |
$203.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$132.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Senior |
$137.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$126.03
|
| Rate for Payer: Heritage Provider Network Senior |
$126.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$221.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$97.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.62
|
| Rate for Payer: Multiplan Commercial |
$152.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.00
|
| Rate for Payer: TriValley Medical Group Senior |
$137.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$147.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM APOLIPOPROTEIN E GENOTYPING
|
Facility
|
IP
|
$203.61
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900914646
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$152.71 |
| Rate for Payer: Adventist Health Commercial |
$40.72
|
| Rate for Payer: Cash Price |
$203.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$137.84
|
| Rate for Payer: Heritage Provider Network Senior |
$137.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.90
|
| Rate for Payer: Multiplan Commercial |
$152.71
|
|
